Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The City of New York Office of Chief Medical Examiner Biological Incident Fatality Surge Plan for Managing In- and Out-of-Hospital Deaths Annex to NYC OCME All Hazards Mass Fatality Management Plan Barbara A. Sampson, MD, PhD Chief Medical Examiner Updated: 2016 Page 1 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 2 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths City of New York Office of Chief Medical Examiner Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Annex to NYC OCME All Hazards Mass Fatality Management Plan 2016 Prepared For Barbara A. Sampson, M.D., Chief Medical Examiner Dina Maniotis, MPA, Executive Deputy Commissioner Frank DePaolo, PA-C, Assistant Commissioner, Forensic Operations 520 First Avenue New York City, NY 10016 This plan was originally developed with the support of the City of New York Department of Health and Mental Hygiene, Bureau of Communicable Disease, Healthcare Emergency Preparedness Program Office of the Assistant Secretary for Preparedness and Response Grant 1 U3RHS0756-01-00 Plan updates were supported by United States Department of Homeland Security Urban Areas Security Initiative FFY 13 Grant C971833, FFY15 Grant C971853 Page 3 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 4 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Biological Incident Fatality Surge Plan for Managing In- and Out-of-Hospital Deaths Revision 2 APPROVAL AND IMPLEMENTATION This Biological Incident Surge Plan for Managing In- and Out-of-Hospital Deaths, Revision 2, is hereby approved for implementation. This planning guide supersedes the NYC Office of Chief Medical Examiner’s Biological Incident Surge Plan for Managing In- and Out-of-Hospital Deaths, dated October 2008. Dr. Barbara A. Sampson Frank DePaolo, PA-C Chief Medical Examiner NYC Office of the Chief Medical Examiner Deputy Commissioner, Forensic Operations NYC Office of the Chief Medical Examiner Date Date Page 5 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 6 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Table of Contents PREFACE................................................................................................................................................. 15 PLAN MAP.............................................................................................................................................. 17 RECORD OF CHANGES ............................................................................................................................ 19 I. INTRODUCTION ................................................................................................................................... 21 FATALITY MANAGEMENT DURING A BIOLOGICAL INCIDENT ................................................................................... 23 PRIMARY OBJECTIVES GOVERNING OCME RESPONSE ......................................................................................... 24 BIOLOGICAL INCIDENT CHARACTERISTICS AND BASIC EPIDEMIOLOGY....................................................................... 24 Epidemic Curves .................................................................................................................................. 27 OFFICE OF CHIEF MEDICAL EXAMINER JURISDICTIONAL AUTHORITY ........................................................................ 29 MASS FATALITIES DUE TO A BIOLOGICAL INCIDENT .............................................................................................. 30 Magnitude........................................................................................................................................... 30 OCME NORMAL DAILY CASE LOAD ................................................................................................................. 32 QUANTITATIVE HAZARD ANALYSIS ................................................................................................................... 32 Trigger Points ...................................................................................................................................... 32 OCME DECISION MAKING STRATEGIES ............................................................................................................ 35 KEY PLANNING CONSIDERATIONS AND ASSUMPTIONS .......................................................................................... 39 INTEGRATED DECISION-MAKING STRATEGY ....................................................................................................... 41 NYC Initial Biological Incident Actions ................................................................................................. 41 NOTIFICATIONS ............................................................................................................................................ 42 DOHMH Notification ........................................................................................................................... 42 OCME Notifications ............................................................................................................................. 42 EXECUTIVE LEVEL CONSIDERATIONS.................................................................................................................. 42 EMERGENCY AND DISASTER DECLARATIONS ....................................................................................................... 44 DOHMH Public Health Emergency Declaration ................................................................................... 44 Mayoral Disaster Declaration ............................................................................................................. 44 Gubernatorial Disaster Declaration .................................................................................................... 44 Presidential Disaster Declarations ...................................................................................................... 44 II. EXTERNAL AGENCY OPERATIONS ....................................................................................................... 45 NYC AGENCIES ............................................................................................................................................ 47 City of New York Office of Chief Medical Examiner ............................................................................. 47 New York City Department of Health and Mental Hygiene ................................................................ 47 New York City Emergency Management............................................................................................. 49 New York City Police Department ....................................................................................................... 52 New York City Department of Information Technology and Telecommunications ............................. 53 City of New York 311 Call Center ......................................................................................................... 53 New York City Health Care Facilities ................................................................................................... 54 City of New York Department of Correction ........................................................................................ 59 New York City 911 Call Center ............................................................................................................. 59 Regional Emergency Medical Services Council of New York City ........................................................ 59 New York City Fire Department ........................................................................................................... 60 New York City Hospital-based, Volunteer, and Private Ambulances ................................................... 61 City of New York Department of Sanitation ........................................................................................ 61 City of New York Department of Citywide Administrative Services .................................................... 62 County Public Administrators .............................................................................................................. 63 City of New York Laboratories ............................................................................................................. 63 STATE SUPPORTING AGENCIES......................................................................................................................... 63 Page 7 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths New York State Department of Health (NYS DOH).............................................................................. 63 New York State Department of Homeland Security and Emergency Services (NYS DHSES) ................ 65 Division of Cemeteries, New York Department of State ...................................................................... 65 New York State Army National Guard................................................................................................. 65 FEDERAL SUPPORTING AGENCIES ..................................................................................................................... 66 Department of Homeland Security (DHS) and Federal Emergency Management Agency (FEMA) ..... 66 United States Department of Health and Human Services ................................................................. 66 Centers for Disease Control and Prevention (CDC) .............................................................................. 67 United States Department of Transportation ..................................................................................... 67 United States Department of Defense ................................................................................................ 67 United States Department of State ..................................................................................................... 68 NON-GOVERNMENTAL SUPPORTING AGENCIES .................................................................................................. 68 Funeral Directors ................................................................................................................................. 68 Private Sector Cemetery Owners......................................................................................................... 69 Private Sector Crematoria Owners ...................................................................................................... 70 State Funeral Director Association ...................................................................................................... 70 American Red Cross............................................................................................................................. 70 The Salvation Army ............................................................................................................................. 71 New York Disaster Interfaith Services ................................................................................................. 71 Other Private and Commercial Entities ............................................................................................... 72 III. EMERGENCY SUPPORT FUNCTION COORDINATION .......................................................................... 73 ESF #1: TRANSPORTATION............................................................................................................................. 75 ESF #2: COMMUNICATIONS ........................................................................................................................... 75 ESF #3: PUBLIC WORKS AND ENGINEERING ...................................................................................................... 75 ESF #5: INFORMATION AND PLANNING ............................................................................................................ 76 ESF #6: MASS CARE, EMERGENCY SERVICES, TEMPORARY HOUSING, AND HUMAN SERVICES ..................................... 77 ESF #7: LOGISTICS MANAGEMENT AND RESOURCE SUPPORT ............................................................................... 77 ESF #8: PUBLIC HEALTH AND MEDICAL SERVICES ............................................................................................... 78 ESF #9: SEARCH AND RESCUE......................................................................................................................... 79 ESF #12: ENERGY ........................................................................................................................................ 79 ESF # 13: PUBLIC SAFETY AND SECURITY .......................................................................................................... 79 ESF #14: LONG-TERM COMMUNITY RECOVERY ................................................................................................. 80 ESF #15: EXTERNAL AFFAIRS.......................................................................................................................... 80 IV. OCME COMMAND OPERATIONS ....................................................................................................... 83 OCME COMMAND OPERATIONS DURING A BIOLOGICAL INCIDENT......................................................................... 85 AGENCY COMMAND ELEMENT ........................................................................................................................ 85 Disaster Response Coordinator ........................................................................................................... 85 Public Information Officer ................................................................................................................... 86 Safety Officer....................................................................................................................................... 87 AGENCY PLANNING ....................................................................................................................................... 88 Agency Operations Center Coordinator .............................................................................................. 88 Planning ............................................................................................................................................. 89 Logistics ............................................................................................................................................. 89 Operations ......................................................................................................................................... 90 Finance/Administration .................................................................................................................... 90 Information Technology ................................................................................................................... 90 Facilities ............................................................................................................................................. 91 AGENCY LOGISTICS ........................................................................................................................................ 91 Agency Logistics Chief ......................................................................................................................... 91 Operations Logistics Support ......................................................................................................... 92 Page 8 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Administrative Logistics Support .................................................................................................... 92 SCENE OPERATIONS ...................................................................................................................................... 93 Fatality Management Branch Director ............................................................................................... 93 DECENTRALIZED OPERATIONS ......................................................................................................................... 93 SCENE OPERATIONS ...................................................................................................................................... 93 Deputy Fatality Management Branch Director – Scene ...................................................................... 93 Scene Safety Officer ............................................................................................................................ 94 Scene Security Officer .......................................................................................................................... 94 Search Group Supervisor ..................................................................................................................... 95 Investigation/Recovery Group Supervisor ........................................................................................... 95 Remains Storage/Transport Group Supervisor ................................................................................... 96 Scene Support Group Supervisor ......................................................................................................... 96 Contamination Control Group Supervisor ........................................................................................... 96 POSTMORTEM PROCESSING OPERATIONS .......................................................................................................... 96 Deputy Fatality Management Branch Director – Postmortem Processing ......................................... 96 Morgue Security Officer ...................................................................................................................... 97 Morgue Safety Officer ......................................................................................................................... 97 Remains Storage Group Supervisor ..................................................................................................... 98 Forensic Group Supervisor .................................................................................................................. 99 Morgue Support Group Supervisor ................................................................................................... 103 Postmortem Quality Assurance/Quality Control Group Supervisor .................................................. 103 Contamination Control Group Supervisor ......................................................................................... 103 ANTEMORTEM PROCESSING OPERATIONS........................................................................................................ 103 Deputy Fatality Management Branch Director – Antemortem Processing ....................................... 103 OCME Liaison .................................................................................................................................... 104 Joint Family Support Operations Center (JFSOC) Representative ...................................................... 104 Manifest Group Supervisor ............................................................................................................... 104 VIC Security Officer............................................................................................................................ 104 VIC Safety Officer .............................................................................................................................. 104 Interview Group Supervisor ............................................................................................................... 106 Antemortem Records Management Group Supervisor ..................................................................... 106 Antemortem Quality Assurance/Quality Control Group Supervisor .................................................. 107 Victim Information Center Support Group Supervisor....................................................................... 107 V. OPERATIONAL STRATEGIES AND COMPONENTS .............................................................................. 109 INTRODUCTION .......................................................................................................................................... 111 OPERATIONAL COMPONENT: TRIGGER POINT - MOBILIZATION LEVEL -RESPONSE ACTIVITY ...................................... 112 OPERATIONAL COMPONENT: BIOLOGICAL INCIDENT IN-HOSPITAL FATALITY SURGE ................................................. 114 OPERATIONAL COMPONENT: OUT-OF-HOSPITAL FATALITY INVESTIGATION / RECOVERY ........................................... 115 OPERATIONAL COMPONENT: BIOLOGICAL INCIDENT VIRTUAL VICTIM INFORMATION CENTER .................................... 117 OPERATIONAL COMPONENT: TEMPORARY INTERMENT STRATEGY ........................................................................ 125 VI: INCIDENT SPECIFIC DEMOBILIZATION ACTIONS .............................................................................. 127 GENERAL DEMOBILIZATION .......................................................................................................................... 129 Agency Command Demobilization: General ..................................................................................... 129 Agency Command Demobilization: Operations Center Surge and Planning ..................................... 129 Agency Command Demobilization: Logistics .................................................................................... 130 Agency Command Demobilization: Finance/Administration ............................................................ 130 DECENTRALIZED COMMAND ACTIVITIES DURING DEMOBILIZATION ....................................................................... 130 Decentralized Command Demobilization: General ........................................................................... 130 Demobilization: Scene Operations .................................................................................................... 130 Demobilization: Postmortem Processing .......................................................................................... 130 Page 9 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Demobilization: Antemortem Processing .......................................................................................... 131 VII. INCIDENT SPECIFIC MITIGATION ACTIVITIES .................................................................................. 133 INTERNAL POST AGENCY RESPONSE ASSESSMENT ............................................................................................. 135 AFTER ACTION REPORT (AAR) ...................................................................................................................... 135 FEMA REIMBURSEMENT ............................................................................................................................. 135 IDENTIFICATION OF RELEVANT INDUSTRY ISSUES ............................................................................................... 136 SUPPORTING AND TECHNICAL REFERENCES ......................................................................................... 137 A. GENERAL INFORMATION ................................................................................................................. 139 ACRONYMS ............................................................................................................................................... 141 GLOSSARY ................................................................................................................................................. 145 INTERNAL CONTACT LIST .............................................................................................................................. 151 EXTERNAL AGENCY CONTACT LIST .................................................................................................................. 155 B. PATHOGEN INFORMATION .............................................................................................................. 159 ANTHRAX (BACILLUS ANTHRACIS)................................................................................................................... 161 PANDEMIC INFLUENZA (INFLUENZAVIRUS A SUBTYPES) ...................................................................................... 162 PLAGUE (YERSINIA PESTIS), ........................................................................................................................... 163 GLANDERS AND MELIOIDOSIS (B. MALLEI, B. PSUEDOMALLEI),............................................................................. 164 HANTAVIRUS, ............................................................................................................................................. 165 SMALLPOX (VARIOLA),, ................................................................................................................................ 166 VIRAL HEMORRHAGIC FEVERS,, ...................................................................................................................... 167 BOTULINUM TOXIN (CLOSTRIDIUM BOTULINUM), .............................................................................................. 168 C. RELIGIOUS CONSIDERATIONS .......................................................................................................... 169 RELIGIOUS CONSIDERATIONS......................................................................................................................... 171 D. SPECIAL CONSIDERATIONS AND GUIDANCE ..................................................................................... 173 BIOLOGICAL INCIDENT – AUTOPSY CONSIDERATIONS ......................................................................................... 175 BIOLOGICAL INCIDENT - CONTAMINATED SPECIMENS ......................................................................................... 176 BIOLOGICAL INCIDENT – IDENTIFICATION CONSIDERATIONS ................................................................................. 177 BIOLOGICAL INCIDENT – BURIAL/CREMATION CONSIDERATIONS .......................................................................... 178 BIOLOGICAL INCIDENT – TEMPORARY INTERMENT CONSIDERATIONS..................................................................... 179 E. SUGGESTED EQUIPMENT AND SUPPLY LISTS .................................................................................... 181 COMMAND AND CONTROL EQUIPMENT AND SUPPLIES BY FUNCTION .................................................................... 183 SCENE EQUIPMENT AND SUPPLIES BY FUNCTION ............................................................................................... 184 POSTMORTEM PROCESSING EQUIPMENT AND SUPPLIES BY FUNCTION .................................................................. 185 ANTEMORTEM PROCESSING EQUIPMENT AND SUPPLIES BY FUNCTION .................................................................. 192 OCME VEHICLES........................................................................................................................................ 195 Refrigerated Box Trucks – CME 66, 68 .............................................................................................. 196 Command Vehicles – CME 53, 54, 55, 69 .......................................................................................... 197 Regional Command Vehicles – CME 88, 89, 90, 92, 93 ..................................................................... 198 Emergency Support Unit (ESU) Truck – CME 63 ................................................................................ 199 Emergency Support Unit (ESU) Truck – CME 21 ................................................................................ 200 LDV Mobile Command Center – CME 51 ........................................................................................... 201 Pickup Truck – CME 64 ...................................................................................................................... 202 Response Cargo Van – CME 47 ......................................................................................................... 203 Response Personnel Van – CME 91 ................................................................................................... 204 Security Command Vehicle – CME 116.............................................................................................. 205 Page 10 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Tractor – CME 83 .............................................................................................................................. 206 Evidence Vehicle – CME 120.............................................................................................................. 207 Evidence Vehicle – CME 100.............................................................................................................. 208 Facilities Vehicle – CME 74 ................................................................................................................ 209 Facilities Vehicle – CME 107 .............................................................................................................. 210 Fleet Vehicle – CME 131 .................................................................................................................... 211 Fleet Vehicle – CME 40 ...................................................................................................................... 212 IT Vehicle – CME 94 ........................................................................................................................... 213 MLI Vehicles – CME 77, 78, 79 .......................................................................................................... 214 MLI Vehicles – CME 108, 109, 110 .................................................................................................... 215 MLI Vehicles – CME 103, 104, 105 .................................................................................................... 216 MLI Vehicles – 128,129,130 .............................................................................................................. 217 Mortuary Vehicles – 37, 45 ............................................................................................................... 218 Mortuary Vehicles – CME 71, 72, 73; 80,82 ...................................................................................... 219 Mortuary Vehicles – CME 102,119 .................................................................................................... 220 Mortuary Vehicle – CME 112 ............................................................................................................ 221 Receiving Vehicle - CME 101 ............................................................................................................. 222 OCME EQUIPMENT .................................................................................................................................... 223 3XB Shelter and Trailer ...................................................................................................................... 224 M Shelter and Trailer ........................................................................................................................ 225 J Shelter and Trailer ........................................................................................................................... 226 J Shelter and Trailer ........................................................................................................................... 226 Light Towers ...................................................................................................................................... 227 Lowe System ..................................................................................................................................... 228 FORTS Systems .................................................................................................................................. 229 OCME MACHINES ..................................................................................................................................... 231 Toyota Forklift ................................................................................................................................... 232 Doosan Forklift .................................................................................................................................. 233 Hyundai Forklift ................................................................................................................................. 234 Gator Utility Vehicles ........................................................................................................................ 235 JCB 520/40 Loadalls .......................................................................................................................... 236 JCB 525/60 Hi Viz Loadall .................................................................................................................. 237 Scissor Lift ......................................................................................................................................... 238 Articulating Boom ............................................................................................................................. 239 OCME GENERATORS .................................................................................................................................. 241 G-120 Wacker Generator .................................................................................................................. 242 G-70 Wacker Generator .................................................................................................................... 243 G-50 Wacker Neuson Generator ....................................................................................................... 244 OCME TRAILERS ........................................................................................................................................ 245 26’ Refrigerated Trailer ..................................................................................................................... 246 48’ Refrigerated Trailer ..................................................................................................................... 247 Aviation Trailer .................................................................................................................................. 248 CBRNE Trailer .................................................................................................................................... 249 DPMU Trailer..................................................................................................................................... 250 Flatbed Trailer ................................................................................................................................... 251 Landoll Trailer 930C .......................................................................................................................... 252 Landoll Trailer 317 ............................................................................................................................ 253 Landoll Trailer 440 ............................................................................................................................ 254 Logistics Trailer ................................................................................................................................. 255 Major Incident Response Trailer (MIRT)............................................................................................ 256 Mobile Office Trailer ......................................................................................................................... 257 Scene Investigations Unit (SIU) Trailer .............................................................................................. 258 Page 11 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Training Trailer .................................................................................................................................. 259 UVIS-CMS Mobile Communications Unit ........................................................................................... 260 Light Open Trailer.............................................................................................................................. 261 Heavy Open Trailer............................................................................................................................ 262 F. JOB ACTION SHEETS ......................................................................................................................... 263 AGENCY COMMAND FUNCTIONS ................................................................................................................... 265 Disaster Response Coordinator ......................................................................................................... 265 Agency Public Information Officer .................................................................................................... 269 Agency Safety Officer ........................................................................................................................ 273 AGENCY PLANNING ..................................................................................................................................... 277 Operations Center Coordinator ......................................................................................................... 277 NYCEM OPERATIONS CENTER REPRESENTATIVE .............................................................................................. 281 DOHMH Operations Center Representative ...................................................................................... 285 Planning Representative ................................................................................................................... 289 Logistics Representative .................................................................................................................... 291 Operations Representative ............................................................................................................... 293 Information Technology Representative ........................................................................................... 295 Facilities Representative ................................................................................................................... 297 FINANCE/ADMINISTRATION REPRESENTATIVE................................................................................................... 299 AGENCY LOGISTICS ...................................................................................................................................... 301 Agency Logistics Chief ....................................................................................................................... 301 Logistics Operations Support Team .................................................................................................. 305 Logistics Administration Support Team ............................................................................................ 307 OPERATIONS .............................................................................................................................................. 309 Fatality Management Branch Director ............................................................................................. 309 SCENE OPERATIONS .................................................................................................................................... 313 Deputy Fatality Management Branch Director – Scene .................................................................... 313 Scene Security Officer ........................................................................................................................ 317 Scene Safety Officer .......................................................................................................................... 321 Investigations/Recovery Group Supervisor ....................................................................................... 325 Investigation/Recovery Team Leader ................................................................................................ 329 Recovery Unit .................................................................................................................................... 333 Scene Photography Unit .................................................................................................................... 337 Remains Storage/Transport Group Supervisor ................................................................................. 341 Remains Storage/Transport Team .................................................................................................... 345 Scene Support Group Supervisor ....................................................................................................... 349 Scene Facilities Team ........................................................................................................................ 353 Scene Supplies Team ......................................................................................................................... 355 Scene Equipment Team ..................................................................................................................... 357 Scene Information Technology Team ................................................................................................ 359 Scene Contamination Control Group Supervisor ............................................................................... 363 POSTMORTEM PROCESSING OPERATIONS ........................................................................................................ 367 Deputy Fatality Management Branch Director – Postmortem Processing ....................................... 367 Morgue Security Officer .................................................................................................................... 371 Morgue Safety Officer ....................................................................................................................... 375 Remains Storage Group Supervisor ................................................................................................... 379 Remains Intake Team ........................................................................................................................ 383 Remains Storage Team ..................................................................................................................... 387 Remains Release Team ..................................................................................................................... 391 Remains Escort Team ........................................................................................................................ 395 Forensic Group Supervisor ................................................................................................................ 399 Page 12 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Triage Team ...................................................................................................................................... 403 Triage Evidence Unit ......................................................................................................................... 407 Triage Photography Unit ................................................................................................................... 411 Radiography Team ............................................................................................................................ 415 Pathology Team ................................................................................................................................ 419 Autopsy Unit ..................................................................................................................................... 425 Fingerprint Unit ................................................................................................................................. 429 Forensic Odontology Unit.................................................................................................................. 435 DNA Unit ........................................................................................................................................... 439 Pathology Photography Unit ............................................................................................................. 443 Pathology Evidence Unit ................................................................................................................... 449 Anthropology Unit ............................................................................................................................. 453 Histology Unit.................................................................................................................................... 457 Toxicology Unit.................................................................................................................................. 461 Morgue Support Group Supervisor ................................................................................................... 465 Morgue Facilities Team ..................................................................................................................... 469 Morgue Supplies Team...................................................................................................................... 471 Morgue Equipment Team ................................................................................................................. 473 Morgue Information Technology Team ............................................................................................ 475 Postmortem Quality Assurance/Quality Control Group Supervisor .................................................. 479 Exit Review Team .............................................................................................................................. 483 Contamination Control Group Supervisor ......................................................................................... 487 ANTEMORTEM PROCESSING OPERATIONS........................................................................................................ 491 Deputy Fatality Management Branch Director – Antemortem Processing ....................................... 491 Victim Identification Center Security Officer ..................................................................................... 497 Victim Information Center Safety Officer .......................................................................................... 501 NYC Office of Chief Medical Examiner (OCME) Liaison ..................................................................... 505 Joint Family Support Operations Center (JFSOC) Representative ...................................................... 507 Interview Group Supervisor ............................................................................................................... 511 Reception Team ................................................................................................................................ 517 Interview Team ................................................................................................................................. 521 Antemortem Records Management Group Supervisor ..................................................................... 527 Antemortem DNA Team .................................................................................................................... 531 Antemortem Dental Records Team ................................................................................................... 535 Medical Records Team ...................................................................................................................... 539 Records Management Team ............................................................................................................. 543 Antemortem Evidence Team ............................................................................................................. 547 Antemortem Fingerprint Team ......................................................................................................... 551 Antemortem Quality Assurance/Quality Control Group Supervisor .................................................. 555 Victim Information Center Support Group Supervisor....................................................................... 559 Victim Information Center Facilities Team ........................................................................................ 563 Victim Information Center Supplies Team ......................................................................................... 565 Victim Information Center Equipment Team .................................................................................... 567 Victim Information Center Information Technology Team ............................................................... 569 G. PRE-SCRIPTED MISSION REQUESTS .................................................................................................. 573 REQUEST: FATALITY SEARCH AND RECOVERY TEAM ........................................................................................... 575 REQUEST: MORTUARY AFFAIRS ..................................................................................................................... 577 REQUEST: REFRIGERATED STORAGE UNITS....................................................................................................... 579 REQUEST: MASS FATALITY MANAGEMENT IMT TEAM....................................................................................... 581 REQUEST: DISASTER MORTUARY OPERATIONAL RESPONSE TEAM (DMORT) ........................................................ 583 REQUEST: DISASTER VICTIM IDENTIFICATION TEAM (INTERPOL) ........................................................................... 587 Page 13 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths REQUEST: NATIONAL GUARD CIVIL SUPPORT TEAM .......................................................................................... 589 H. CORE AND TARGET CAPABILITIES ..................................................................................................... 591 CORE CAPABILITY: FATALITY MANAGEMENT SERVICES ....................................................................................... 593 TARGET CAPABILITIES: FATALITY MANAGEMENT SERVICES .................................................................................. 593 I. FORMS .............................................................................................................................................. 595 OCME INCIDENT CHARACTERIZATION FORM ................................................................................................... 597 INCIDENT OBJECTIVES .................................................................................................................................. 601 ORGANIZATIONAL ASSIGNMENT LIST .............................................................................................................. 603 ASSIGNMENT LIST ....................................................................................................................................... 605 INCIDENT RADIO COMMUNICATIONS PLAN ...................................................................................................... 607 INCIDENT CHECK IN LIST ............................................................................................................................... 613 ACTIVITY LOG............................................................................................................................................. 615 VEHICLE/EQUIPMENT LOG ........................................................................................................................... 617 J. PRE-ESTABLISHED BODY COLLECTION POINTS .................................................................................. 619 ANNEXES.............................................................................................................................................. 623 1: BIOLOGICAL INCIDENT DECEDENT RECOVERY STRATEGY FOR HEALTH CARE FACILITIES................... 625 BIOLOGICAL INCIDENT SURGE RESPONSE TRIGGERS ........................................................................................... 627 ASSIGNMENT OF RESPONSIBILITIES ................................................................................................................. 627 ESSENTIAL SUPPORT PROCESSES .................................................................................................................... 628 Decedent Tracking ............................................................................................................................ 628 Personal Effects Management .......................................................................................................... 629 Interagency Communication ............................................................................................................. 629 BCP OPERATIONS STAFFING ......................................................................................................................... 631 Morgue Manager .............................................................................................................................. 631 BCP LOGISTICS REQUIREMENTS .................................................................................................................... 635 SPECIAL CONSIDERATIONS ............................................................................................................................ 639 Direct Drop-Offs ................................................................................................................................ 639 Interaction with Funeral Directors .................................................................................................... 639 Staff Attrition .................................................................................................................................... 639 Religious Traditions ........................................................................................................................... 640 JOB ACTION SHEETS .................................................................................................................................... 641 HCF Morgue Manager....................................................................................................................... 641 HCF Operations Center Representative ............................................................................................. 645 HCF Assistant Morgue Manager – Operations.................................................................................. 647 HCF Body Handlers ............................................................................................................................ 651 HCF Personal Effects Manager .......................................................................................................... 655 HCF Assistant Morgue Manager – Support ....................................................................................... 659 HCF Morgue Logistics Manager ........................................................................................................ 661 HCF Morgue Security Manager ......................................................................................................... 663 FORMS ..................................................................................................................................................... 667 Remains Storage Inventory Form ...................................................................................................... 667 Personal Effects Chain-of-Custody Tracking Form ............................................................................ 669 2. EBOLA VIRUS DISEASE OPERATIONAL PROTOCOL ............................................................................ 671 Page 14 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Preface The City of New York Office of Chief Medical Examiner (OCME) developed a plan to manage a surge in deaths that may result from a biological incident affecting New York City. This Biological Incident Surge Plan is an annex to the OCME All Hazards Mass Fatality Management Plan, which outlines the City's all-hazard response strategy for managing mass fatality operations. The concept for managing deaths due to a biological incident is simple: OCME will recover, process, and hold decedents from residential and healthcare facility (HCF) locations until private sector entities are able to manage final disposition. The goal of this OCME response strategy is to honor life by respectfully managing one’s death. This annex was developed with the support of the City of New York Department of Health and Mental Hygiene’s (DOHMH) Bureau of Communicable Disease, Healthcare Emergency Preparedness Program. Additionally, it has been developed in accordance with the Citywide Incident Management System (CIMS), as constructed by the City of New York Office of Emergency Management (NYCEM). Grant funding provided by the Office of the Assistant Secretary for Preparedness and Response was used to develop this plan, via Grant 1 U3RHS0756-01-00. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Assistant Secretary for Preparedness and Response. Grant funding provided by the United States Department of Homeland Security – Urban Areas Security Initiative was used to update this plan, via Grant FFY 2013 C971833 and Grant FFY 2015 C971853. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Homeland Security. Disclaimer Statement –This document was supported by the Office of the Assistant Secretary for Preparedness and Response via Grant 1 U3RHS07565-0100. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of Assistant Secretary for Preparedness and Response. Disclaimer Statement –This document was supported by the United States Department of Homeland Security – Urban Areas Security Initiative via Grant FFY 2013 C971833 and Grant FFY 2015 C971853. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of Department of Homeland Security. Page 15 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 16 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Plan Map The Biological Incident Fatality Surge Plan for Managing In- and Out-of-Hospital Deaths is an Annex to the OCME All Hazards Mass Fatality Management Plan. Chapter Title Description A brief overview of the OCME’s response planning concepts and its agency authority to manage decedents during a biological incident. I Introduction II External Agency Operations A list of potential tasks and decisions City agencies may need to execute in support of fatality management operations during a biological incident. III ESF Coordination A list of potential tasks and decisions, organized by ESF related to fatality management operations during a biological incident. IV OCME Command Operations An overview of the internal OCME Command structure in response to a biological incident. V Operational Components and Strategies A review of Operational Strategies and Components (full text in the OCME All Hazards Mass Fatality Management Plan) and a description of Operational Components specific to managing a biological incident. V Incident Specific Demobilization Actions An overview of strategies for demobilization and agency recovery. VII Incident Specific Mitigation Activities An overview of strategies for developing after action items related to a biological incident. Supporting Technical and Reference Sections A General Information Includes acronyms and glossary terms specific to fatality management operations in a biological incident and important contact information. B Pathogen Information Includes relevant information regarding likely biological threats (natural or terroristic) in NYC. C Religious Considerations Special considerations regarding common religious practices that may conflict with fatality management operations. D Special Considerations and Guidance Special considerations and guidance on topics that may be relevant during the course of operations E Suggested Equipment and Supply Lists Includes basic equipment and supply lists broken down by response functional areas. F Job Action Sheets Objectives and action items for each OCME (Section D.1) and HCF (Section D.2) position that could potentially be staffed during a biological incident. Page 17 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Chapter Title G Pre-Scripted Mission Requests H Target and Core Capabilities I Forms J Pre-Established Body Collection Points Description Compilation of pre-scripted mission requests. Overview of OCME’s required target and core capabilities as described by FEMA Internal and ICS-based forms specific to biological incident response activities. Information relating to the ability of NYC hospitals to support a body collection point, including hospital capabilities and capacities. Annexes 1 Biological Incident Decedent Recovery for Health Care Facilities 2 Ebola Virus Disease Operational Protocol The Biological Incident Decedent Recovery for Health Care Facilities details specific operations and responsibilities for HCFs during a biological incident with fatality surge The Ebola Virus Disease Operational Protocol details specific operations and responsibilities related to handing decedents whose deaths are confirmed or suspected cases of EVD. Page 18 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Record of Changes 2016 Chapters I - VII ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Generalized the plan to cover all biological incidents, not just pandemic influenza General agency information Additional supporting grant funding Update of Plan Map Update of Table of Contents Addition of H1N1 outbreak in 2009-2010 Information regarding H5N1 and H7N9 Updated OCME daily operations metrics Updated NYC demographics and vital statistics Updated modeling data based on new demographics and metrics Updated information regarding influenza monitoring and testing Corrected formatting throughout document Updated OCME organizational charts Updated body collection point (BCP) requirements and strategies Updated content for all Operational Strategies Updated Hart Island/City Burial metrics Addition of appropriate UVIS-CMS-CMS developments Updated information specific to NYC agency capabilities Updated cemetery and crematory information and metrics Updated information specific to NYS agency capabilities Updated information specific to Federal agency capabilities Updated information specific to Private agency capabilities Updated OCME organizational charts Updated body collection point (BCP) requirements and strategies Updated content for all Operational Strategies and Components Developed new Operational Components Updated Hart Island/City Burial metrics Addition of appropriate UVIS-CMS-CMS developments Updated information specific to NYC agency capabilities Updated cemetery and crematory information and metrics Updated information specific to NYS agency capabilities Updated information specific to Federal agency capabilities Updated information specific to Private agency capabilities Generalized the plan to cover all biological incidents, not just pandemic influenza Updated OCME daily operations metrics Updated NYC demographics and vital statistics Corrected formatting of document Updated all OCME organizational charts Developed incident response positions based on applicable Regional Field Operating Guides Updated agency demobilization and after action items Page 19 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Supporting Technical and Reference Sections – Section A ▪ ▪ ▪ Updated acronyms based on usage in text Updated glossary items and definitions based on text Developed updated OCME and interagency contact information Supporting Technical and Reference Sections – Section B ▪ Developed basic information sheets specific to biological threats (natural and terroristic) for NYC Supporting Technical and Reference Sections – Section C • Developed basic information regarding religious considerations and fatality management operations Supporting Technical and Reference Sections – Section D • Developed considerations for biological incident-specific agency policies on burial/cremation, autopsy, identification Supporting Technical and Reference Sections – Section E ▪ Developed suggested equipment and supply lists based on operational function Supporting Technical and Reference Sections – Section F ▪ Developed Job Action Sheets for all operational response positions for OCME Supporting Technical and Reference Sections – Section G ▪ Developed pre-scripted mission requests for fatality management support Supporting Technical and Reference Sections – Section H ▪ Developed description of OCME federally-defined target and core capabilities Supporting Technical and Reference Sections – Section I ▪ Developed customized versions of common ICS forms for use by OCME in an incident response Annexes ▪ ▪ Developed expanded informational section for Operational Component: Biological Incident Decedent Recovery for Health Care Facilities Added Ebola Virus Disease Operational Protocol Page 20 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths I. Introduction This segment of the document provides an overview of the City of New York’s response to a biological incident. This section outlines the fatality management response by the Office of Chief Medical Examiner and other NYC agencies during a biological incident. Page 21 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 22 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Fatality Management during a Biological Incident The New York City Office of Chief Medical Examiner (OCME) is prepared to manage multiple types of disaster incidents that would result in numerous fatalities. Past planning and response efforts have focused on structural incidents, such as the Happy Land Social Club fire on March 25, 1990, the East Harlem Building collapse on March 12, 2014, and the East Village Building collapse on March 26, 2015; transportation incidents, including the crash of American Airlines Flight 587 in Queens on November 12, 2001, the Bronx Tour Bus crash on March 12, 2011, and the Metro-North Train Derailment in the Bronx on December 1, 2013; water recoveries like the Staten Island Ferry crash on October 15, 2003 and the Mid-Hudson Air Collision on August 8; natural disasters, including Hurricane Sandy on October 30, 2012; terrorist incidents, including the February 26, 1993 World Trade Center bombing and the September 11, 2001 attack that tragically leveled both towers of the World Trade Center. Through experiences such as these, the OCME has become accustomed to dealing with extensive fragmentation, portion reassociation, family grief and tremendous victim identification challenges. Now the OCME must prepare for a different disaster incident – a biological incident. A biological incident will be particularly challenging due to the potential for tens-ofthousands to hundreds-of-thousands of deaths to occur. The private sector could be left with the responsibility to deal with decedents, as most naturally occurring deaths never come under the OCME’s jurisdiction. The magnitude of a biological incident, however, would demand a response from the OCME, to assist both City health care facilities (HCFs) and to support private sector funeral directors, cemetery/crematorium owners, and religious communities. In such an instance, the OCME’s goal would be to provide a Page 23 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths service to the community, so that decedents could be cared for respectfully even during a devastating disaster likely to create a “new normal” regarding how human remains are processed. This planning document will present the OCME’s operational response strategies to arrange for the recovery, transport, storage, tracking and processing of disaster and non-disaster decedents. These strategies take into consideration expanding the OCME’s capability when mortuary affairs personnel, equipment and supplies will likely be limited. As the OCME learns new methods of managing remains, caring for families, and instituting new technology, these lessons will be incorporated into the operational response strategies. They will also be added to the OCME All Hazards Mass Fatality Management Plan, just as the lessons learned from previous experiences have been implemented and used to formulate this Biological Incident Fatality Surge Plan. Primary Objectives Governing OCME Response • • • • • • • • • The OCME will coordinate its response activities with the DOHMH to mitigate a public health hazard with regard to decedents. The OCME will maximize staff safety, in order to prevent secondary exposures. The OCME will avoid competing with other agencies to obtain vital resources, by coordinating its requests through New York City’s Emergency Operation Center (EOC). The OCME will establish jurisdictional authority with regard to decedents in order to collect and preserve postmortem and antemortem evidence required for the determination of the cause and manner of death and for identification according to established forensic standards. The OCME will make every effort to minimize the burden placed on NYC’s health care system, by assisting HCFs with storing and processing decedents. The OCME will positively identify victims, determine the victim’s cause and manner of death, and will release remains to the next of kin (NOK) without delay. The OCME will establish a single, centralized mechanism for reporting and communicating with family and friends of decedents. The OCME will provide families with factual and timely information in a compassionate manner, in advance of public release. The OCME will enhance its capabilities to buffer the impact placed on final disposition entities by holding bodies in storage until funeral directors and cemetery/crematorium owners are ready to manage final disposition. Biological Incident Characteristics and Basic Epidemiology An epidemic is defined as a sudden increase in the number of cases of a disease above what is normally expected in an area. A pandemic is defined as an epidemic that has spread over several countries or continents affecting a large number of people. Epidemics are more likely to occur when there has been a recent increase in the amount or virulence of an agent, the agent has not occurred in the geographic area before and therefore natural immunity is low or nonexistent, and when any part of the transmission Page 24 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths or susceptibility of an agency has changed1. Both epidemics and pandemics may result in a biological incident resulting in mass fatalities and an activation of the Biological Incident Surge Plan for Managing In- and Out-of Hospital Deaths. A biological incident can be caused by a wide variety of pathogens and may be categorized as a natural event, a criminal act, or an accident. Major categories of biological threats include2: 1. Airborne diseases 2. Vector-borne disease 3. Water-borne diseases 4. Epidemic meningitis 5. Rodent-borne diseases 6. Hemorrhagic fevers 7. Smallpox and monkeypox 8. Antimicrobial resistance 9. Other zoonotic diseases 10. Emerging diseases These categories represent significant public health threats that the OCME will need to be aware of, but not all represent a potential mass fatality incident. Diseases and infections with low fatality rates, either due to the nature of the disease, limited exposures, or available treatment options, will not trigger an activation of this surge plan as deaths will not occur in large numbers in a short period of time. Some public health threats, while not triggering the surge plan, may require a more advanced recovery protocol by OCME in an effort to protect public health, as was observed during the 2014 Ebola pandemic. Several pathogens are capable of causing a mass fatality incident, either through natural or man-made (i.e. terrorism or accidental) mechanisms. The Department of Homeland Security includes three biological incidents in the National Planning Scenarios: pandemic influenza, aerosolized anthrax, and plague3. With the advancement of medical science, many of the pathogens included in the categories above do not pose a threat of mass numbers of fatalities. Pandemic influenza is currently the primary naturally occurring epidemic of concern in the United States, although antibiotic resistance and other emerging diseases may pose future threats of mass fatality incidents. Bioterror attacks involving weaponized pathogens are improbable but if executed well could cause large numbers of fatalities, as communities may not be prepared to respond, typical treatments may be less effective, or there may be a delay in identifying the dispersal due to changes in the natural progression of the disease4. Some recent examples of worldwide biological incidents are detailed below. Please note that not all incidents below would be categorized as a mass fatality incident or trigger the surge plan in NYC, largely due to the geographically dispersed nature of the incidents. 1 Introduction to Epidemiology. Centers for Disease Control and Prevention, 2012. “Pandemic and Epidemic Diseases”. 2014. World Health Organization. 3 National Planning Scenarios. United States Department of Homeland Security, 2007. 4 Pavlin, Julie A. 1999. Epidemiology of Bioterrorism. Emerging Infectious Diseases: Vol 5(4). 2 Page 25 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Pathogen Description Impact Anthrax5 Anthrax-laced letters were sent via the United States Postal Service to several media and congressional offices in the fall of 2001. 22 infections 5 fatalities SARS6 The epidemic began in Asia in November 2002 and subsided by July 2003. 29 countries in Asia, North America, Europe, and the Middle East were affected. 8,098 infections 774 fatalities H1N1 Influenza7,8 An H1N1 virus identified in Mexico in April 2009, spreading throughout much of the world by late May 2009. Recent research has indicated a fatality rate 15x higher than previously reported figures, which only included laboratory-confirmed cases. Fatalities: 18,500 confirmed 284,500 estimated The epidemic began in Saudi Arabia in 2012 and MERS-CoV9 spread to 26 countries in Asia, Europe, North America, and Africa. 1,356 infections 484 fatalities Ebola Virus The outbreak began in March 2014 in Guinea and Disease10,11 spread to 10 countries, including the United States. 27,479 infections 11,222 fatalities Table 1: Recent biological incidents affecting the United States. Recognizing the possibility of a future biological incident, key New York City (NYC) government and private sector agencies have conducted planning sessions and developed response strategies both for managing the influx of medical patients and for handling the fatalities. The City of New York Office of Chief Medical Examiner (OCME), as part of the NYC Department of Health and Mental Hygiene (DOHMH), has developed an annex to its OCME All Hazards Mass Fatality Management Plan. This annex, entitled " The City of New York Biological Incident Surge Plan for Managing In- and Out-of-Hospital Deaths,” 5 GAO-04-152 Public Health Response to Anthrax Incidents, 2003. Morbidity and Mortality Weekly Report: Revised US Surveillance Case Definition for SARS and Update on SARS Cases – US and Worldwide, 2003. 7Shrestha, SS et al, “Estimating the burden of 2009 biological incident A (H1N1) in the United States (April 2009 – April 2010)”, Clin Inf Dis, 2011; 52:S75-82. 8 Dawood, FS, et al., “Estimated global mortality associated with the first 12 months of 2009 biological incident A H1N1 virus circulation: a modeling study”, Lancet Infect Dis, 2012; 12:67895. 9 Middle East respiratory syndrome coronavirus (MERS-CoV), World Health Organization. 10 2014 Ebola Outbreak in West Africa, Centers for Disease Control and Prevention. 6 Torok, M. Focus on Field Epidemiology. North Carolina Center for Public Health Preparedness – The North Carolina Institute for Public Health. 1(5):1-6. 12 Page 26 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths is designed to outline the OCME’s planned response to a biological incident, natural or terroristic, that results in a surge of deaths. Biological incidents will stress a jurisdictions’ ability to care for the living and manage fatalities. The specific pathogen and the exposure pathway will affect that rate at which illnesses present, the rate at which fatalities occur, and the overall length operations must be maintained. All fatality surge planning should be scalable to allow for this variability. Incorporating epidemic curve patterns can help in planning for differential rates of recovery. Epidemic Curves Common source epidemics result from exposure to a single source. The duration of exposure to the source differentiates between point, intermittent, and continuous common source exposures. Point common source epidemics12 occur when the exposure occurs in a single brief period of time, such as the intentional release of a pathogen in a building’s HVAC system. Bioterrorism incidents would most likely follow this type of epidemic curve. With this type of exposure, all illnesses will occur within a single incubation period with a single peak in cases; leading to a short term operation with a high volume of fatalities. Figure 1: Example of a point common source epidemic curve (illnesses). Fatality distributions would likely follow a similar but delayed pattern. An intermittent common source epidemic occurs when individuals are exposed to a single source at multiple but discrete periods of time. This type of exposure pattern leads to illnesses occurring in multiple incubation periods, with multiple peaks in cases, leading to a variable rate of recovery with a longer operation. Torok, M. Focus on Field Epidemiology. North Carolina Center for Public Health Preparedness – The North Carolina Institute for Public Health. 1(5):1-6. 12 Page 27 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths A continuous common source exposure occurs when individuals are exposed to a single source over an extended period of time. This exposure pattern will manifest in illnesses occurring in overlapping incubation periods, with a plateau in cases until the source is remediated. Propagated epidemics are caused by pathogens that are transmitted between individuals, such as pandemic influenza. This type of epidemic is characterized by multiple overlapping waves of cases, and generally lasts for a longer period of time than any common source epidemic. Naturally occurring transmissible pandemics (including pandemic influenza) and bioterrorism incidents involving a transmissible pathogen would follow the propagated epidemic curve. Figure 2: Example of propagated epidemic curve. Fatality distributions would likely follow a similar but delayed pattern. The rate of recovery will depend on the type of epidemic curve and the lethality of the pathogen. Appendix B provides fact sheets on pathogens that would necessitate an activation of the surge plan, either due to natural progression or bioterrorism. Health authorities are constantly monitoring for rare or novel bacterial and viral strains that may cause future natural pandemics, including antibiotic resistant bacterial strains and respiratory viruses. Page 28 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Office of Chief Medical Examiner Jurisdictional Authority By the provisions of Section 557 of the NYC Charter, OCME shall have all powers and duties as may be provided by law in respect to bodies of persons dying from criminal violence, by accident, by suicide, suddenly when in apparent health, when unattended by a physician, in a correctional facility, mental health facility, or in any suspicious or unusual manner or where an application is made pursuant to law for a permit to cremate the body of a person. OCME may, to the extent permitted by law, provide forensic and related testing and analysis, and ancillary services in furtherance of investigations concerning persons both alive and deceased, including but not limited to: performing autopsies; performing deoxyribonucleic acid (DNA) testing and other forms of genetic testing and analysis; obtaining samples and exemplars performing pathology, histology and toxicology testing and analysis; and determining the cause and manner of injuries and/or death. OCME shall perform the functions of the city mortuary and related functions, including the removal, transportation and disposal of unclaimed or unidentified remains and the remains of those individuals who have died outside of a medical institution. OCME is responsible for managing final disposition for unidentified and unclaimed bodies, and for claimed bodies when requested by the NOK. The context of death determines the case type and subsequent processing. Medical Examiner cases (ME Case) include all deaths OCME is legislated to examine by Section 557, including suicides, homicides, and others. Claim Only/Release to Funeral Home cases are natural deaths, many coming from health care facilities, and generally only fall under OCME responsibility if the HCF requires assistance with storage. Fatalities from biological incidents may be either case type, as pandemic influenza will result in cases where the manner of death is natural (Claim/Release to Funeral Home/No Case) while a bioterror attack will produce cases where the manner of death is homicide (ME Case). Further sections of this plan will outline the operational differences in responding to a natural vs. criminal incident. In addition to its daily operations, the OCME is responsible for the Fatality Management Core Competency during disaster events, as specified by NYC’s Emergency Management Plan, Citywide Incident Management System (CIMS). Moreover, during a declared public health emergency, it may be necessary for the NYC Commissioner of Health to legally expand the OCME’s authority to include management of all naturally occurring deaths during a biological incident. The Commissioner of Health may expand the OCME’s authority in a limited manner, particularly if its involvement helps prevent a potential public health hazard. This will allow OCME to take custody of natural deaths that present a threat to public health, as in ebola virus disease cases. A more significant expansion of authority will require the issuance of detailed Emergency Orders by the Governor and/or Mayor. In such instances the OCME will contact the General Counsel for Health at DOHMH and the City’s Office of the Corporation Counsel as soon as a public health emergency is anticipated, in order to discuss expanding jurisdictional authority. Page 29 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Mass Fatalities due to a Biological Incident As numerous deaths occur during a biological incident, the Office of Chief Medical Examiner (OCME) will characterize the event as a “mass fatality incident,” consistent with OCME’s mass fatality incident (MFI) criteria. OCME Mass Fatality Criteria ▪ ▪ ▪ ▪ ▪ An incident with the potential to yield 10 or more fatalities An incident involving a protracted or complex decedent recovery operation An incident that has yielded more decedents than can be recovered and examined by OCME and its associated resources An incident involving decedents contaminated by chemical, biological, radiological, nuclear, or high-yield explosive (CBRNE) agents or materials An incident involving special circumstances that requires multi-agency support of MFM operations Magnitude National planning experts have not been able to characterize fully how a biological incident might unfold. Biological incident deaths will likely increase and decrease in one or more waves, depending on the specific pathogen, In any event, the OCME must be prepared simultaneously to recover bodies, conduct operations to identify remains, determine cause and manner of death and, in many cases, facilitate final disposition, in addition to managing its usual caseload. To understand the magnitude of a biological incident in NYC, the OCME worked with the Department of Health and Mental Hygiene (DOHMH) to develop modeling for a pandemic influenza incident, including fatality estimates. Based on NYC’s estimated population of 8.4 million (which increases to about 9.0 million during business hours13), an estimated infection rate of 18-30% of the population and a mortality rate of 2.0% of the population infected,14 the OCME must be prepared to manage 50,435 additional pandemic influenza decedents. This is more than the number of decedents that the OCME processes annually and it must be prepared to manage this influx during an 8week period. These deaths will occur over the entire 303 square miles that make up New York City’s five boroughs. They will occur in NYC’s private residences, 47 hospitals15, more than 275 nursing/assisted living facilities, more than 400 clinics and physicians’ offices, and at 11 correctional healthcare facilities (HCFs) associated with NYC’s prisons. 13 US Census Bureau, Commuter Adjusted Daytime Population Data Centers for Disease Control and Prevention Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States – Early, Targeted, Layered Use of Nonpharmaceutical Interventions 15 This number of hospitals references those only with emergency rooms, as used in NYC Emergency Management planning. 14 Page 30 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 31 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Normal Daily Case Load Approximately 75 cases are reported to the OCME each day. On average, 25%of these cases require an investigation; the remaining 75%, which come from hospitals, do not. Of the cases that must be investigated, about 75% require an autopsy. The others require an external exam. Of the cases that do not require investigation, most are claimonly cases, to be held by OCME pending disposition arrangements by the next of kin (NOK), or are certified at the scene by a medicolegal investigator (MLI) and granted direct release to a licensed funeral director. The City of New York Office of Vital Records publishes the locations where deaths occur annually. In 2013, 59% of deaths occurred in-hospitals, 23% in residences, 17% in assisted living centers, and 1% in other locations. Quantitative Hazard Analysis Trigger Points Since a biological incident can occur before authorities know about the outbreak, the OCME has established caseload hazard trigger points. These will help professionals determine whether a situation that might signal a biological incident has occurred. In addition to identifying an unusual incident, these trigger points are associated with specific response activities. Based on the trigger points, the OCME can modularly increase its capability in relation to the magnitude of the event. Surveillance indicators will depend on the specific pathogen, but can be generally defined as an unexplained uptick in similar symptoms/illnesses that is identified during routine analysis. These trigger points are only applicable in biological incidents without postmortem cross contamination risks (i.e. ebola or other viral hemorrhagic fevers). • • • • • • Less than 60 deaths per day – with no surveillance indicators reported 60 - 200 deaths per day – with or without surveillance indicators reported 200 - 500 cumulative deaths – additional surveillance indicators present 500 - 2,000 cumulative deaths – additional surveillance indicators present 2,000 - 5,000 cumulative deaths – additional surveillance indicators present Above 5,000 cumulative deaths – additional surveillance indicators present Early increased numbers of daily fatalities will manifest at all stages of decedent processing: • An increase in the number of requests by health care facilities for OCME to hold decedents • An increase in funeral directors being unable to pick up decedents from HCFs or OCME in a timely manner • An increase in cases that exceeds OCME’s standard storage capacity • Inability of cemeteries and City Burial to keep up the number of requested burials In addition to specific trigger points, OCME must assess several variables when conducting the hazard analysis. Page 32 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Infectiousness/Pathogenicity of the Biological Outbreak Exposure risks for OCME personnel during the incident response will vary depending on the specific pathogen. The DOHMH will work with the OCME to develop and distribute guidance regarding standard precautions or transmission-based precautions that OCME personnel should practice specific to fatality management. This information will cover required personal protective equipment (PPE) when performing specific tasks, distribution of prophylactic medications, and other health and safety plan recommendations (such as establishing a fever watch program), specific to the disease outbreak. Institution of Community Control in New York City During an outbreak, DOHMH will assess epidemiologic, clinical, and behavioral characteristics of the pathogen. The Commissioner of Health will then recommend containment measures to City Hall officials, to limit the spread (if applicable), morbidity, and mortality of the disease. Such community control recommendations may include closing schools, canceling or limiting large public gatherings, issuing hygiene advisories, establishing voluntary or required quarantine/isolation of confirmed or suspected cases and their household contacts during specific phases of the incident, using masks in community settings, issuing travel advisories to and from specific locations, screening people at ports of entry, and reducing crowding on mass transit vehicles. It is important to note that these community control measures may also slow responder activities. Differentiation between Causes of Biological Incident Deaths from Other Causes General signs and symptoms of the suspected/confirmed pathogen will be the first indication to authorities whether or not to attribute the death to the incident (see Appendix B for pathogen-specific fact sheets). Ultimately, laboratory diagnostic testing is the gold standard for identifying the presence of a pathogen and the specific strain if applicable. The optimal technique for identifying a pathogen is variable, although specimen plating, polymerase chain reaction, enzymelinked immunosorbent assays, and isolation techniques are commonly used. The sensitivity and speed varies depending on the specific method utilized. The DOHMH may request that the OCME provide additional blood and tissue samples of sentinel cases during the outbreak. Anticipation of Constraints in the Normal Process Several variables have the potential to slow down the process of managing decedents. During a biological incident, the OCME has identified the following areas where such bottlenecks are likely to occur. • Signing Death Certificates – Physicians may not be available to sign death certificates for Claim/Release to Funeral Home cases, particularly when their patient dies at home, because they will be focused on providing medical care to the living. Page 33 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Unidentified Decedents – During a biological incident, decedent’s family members may also be ill and therefore unavailable to identify the body. Normal Disaster Victim Identification (DVI) practices may need to be altered to accommodate a protracted response by family. Potential delays will also affect the OCME process, since it may be difficult to store remains without implementing temporary interment. • Private Sector Funerary Businesses – Private funeral directors, cemeteries, and crematoria may not be able to accommodate the large influx of deaths during a biological incident. Depending on the pathogen, some funeral directors, cemeteries, and crematoria may be unwilling to handle decedents due to fear. The pathogen may affect whether or not decedents are allowed to be buried or if cremation is mandatory. • Limited Hospital Storage – Hospitals have limited cold storage facilities for decedents. Even in the best of times, some facilities require the OCME to hold bodies for them due to limited space. • Decedents Brought to Various City Locations by NOK – During a biological incident, it is also possible that NOK will bring their deceased family members to a HCF, fire house, police station, or OCME office due to lack of correct information or delayed city processes. • Death Certificate Registration and Burial/Cremation/Transportation Permit – Although the Electronic Death Registration System (EDRS) has been fully implemented across NYS, it is possible that funeral directors may still have to register death certificates at the Office of Vital Records if the electronic system fails or becomes overwhelmed. • High Death Rate at Assisted Living Facilities and Prisons – These facilities are likely to experience a greater number of deaths than the general public, due to close living quarters, vulnerable resident populations, and inability to leave the facility. • Unattended Deaths – Those who die without family and friends, present different challenges, including difficulty establishing decedent identify or locating NOK; the ability to enter a residence, requiring the presence of an NYPD Officer; the management of decedent’s pets; and the management of decedent’s estate. • Attended Deaths and NOK with Special Needs – OCME personnel may recover bodies where a decedent was attended by a family member with special needs, such as a hearing or speech disability or a language barrier. In cases where a NOK requires medication or home healthcare, there may be a need for the involvement of a social services agency. • Homebound Individuals – Many NYC homebound residents are under the care of a large home care organization. Those not in a home care organization who die from the incident may go undiscovered for several days. Decedents not promptly reported to 911 will decompose and make it more difficult for the OCME to identify the body. • Undocumented Persons – The DOHMH acknowledges that undocumented persons will encounter barriers to accessing healthcare during a biological incident. When the Page 34 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME recovers these bodies, they may find other undocumented persons who are unwilling to provide decedent identification. OCME Decision Making Strategies Due to the distributive nature of a biological incident, the Office of Chief Medical Examiner (OCME) has created a decision-making strategy that will drive its operational response. The goal is to support widespread recovery and processing of decedents throughout the five boroughs. This strategy allows the OCME the flexibility to manage its daily caseload, in addition to disaster-related deaths by allocating a specific percentage of staff and resources to focus solely on the daily caseload and another to manage the disaster caseload. The OCME will reallocate the percentage of staff and resources to both caseloads as needs change. To manage the additional thousands of deaths, the OCME developed a general decision-making strategy based on hazard trigger points identified in the Hazard Overview Section. Each hazard trigger point is associated with an asset mobilization level and specific response activities, to enhance the OCME’s overall response. The various mobilization levels, depicted on the following pages, will guide the OCME response, so that it can modularly increase its capabilities in anticipation of PI-related deaths. The key response activities will reveal how usual processing methods will change to accommodate the increased caseload. These key activities include: recovering decedents from Health Care Facilities (HCF) and residences, medicolegal death investigations, decedent storage, morgue operations, and the death certificate registration and burial/cremation permit application process. Page 35 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 36 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Trigger Point Mobilization Level Under 60 deaths/day No surveillance indicators Tier I 60 – 200 deaths/day Surveillance indicators may be present Tier II 200 – 500 cumulative deaths Key Response Area Recovery Investigations Surveillance Normal OCME Medical Examiner Transport Team (METT) recovery Normal MLI operations Normal OCME biosurveillance for unusual patterns or findings Storage Examinations Death Certificate Regulations Normal OCME facility storage Normal external and autopsy practice Normal death certificate/burial permit process Recovery Investigations Enhance METT operations by modifying METT schedule Normal MLI operations Surveillance Examinations Death Certificate Regulations Heighten OCME biosurveillance Maximize Borough Office of Chief Medical Examiner (B-OCME) storage facilities with unit shelving and space enhancing techniques Normal external and autopsy practice Normal death certification/burial permit process Recovery Establish Investigation/Recovery Groups Investigations MLI investigates cases by phone with input from the NYPD on scene if possible; For cases requiring an on-scene investigation, the MLI will respond Storage Enhance storage by placing BCPs at specific HCFs Examinations Establish an Off-site Morgue (OSM) and Remains Storage Facility (RSF) at each OCME facility to process biological incident cases; Process daily caseload and suspected biological incident cases requiring examination/autopsy at OCME Death Certificate Regulations Establish Distributed Death Registration Process (DDRP) for registering death certificates and obtaining burial/cremation permits at B-OCMEs and OSMs Storage Tier III Surveillance indicators present Activities *Please note: Does not apply to incidents with high postmortem cross-contamination risks. The specific characteristics of the incident will determine the ranges for trigger points and the associated mobilization and response. Page 37 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Trigger Point Mobilization Level 500 – 2,000 cumulative deaths Tier IV Surveillance indicators present Key Response Area Recovery Request for outside agency support to assist Investigation/Recovery Groups Investigations MLI investigates cases by phone with input from the NYPD on scene if possible; For cases requiring an on-scene investigation, the MLI will respond Storage Examinations Death Certificate Regulations 2,000 – 5,000 cumulative deaths Tier V Tier VI Surveillance indicators present Enhance storage by placing BCPs at additional HCFs as needed Establish second OSM with associated RSF at each B-OCME; Continue to process daily caseload and suspected biological incident cases requiring external exam/autopsy at B-OCME Establish DDRP at all new OSMs Recovery Continue to request for outside agency support to assist Investigation/Recovery Groups; OCME staff continues as Group Supervisors Investigations MLI investigates cases by phone with input from the NYPD on scene if possible; For cases requiring an on-scene investigation, the MLI will respond Storage Enhance storage by placing BCPs at additional HCFs Note: families may try to bring decedents directly to BCPs, B-OCMEs, or OSMs Examinations Establish third OSM with associated RSF at each B-OCME, based on OCME staffing capability; Continue to process daily caseload and suspected biological incident cases requiring external exam/autopsy at B-OCMEs Death Certificate Regulations Establish DDRP at all new OSMs Recovery Maintain recovery operations Investigations MLI investigates cases by phone with input from the NYPD on scene if possible; For cases requiring an on-scene investigation, the MLI will respond Surveillance indicators present >5,000 cumulative deaths Activities Storage Examinations Death Certificate Regulations Maintain BCPs Establish Disaster Portable Morgue Unit (DPMU) to handle biological incident cases that require extensive external exam/autopsy to take burden off B-OCMEs; Maintain OSMs with RSF and B-OCME operations Continue and maintain DDRP at the DPMU Page 38 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Key Planning Considerations and Assumptions Affects Nationwide It is unlikely that professionals from surrounding regions will be able to provide help outside their locale. Local and state authorities throughout the region or the nation will have insufficient personnel, supplies, equipment and storage to handle the local demand. Thus, the OCME will need to acquire personnel and other resources from within the immediate and nearby jurisdictions. Infection Rate The infection rate will depend on the specific pathogen. Infection rates for communicable infections will be higher in densepopulation areas, including office buildings and schools. For noncommunicable infections, infection rates will be dependent upon the population at the source. Case Fatality Rate (CFR) The case fatality rate is dependent upon the pathogen and the treatments available and/or administered treatments, but has the potential to double or triple OCME’s annual caseload of 27,500. For example, a pandemic influenza with an attack rate of 30% and a CFR of 2% will cause an estimated 50,000 deaths over 8 weeks. Biological Incident Characteristics There are three main types of epidemics: point source, continuous common source, and propagation (person-to-person) spread16. The type of epidemic will determine whether or not the OCME should expect one or more waves of fatalities. Points of Dispensing (POD) If an effective vaccine or antibiotic is readily available, NYC DOHMH will likely set up PODs to distribute doses. However, many pathogens associated with biological incidents lack effective and timely treatments. For instance, seasonal flu vaccines would be ineffective against a novel strain associated with a pandemic. Limited Staff OCME personnel will be limited, as they too may become infected or need to care for their family members. Federal assistance will likely only provide limited supplemental staffing, as Disaster Mortuary Operational Response Team (DMORT) personnel are temporary federalized employees – many of whom operate funeral and mortuary businesses. These team members may need to maintain their primary businesses to support their own community’s increase in biological incident deaths, depending on the type of incident. Limited Resources Certain types of resources will be more difficult to obtain. The OCME and other death care providers may experience a delay or shortage in obtaining supplies, such as caskets and PPE. Potential for Protracted Response Even when working to capacity, the OCME and final disposition entities may experience a protracted response due to the magnitude of increased biological incident deaths. 16 Quick-Learn Lesson: Using an Epi Curve to Determine Mode of Spread. Centers for Disease Control and Prevention. Page 39 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Key Planning Considerations and Assumptions Restraints Placed on Public Gathering City officials may place restraints or prohibitions on community gatherings if the pathogen is contagious. This will impact funerals and religious services as well as OCME’s antemortem function, which is typically conducted at the Family Assistance Center (FAC). Difficulty Obtaining Signed Death Certificates Physicians will be inundated with caring for biological incident patients and will likely be unable or slow to pursue notifications regarding patients who die outside an HCF. Without signed death certificates, funeral directors are not able to process decedents for final disposition. Managing the Overflow of Decedents Funeral directors may not be able to both recover bodies from residential locations and healthcare sites and continue to conduct other aspects of their service at the same rate as authorities are ready to release remains to their custody. Coordinating City-Burial Operations for Final Disposition Hart Island, the City cemetery managed by the Department of Correction (DOC), has limited burial space for the city’s unidentified and unclaimed decedents. The island may not be able to accommodate a large influx of decedents requiring burial. It is currently estimated that the remaining capacity is between 30,000 and 50,000 decedents. OCME Capacity OCME processes approximately 27,500 cases annually; it may take more than a year to process, store, track, and manage the additional fatalities resulting from a biological incident outbreak at current agency size and infrastructure. Quality Assurance/Quality Control (QA/QC) During disasters, fraudulent cases of death may occur (i.e. homicide by poisoning being passed off as a biological incident death); thus the OCME must perform a QA/QC check of all OCME cases before decedents are released for final disposition. Just-in-Time Inventory System This inventory method, which only stocks enough supplies for a short period, will not sufficiently provide the needed resources during a biological incident when multiple jurisdictions make the same requests of manufacturers. One specific concern is a shortage of human remains pouches (HRP). Unattended Deaths Management of unattended deaths becomes more challenging during a biological incident, as they require the OCME to locate NOK, which is complicated when NOK may be ill, hospitalized, or deceased. This challenge then creates the demand for establishing a means of storing bodies for a longer period of time. Family Influence Families will complain to politicians should the OCME not release their loved ones within a traditional time frame. NOK will likely leverage their need to manage the decedent’s estate, which in turn results in City officials applying pressure on the OCME to process bodies more quickly. Page 40 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Integrated Decision-Making Strategy When NYC establishes a unified command system, the OCME will integrate its decisionmaking process with those established by DOHMH and NYCEM. The OCME recognizes that specific actions taken by NYC agencies are necessary to mitigate the effects of a biological incident. These actions include: City pre-incident actions, notifications, and emergency and disaster declarations to mitigate the effects of a biological incident. The Citywide Biological Incident Plan is currently under development in order to ensure crucial gaps in infrastructure, resources, laws or statutes are identified and addressed; strategies are developed to inform key government officials, legislators, health care providers, the public, and various stakeholders to address and resolve identified gaps; and that planning activities are coordinated with bordering jurisdictions. Conducting a variety of trainings and exercises related to the plan ensures personnel are adequately familiar with their responsibilities prior to an actual incident. NYC Initial Biological Incident Actions As the potential for the DOHMH, with support from NYCEM, will meet with appropriate NYC agencies; modify the plan based on information about the specific pathogen; institute enhanced surveillance; communicate to health care providers the need to remain alert for potential travel-related cases of the pathogen; prepare plans for prophylaxis distribution as available and as indicated; and notify government officials regarding specific information related to the outbreak. NYCEM will ensure that all appropriate agencies are in attendance and have access to any plan modifications as well as additional information related to the outbreak. Particularly during later phases of the incident, DOHMH may implement all or part or its response plan, based on the magnitude of the potential biological incident threat. Coordinating its activities with NYCEM, the DOHMH will interface with appropriate counterparts at the local, state and federal levels. Specifically, DOHMH will activate and conduct surveillance and epidemiological activities. DOHMH may request that the OCME perform autopsies on suspected fatal cases, unexplained fatalities with symptoms similar to the pathogen, or deaths occurring among travelers returning from affected areas overseas. As part of this request, the OCME may need to gather sufficient decedent blood and tissue samples for viral and immunohistochemical staining and testing. DOHMH Syndromic Surveillance Response During the initial phases of the biological incident, the DOHMH will rely on traditional and syndromic surveillance techniques to identify the first biological incident cases. Where traditional surveillance focuses on diagnostic data, syndromic surveillance looks for trends in presenting symptoms before potential cases are diagnostically confirmed through laboratory testing. Syndromic surveillance includes identifying an increase in emergency room visits, monitoring Emergency Medical Services (EMS) run reports for pathogen-specific symptoms, and monitoring hospital admissions for specific pathogenrelated signs and symptoms. Syndromic surveillance may also include compiling Page 41 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths morbidity reports and laboratory reports, and monitoring death certificates, via the Office of Vital Records, for incident-related mortality. OCME Surveillance Response During the initial phases of the biological incident, OCME will help identify sentinel cases through autopsy of suspected or DOHMH-identified cases. Such cases will include decedents who die from symptoms that are similar to those of the pathogen associated with the incident or have an epidemiological link to a confirmed case. These initial sentinel cases will require laboratory testing for confirmation and subtyping, if applicable. Once the biological incident is established in NYC, the DOHMH may request that the OCME investigate unusual incident-related deaths, such as suspected cases of vaccine failure. Notifications DOHMH Notification The Center for Disease Control and Prevention and the World Health Organization continuously monitor worldwide for various disease outbreaks, epidemics, and pandemics. When an outbreak occurs that has the potential to reach NYC or the surrounding areas DOHMH will enhance its surveillance practice to detect the arrival of the pathogen in NYC. DOHMH will notify all appropriate NYC agencies and the healthcare community as soon as the first case of the particular infection is confirmed. OCME Notifications Based on the information provided by DOHMH, the OCME will notify appropriate personnel, including key staff assigned to command and agency operations center, and determine the appropriate mobilization level. Executive Level Considerations The following table is intended to guide senior leaders in their agency’s response, should a biological incident result in numerous in- and out-of-hospital deaths and require their agency’s support to manage decedents. Action Responsible Party Notify OCME of possible biological incident having potential to result in numerous fatalities DOHMH NYCEM NYPD FDNY-EMS Dispatch staff to Unified Command Post, DOHMH Operations Center, and NYCEM Emergency Operations Center (EOC) OCME Various City agencies Characterize the incident based on Trigger Point Mobilization Level OCME Page 42 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Action Responsible Party Establish OCME Agency Command and surge Agency Operations Center and assign personnel to relevant OCME positions Activate/mobilize OCME Command Posts OCME NYPD Develop Mass Fatality Management (MFM) Operational DOHMH Plan and Annex to the Incident Action Plan (IAP) OCME Determine locations for establishing Body Collection Points (BCP) at various health care facilities (HCF) OCME HCFs NYCEM Health & Medical ESF Approve location for BCP(s) Fatality Management Branch Director Expand OCME operations as necessary to include establishment of Off-Site Morgues (OSM) and Remains OCME Storage Facilities (RSF) Determine most appropriate means of recovering bodies from residential locations OCME Determine most appropriate means of coordinating residential recovery of decedents with NYPD when citizens call 911 NYPD 911 OCME Submit resource request to NYCEM for logistics support OCME NYCEM Determine most appropriate means to temporarily store OCME remains OCME Determine most appropriate means to temporarily inter DOC remains Private Sector Entities Disseminate health and safety plans (HASP) for personnel handling human remains OCME DOHMH NYS - Occupational Safety and Health Establish Distributive Death Registration System (DDRS) at appropriate OCME locations OCME DOHMH - Vital Statistics Determine most appropriate means of establishing a virtual or physical Victim Information Center (VIC) OCME within the Family Assistance Center (FAC) location and service NYCEM OCME Coordinate establishment of a VIC with NYPD and 311 NYPD Missing Persons DoITT 911 Page 43 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Action Responsible Party Establish processes, policies, and procedures regarding decedent identification for both antemortem and postmortem data collection OCME Coordinate with funeral directors and religious entities regarding new standards or recommendations for decedent management OCME Provide staff access to anti-viral medications in coordination with DOHMH OCME DOHMH NYCEM Emergency and Disaster Declarations DOHMH Public Health Emergency Declaration The DOHMH Commissioner of Health may declare a public health emergency during a biological incident. Typical declarations made by the Commissioner of Health do not require deviation from existing laws and do not require detention of individuals pursuant to NYC Health Code Section 11.5. In instances when the Commissioner believes it may be necessary to extend jurisdiction to secure the public’s health, the Commissioner will coordinate closely with the NYC Office of Corporation Counsel and Office of the Mayor. Mayoral Disaster Declaration During a biological incident, it is likely the Mayor will make a Mayoral Disaster Declaration. Such declarations allow city agencies faster access to resources and funding. With input from the Primary City Agencies – FDNY, NYPD, and DOHMH, a Mayoral Disaster Declaration may include quarantining buildings or jurisdictions or isolating or detaining individuals in their homes in attempts to curb the spread of the disease. Mayoral Disaster Declarations, in addition to public health emergency declarations, provide greater emphasis of the magnitude of the event and serve to publicly validate the Commissioner of Health’s suspension of specific provisions of the health code or local laws necessary for mitigating the effects of the outbreak. Gubernatorial Disaster Declaration Gubernatorial Disaster Declarations are required when state law provisions need to be suspended or activated during a biological incident. One example is the need to suspend/alter state credentialing and/or licensing requirements to authorize use of outof-state personnel. Gubernatorial Disaster Declarations allow local agencies quicker access to state resources and funding. Presidential Disaster Declarations Presidential Disaster Declarations allow local and state government agencies access to federal money and other federal resources. Page 44 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths II. External Agency Operations This segment of the document identifies a list of potential tasks and decisions that New York City agencies may need to execute in support of fatality management operations during a biological incident. Page 45 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 46 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths NYC Agencies City of New York Office of Chief Medical Examiner OCME will direct and oversee the processes associated with management of human remains during a biological incident. Accordingly, OCME has developed several strategies to relieve HCFs and the funeral industry of the burden associated with managing numerous decedents. OCME will arrange for the recovery, transport, storage, tracking and processing of decedents, in order to ascertain decedent identification, as well as cause and manner of death. The primary responsibilities of OCME during the biological incident will include the following: • • • • • • • • • • Assist HCFs with storage of bodies when their morgue capacity is exceeded by establishing BCPs at their location Hold decedents until funeral directors, cemeteries, and crematoria are able to execute final disposition of the remains Arrange city burial/final disposition of unclaimed and unidentified bodies released to the OCME Coordinate temporary interment, if necessary Identify decedents using accepted scientific modalities Meet with family members of deceased to review and discuss identification, as needed Process and manage the daily OCME caseload utilizing UVIS-CMS (see insert below) Perform quality assurance/quality control (QA/QC) case review to identify case reports requiring additional data and/or detect fraudulent cases Conduct medicolegal investigations to determine cause and manner of death for all suspected biological incident cases by phone/scene investigation, external exam, and autopsy Assist DOHMH by performing relevant examination and/or autopsy of sentinel biological incident cases, provide OCME statistics, and obtain blood samples and other tissue samples for laboratory analysis to determine virus strain, type, and subtype New York City Department of Health and Mental Hygiene During biological outbreaks, the New York City Department of Health and Mental Hygiene (NYC DOHMH) is considered a “Primary Agency” under the Citywide Incident Management System (CIMS), responsible for managing the disaster event. During a biological incident, the DOHMH will activate its Incident Command System in order to coordinate and sustain its agency’s response to the event; facilitate communications and information dissemination to other key agencies, meaning the health care community and the public; and provide technical information needed for City agency decision making. The DOHMH response will be integrated with other City agencies through a Unified Command (UC), as mandated by CIMS for a public health emergency. The DOHMH will provide subject matter expertise to manage the biological outbreak in support of the other City Primary Agencies, NYPD, and FDNY. Page 47 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The DOHMH will monitor potential biological incidents, focusing on the following key areas: • Surveillance and Epidemiology – DOHMH will conduct surveillance to monitor for the introduction and impact of potential or confirmed biological outbreaks in the City. This will help guide clinical and public health decisions, including how best to use limited medical resources such as antiviral drugs and ventilators. – DOHMH will monitor trends in abnormal hospitalizations and death , and will conduct investigations to describe the epidemiologic and clinical features of the outbreak (i.e. age-related morbidity and mortality trends, transmission factors, predictors of survival, antiviral resistance and vaccine failures, and unexpected complications). • Laboratory Testing – The Public Health Laboratory is licensed to perform rapid antigen testing. Public Health Laboratory will provide reference laboratory services to confirm the initial cases of a biological incident in NYC, and will facilitate collaboration between the NYS DOH and the CDC, to monitor changes in strain characteristics. • Community Control Measures – Based on the epidemiologic, clinical, and behavioral characteristics of the pandemic strain, the DOHMH will recommend containment measures to limit the spread, morbidity, and mortality of the outbreak, while minimizing social disruption and cost. School closures, cancellation of large public gatherings and hygiene advisories (e.g., hand washing, wearing of masks) are examples of measures that might be taken. • Health Care Planning and Emergency Response – DOHMH will work with the Greater New York Hospital Association (GNYHA), the NYC Health + Hospitals (H+H) and other key partners to monitor and address staffing, supply and equipment resource needs of HCFs during a biological incident. In addition, DOHMH will provide guidance to HCFs for managing patient surge and implementing screening and isolation protocols, to ensure efficient use limited resources. In close coordination with New York State Department of Health (NYS DOH), when indicated, the DOHMH will also provide guidance on altering standards of care to help maximize the ability of the health care system to provide care to those most likely to benefit. Finally, DOHMH will assist in implementing screening and isolation protocols. • Treatments and Prophylaxis – NYC will request antibiotic, antiviral drugs and other treatments from both the Strategic National Stockpile and NYS DOH, for distribution to HCFs treating biological incident patients. If supplies are limited, drugs will be used only for treatment, not for prophylaxis, and will be distributed based on prioritization guidelines adapted from the federal government. • Vaccination Page 48 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – The DOHMH will distribute vaccines (if available and appropriate) to HCFs through established distribution systems, private physicians’ offices and employee health programs for those agencies providing essential services (e.g., first responders). • Mental Health Needs Assessment and Service Coordination – A biological incident is anticipated to have far-reaching psychosocial consequences for a large proportion of the population. Interventions will be directly targeted to affected communities; to physicians and other front-line health care workers; and to populations such as children, the homeless and the homebound, and those who may be especially vulnerable to mental health consequences of a biological incident. • Communications – Given the many unique issues associated with a biological incident, communications activities will focus on educating the public and guiding the health care community. During the incident, communications will be accurate, consistent, and frequent, and will utilize the media, the City’s 311 Call Center, educational tools, and the DOHMH Web site. DOHMH will define and test communications, prepare communication tools in advance, train key staff in crisis and risk communication, and maintain relationships with critical community partners. Language needs for materials have been identified, and messages will be developed to meet the needs of special and vulnerable populations. • DOHMH Office of Vital Records – Within DOHMH’s Division of Epidemiology, the Bureau of Vital Statistics carries out the registration, processing and analysis of all vital events in NYC, including births, deaths and spontaneous and induced terminations of pregnancy. – During a biological incident, the Office of Vital Records will coordinate with OCME to ensure accurate and complete tracking of incident-related deaths. Specific responsibilities may include: – Providing certified copies, corrections, analysis, and dissemination of vital record data – Maintaining 24-hour, seven-days-a-week tracking of all deaths – Providing mortality statistics to determine populations at risk – Registering death certificates, which typically must be accomplished within 72 hours of the death unless that requirement is suspended by Mayoral Order – Issuing burial/cremation/transport permits – Establishing a DDR function at each OCME facility; and managing the Electronic Death Registration System (EDRS) to facilitate the registering of death certificates and the issuance of burial/cremation/transport permits at remote locations, in coordination with OCME and funeral directors New York City Emergency Management Page 49 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths New York City Emergency Management (NYCEM) acts as NYC’s coordinating agency during disaster events. NYCEM ensures that CIMS command structure is in place for all incidents; coordinates resources for response and recovery agencies; and relays situational information and emergency response activities via the EOC and to elected officials. Operations requiring interagency cooperation will be coordinated through the NYC Emergency Operations Center (EOC), if activated. All fatality management intraagency operations will be managed from the OCME’s operations center. NYCEM supports logistics and communication needs; locates subject matter experts, as needed; facilitates transition of command; and resolves interagency conflict. During disaster events, NYCEM coordinates with all appropriate local agencies to obtain needed resources for mitigating the event. For all declared disasters, NYCEM will also notify, inform, and coordinate its actions with the New York State Department of Homeland Security and Emergency Services (DHSES), to obtain resources not located within the city. Should the City require resources that are unavailable in NYC, the surrounding area, or NYS, NYCEM will work with DHSES to obtain federal assets. Specific responsibilities may include: • • • • • • • Coordinating local, state and federal disaster response by activating the City’s EOC Assisting political entities in determining if the incident warrants an Emergency Proclamation to open the possibility of additional resource allocations, cost sharing and both emergency and long-term disaster relief measures Provide situational assessments and awareness by collecting, processing and sharing information required by agencies in the EOC Establish coordination with agency and political entities by working with elected and appointed officials at all levels of government Convene a Joint Information Center by working with the Mayor’s Press Office and the Primary Public Information Officer (PIO) and staffed by all agencies affected by the biological incident Facilitate the execution of the Point of Dispensing (POD) Plan with DOHMH by coordinating logistical support Identify and allocate critical resources by determining which critical resources can be acquired from NYC or external agencies NYCEM Planning The NYCEM Planning Section is assigned primary responsibility for information management and incident documentation. Citywide planning will be conducted at the EOC or situation room, if activated. Geographic Information Systems The responsibilities of NYCEM’s GIS division include providing maps with the following: • Emergency routes • Health care facilities • HCF body collection points (BCPs) • Borough OCME locations • Off-site Morgue (OSM) locations Page 50 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • Remains Storage Facility (RSF) locations Temporary Interment locations NYCEM Logistics OCME may require NYCEM Logistics support to enhance their facilities and obtain additional supplies, equipment, and personnel, such as: • Operations, including command posts, morgues, and Victim Information Centers (VIC) • Remains recovery and transport • Temporary interment • Additional and/or specialized personnel NYCEM Finance/Administration During a biological incident, OCME is likely to require NYCEM to help establish contract support services. These might include maintenance and other services, such as: • Facility maintenance • Vehicles and vehicle maintenance • City-managed final disposition or temporary interment, should the Hart Island cemetery reach capacity • BCP containers, to include a crane and/or crane operators, flatbed trucks and/or roll-off vehicles • Cold storage unit maintenance contracts • IT support services • Body containment equipment including, but is not limited to, HRPs, lifting devices, and caskets/coffins Page 51 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths New York City Police Department The mission of the New York City Police Department (NYPD) is to enhance the quality of life in the City by working in partnership with the community and in accordance with constitutional rights to enforce the law, preserve the peace, reduce fear, and provide a safe environment. During emergency management incidents, NYPD retains several core competencies. Specific to decedents, NYPD’s core competencies include law enforcement; investigation and crime scene processing/evidence preservation; and site management, including site security and force protection. When the mayor declares an emergency under Article 2B of the Executive Law during a biological incident, NYPD is responsible for investigating all deaths reported to 911, in order to rule out criminal activity. The NYPD is also responsible for notifying the NOK and guarding decedents until they are transferred to either a licensed funeral director or the OCME. NYPD will continue to respond to all reports of possible death in the usual manner. This includes responding to all possible death reports made to 911, going to the incident sites and ensuring that remains of all confirmed decedents are released appropriately. Since NYPD cannot pronounce a patient’s death, they must wait until an appropriate provider, such as an Emergency Medical Technician (EMT), paramedic, nurse, or physician arrive on-scene to make this pronouncement. When a decedent is pronounced by an appropriate entity, NYPD must secure the scene until OCME arrives. Specific responsibilities may include: • • • • • • • • • Become a Primary Agency, along with DOHMH (OCME) and FDNY under CIMS, for managing the outbreak Investigate reports of deaths that citizens call in to the 911 Center, by responding and requesting EMS and/or OCME support as appropriate NYPD will secure the body until OCME personnel conduct the investigation and take custody of the body Staff the FAC, which may be a virtual FAC during a biological incident, to assist with NOK notification of death and missing persons’ interviews, for the purpose of gathering relevant information to support investigations Disseminate information from One Police Plaza to the precincts citywide, so that officers and detectives are familiar with any changes regarding NYPD’s approach to managing citizen reports of death Secure decedent’s estate, as is customary, and contact the County Public Administrator to safeguard possessions until arrangements can be made with the NOK Provide morgue security at specific City locations, as requested by OCME Provide technical resources, such as fingerprinting decedents, to OCME Respond to the OCME, HCFs, and FDNY locations when NOK bring decedents directly to these locations Page 52 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths New York City Department of Information Technology and Telecommunications NYC’s Department of Information Technology and Telecommunications (DoITT) oversees the City’s use of existing and emerging information technologies, both in government operations and in the City’s delivery of services to the public. DoITT’s mission is to improve governmental efficiency through technology and to make communication with government straightforward and clear. During a biological incident, DoITT will: • Provide telephonic and computer connectivity • Link the NYC Intranet, CityNet, and UVIS-CMS system • Operate technical components of the 311 Call Center • Provide computer server support at OCME locations for the Office of Vital Statistics, to establish their DDR System • Offer technical and logistics support for UVIS-CMS operations at the Victim Information Center (VIC) at the Family Assistance Center (FAC) • Establish IT infrastructure to set up UVIS-CMS at all OCME operations, including field recovery sites City of New York 311 Call Center The 311 Call Center is the general call number for NYC visitors and residents to use to report and/or gather information about various aspects of the City. During disasters, it is the call number to report missing persons. As part of its missing persons service, 311 utilizes UVIS-CMS in order to facilitate missing persons investigations. Operators gather specific caller information and enter it into UVIS-CMS to develop a list of missing Page 53 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths persons. The system is able to compare and compile duplicate records, which typically occur when several family members and/or friends report the same missing person. It is also able to prioritize its lists by those most likely to be missing, based on specific parameters related to the disaster event. The NYPD will follow up on all reports of missing persons. During a biological incident, the 311 Call Center will: • • Initiate all missing person reports using the UVIS-CMS system Transfer all calls reporting a death to the NYPD 911 Center New York City Health Care Facilities During a biological incident, NYC’s health care facilities (HCFs) will focus on caring for the living, but will also need to manage those who die under their care. To avoid competing for mortuary resources, the OCME will coordinate with City HCFs to manage decedents. Specifically, HCFs will: • • • • • • • • • • • • • Submit requests for decedent support through their representative at the City’s EOC ESF #8 Health and Medical Desk Request a body collection point (BCP) via the Health and Medical Desk or UVISCMS to store decedents, both biological incident and non-biological incident related Report cases requiring Medical Examiner investigation to OCME as usual (i.e. homicides, suicides, therapeutic complications and meningitis cases) Report biological incident deaths to the OCME until BCPs are established at HCFs or to their representative at the City EOC at designated times Ensure the necessary infrastructure is in place to support a BCP Maintain resources to support a BCP via the OCME representative at the City’s EOC ESF #8 Health and Medical Desk Direct physicians to sign death certificates and file death certificates as normal, until BCPs are established at their HCF At that point, HCF personnel will direct physicians to sign death certificates as usual, but not to file death certificates unless they have access to the DOHMH EDRS. The OCME will do this in coordination with the Office of Vital Records, located at each BOCME and OSM location Direct physicians to identify the pathogen responsible for the incident as primary or secondary cause of death on death certificates, if appropriate, to facilitate tracking of incident-related deaths by DOHMH Maintain and return decedent personal effects (PE) and property, as usual, until reclaimed/returned to the NOK Document and track biological incident and non-biological incident decedents until they are transferred to the OCME Secure bodies until OCME collects them using HCF security personnel or an appropriately assigned substitute Relinquish possession of the body to the OCME or funeral director for all biological incident and non-biological incident cases as appropriate Page 54 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Management of In-Hospital Fatality Surge Using Body Collection Points What Healthcare Facilities Need to Know Predicted Issues for Health Care Facilities (HCF) during a Biological Incident Assumptions • • • HCFs will be overwhelmed by providing medical care for biological incident casualties and managing in-hospital deaths, in addition to their usual caseload. HCFs do not have significant decedent storage space and will require additional space and support. During a biological incident, HCFs will look to the OCME to assist with their storage needs, as they do routinely. Numbers of HCFs Likely to Need Support • • • Hospitals (57), which includes Veteran Administration, Pediatric, and Acute Care Facility Hospitals Prison Health Care facilities (11) Assisted living/nursing homes (approximately 275) Types of BCPs • • • • BCPs are refrigerated trailers or other cold storage units that can hold approximately 9-44 bodies, depending on shelving. BCPs typically have metal floors; the OCME will avoid obtaining refrigerated storage with porous wooden floors for sanitary and health reasons. Two most common types are refrigerated trailers and refrigerated CONEX units - Trailer BCPs are the preferred option due to the ease of transport Shelving: It is unlikely that trailers or CONEX units will initially have shelving. Shelving units should not typically exceed waist level, as bodies become too difficult to manage at greater heights. HCFs Eligible to Receive a BCP • • • • BCPs can be placed at hospitals, assisted living residences/nursing home living facilities, prisons and other areas where the rate of death is predicted to be higher than can otherwise be managed. BCPs will be placed only at HCFs having the appropriate personnel and infrastructure to support managing a BCP. HCFs must work with their NYCEM representative at the EOC ESF Health Medical Desk to obtain a BCP, and must notify the Desk when a small number of remains must be removed, when they need to exchange a full BCP, or when they need to request service for a BCP. The UVIS-CMS Application will allow HCFs to communicate their needs to obtain, exchange, refuel or obtain maintenance support of a BCP to the ESF 8 Health and Medical Desk at the NYC EOC. Page 55 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Infrastructure Requirements • Determine Location of BCP on hospital grounds: HCFs must determine where they will place a BCP. There must be sufficient room to locate two BCPs, in order to accommodate exchange/replacement of the units. • Provision of basic utility infrastructure: - For Trailer BCP Type: ▪ Should not exceed 53-ft.-long by 8.5-ft-wide ▪ Delivery of this unit requires a tractor (semi-truck) ▪ Must specify refrigeration unit ▪ Must be placed at a loading dock if the trailer is not equipped with a lift gate ▪ Operating Range: 37 degrees Fahrenheit ▪ Fuel: 50-gallon diesel tank; refuel as needed ▪ Electric requirements: 230 volts, 3-phase, 50 amps circuit, CS plug style ▪ Maintenance: as needed - For the CONEX BCP: ▪ Delivery of these units requires a heavy duty forklift or crane and a flat-bed or rolloff trailer ▪ Must request clip-on generator and refrigeration unit ▪ Operating Range: 37 degrees Fahrenheit ▪ Fuel: diesel tank; refuel as needed ▪ Electric requirements: 380/460 volts, 3-phase, 50/60 Hz, 50 amp power supply ▪ Maintenance: as needed • Maintenance and Fueling: OCME will ensure equipment maintenance and fueling are included in the contract(s) established to support HCF BCP Operations. HCFs should be prepared to provide basic support to keep their units running initially. - OCME highly recommends that HCFs stock enough fuel for one to two fill-ups for a 50gallon tank. - HCFs are responsible for basic cleaning of the BCP while it is in their custody. • Decedent Tracking: HCFs must develop and provide OCME personnel with a copy of the manifest for each BCP. The manifest must identify decedents by name and a hospital identifier. HCFs may opt to print out a manifest report identifying decedents relinquished to the OCME using the UVIS-CMS application, or may utilize an internal or paper system. - OCME recommends using tags and an electronic means that tracks bodies by unique identifiers. Associated PE should be linked to the decedent via the unique identifier. - OCME personnel will confirm the BCP manifest prior to issuing approval for the contractor to transfer the BCP to OCME. • Management of PE: HCFs will continue to manage decedent PE (including returning PE to NOK). In criminal incidents, NYPD may have additional requests for evidentiary material. - HCFs must track PE using unique identifiers that can be linked to the decedent’s unique identifier. • Physician Issued Death Certificates: HCFs will maintain the responsibility of physicians issuing and certifying death certificates only during incidents resulting in natural deaths. Page 56 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Personnel Requirements • HCF Morgue Manager: This person will initially track/tag the body; develop and manage a roster/manifest of those placed in each of the BCPs; notify their NYCEM representative at EOC ESF Health Medical Desk regarding the number of bodies in the BCP requiring pick up, and if there is a need for total exchange of the unit. This person will also need to provide the OCME with as much information about the decedents as possible, regarding the decedent and NOK identification, and determination of cause and manner of death. This person should specifically highlight/identify which decedents are non-biological incident cases, as the OCME will process daily cases separate from disaster cases. • Body Handlers: HCFs must utilize their own personnel to place decedents in the BCP. • Security Staff: HCFs must provide their own security to guard BCPs, which are on HCF property. Although BCPs can be locked (with the hospital obtained locks), general surveillance of the unit and surrounding area is highly recommended. • Logistics / Maintenance Staff: HCFs should have staff on hand to take care of initial BCP maintenance issues until contract service providers arrive. Manage Storage for Non-Incident Cases • • • • • OCME and HCFs must continue to manage decedents not involved in the incident. As the mortuary for the City of New York, OCME must assist HCFs in decedent storage. OCME will take custody of all Medical Examiner (ME) cases (i.e. homicides, suicides, etc) from the HCF, per standard protocol. Pickups of ME cases may be coordinated with pickup of BCPs. Claim cases from the HCF should be released directly to a funeral director when requested. - Claim Only cases must be reported to OCME per standard protocol. OCME and HCF leadership may decide to suspend the 7 day hold for non-incident claim cases. OCME will determine based on the specifics of an incident whether non-incident cases may be stored in the HCF BCP Maximizing BCP Space • • • • Bodies must never be stacked. Bodies are to be lined up, parallel with the long side of the BCP and placed along each side of the BCP, leaving a center aisle space for staff to walk in and out of the unit. The first body is to be placed on the floor parallel to the long wall of the unit, at the farthest end of the BCP; the head of the next body is placed on the abdomen of the first body with the legs placed alongside the first body. This fishbone positioning will accommodate approximately 9-22 bodies on each side of the BCP (see diagram below). Initial BCPs will not have shelving. If shelving is needed, OCME will work with NYCEM to obtain a contract to outfit BCPs with appropriate shelving. Page 57 of 688 FOR OFFICIAL USE ONLY Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Other Issues • Direct Drop-off of Decedents at HCFs: HCFs should be prepared for family members to drop off decedents at their location. This may occur for a multitude of reasons including, but not limited to: NOK is unaware of the City’s decedent plan; the system is overwhelmed; NOK did not want to wait for NYPD and OCME to recover the body; and/or the OCME’s capability has reached maximum capacity and is not able to recover bodies within an appropriate period of time. In this situation, HCFs should: - Treat decedents as patients and pronounce death as appropriate. - Obtain information about the decedent. - Obtain information about the person dropping off the decedent. - Notify NYPD of decedent dropped off at HCF, so as to initiate a scene investigation. - Notify hospital PIO of this occurrence so that he/she can coordinate with the NYCEM ESF Health and Medical Coordinator, who will provide the information to the JIC and issue statements regarding appropriate decedent management. • Religious Considerations: HCFs should be aware of the funerary practices of major religions and be prepared to communicate with families in the event of conflict HCFs Should Know What OCME Will Provide • Coordination: OCME will coordinate through the EOC to obtain BCPs, delivery vehicles, and drivers. OCME and NYCEM will work with the HCFs and the vendor to coordinate the delivery, transport, and replacement of BCPs as necessary. • Maintenance: OCME will coordinate through the EOC to obtain service contracts for maintenance and refueling of BCPs, as required with external vendors. Initially, OCME will work with DCAS to establish emergency fuel deliveries to BCPs and establish contract requirements. • Shelving: OCME will coordinate through the EOC for contract services to provide shelving for BCPs if required. Initial BCPs will not have shelving, but if OCME determines the need, then they will work with a vendor to obtain this resource and retrofit BCPs accordingly. • Disaster Human Remains Pouches: OCME will provide HRPs for adult and pediatric decedents. (*Note: HRPs may not be provided immediately.) • UVIS-CMS IT Support: OCME will assist HCFs with anytechnical issues related to the HCF BCP Reporting Module. • Public Information: OCME’s Agency PIO will work with NYCEM’s PIO to develop public messages concerning the management of decedents. One aspect of the message will address what NOK should do when their family member dies. Specifically, it will stress that decedents should not be brought to HCFs, OCME or other government locations directly. Page 58 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths City of New York Department of Correction The Department of Correction (DOC) houses approximately 11,000 inmates in its 18 facilities, which is more than most state correctional systems. Additionally, DOC maintains secure facilities at two City hospitals: Elmhurst Hospital Prison Ward, in Queens, for female inmates requiring acute psychiatric care or medical treatment; and Bellevue Hospital Prison Ward, in Manhattan, for male inmates requiring psychiatric or medical treatment. The DOC also manages the City cemetery on Hart Island, located off City Island in the Bronx. City-sentenced inmates are transported to this 101-acre area from Riker’s Island to clear fields or bury remains sent to the City cemetery. There are an estimated 30,000 – 50,000 burial plots remaining on Hart Island. During a biological incident, DOC: • • • Identify and provide appropriate personnel to the OCME to enhance METT and recovery operations Establish BCPs at the Riker’s Island HCF to manage inmate deaths, if warranted, and coordinate their requests for pick up and removal of BCPs with the OCME via the EOC ESF #8 Health Medical Desk Coordinate city directed burials at Hart Island as necessary New York City 911 Call Center In the US, 911 is the universal number to report emergencies. NYC has an enhanced 911 system that can identify the phone number and location of the caller in most instances. Operators screen all calls to determine the type of support by NYPD, FDNY, and/or EMS required, and subsequently transfer the call to the specific operator and maintain connectivity until appropriate units are dispatched. Reports of death are directed to the NYPD 911 Center. During a biological incident, the 911 Call Center: • • • Transfers all reports of deaths to NYPD Dispatches NYPD resources as appropriate Relays information from the officer on-scene to the NYPD liaison at the appropriate Incident Command Post regarding confirmed deaths to initiate OCME investigation and response to the incident location o If possible, officers should note whether the decedent is suspected to have died of the pathogen in question, as the OCME may establish separate teams to manage suspected biological incident deaths, and other deaths Regional Emergency Medical Services Council of New York City Regional Emergency Medical Services Council of New York City (REMSCO) represents all 62 EMS agencies within NYC, which includes FDNY EMS and 34 volunteer, 14 hospital-based, and 14 private agencies. The REMSCO oversees regional operational Page 59 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths issues, including the current regional mutual aid mobilization plan. Within REMSCO is the subcommittee, Regional Emergency Medical Advisory Committee, responsible for developing EMS pre-hospital care, treatment and transportation protocols. These protocols are based on meeting the minimum requirements put forth by the NYS DOH and regional needs. The Regional Emergency Medical Advisory Committee also has the authority to conduct quality assurance reviews of regional EMS programs/agencies and defines the minimum standards of care and staffing standards for the City. Current protocol mandates that EMS providers may pronounce death only under certain circumstances. Routinely, EMS providers perform this task only when patients present with indisputable signs of death, such as decapitation, extensive decomposition, and/or the presence of lividity. In other apparent situations, EMS providers, with the permission of an on-line Medical Control Physician, may pronounce death. After pronouncements of death in the field, EMS personnel generally remain on scene until NYPD or OCME arrives. During a biological incident, this may be difficult to do, as numerous medical patients will require EMS support and it may take the OCME several hours to arrive, based on increased workload and responsibilities. During a biological incident, REMSCO will: • • • Distribute guidance to EMS providers regarding appropriate infectious control measures, as determined by the NYS DOH or DOHMH Distribute guidance to EMS providers regarding appropriate management of decedents with potential biological contamination in keeping with established protocols and City ordinance Enhance EMS’s role by authorizing practices such as leaving the run report for NYPD and OCME personnel, and writing a thorough history of present illness on the run report New York City Fire Department FDNY provides fire safety and protection for the City. EMS is a division of FDNY, providing both Basic Life Support and Advanced Life Support. Not only does FDNY handle over one million EMS calls for the City17, but it also manages the Emergency Medical Dispatch Center for all 911 calls requiring EMS assistance. During disaster incidents, FDNY retains the core competency for Pre-Hospital Emergency Medical Care, among many other core competencies. It is through this core competency that FDNY is most likely to coordinate City activities regarding decedents with the OCME. During a biological incident, FDNY EMS personnel will likely respond to numerous requests for medical support. While FDNY does not specifically have an active role in supporting the OCME’s management of biological incident-related fatalities, it is possible the NOK may bring their deceased loved ones to City firehouses, or make 911 calls depicting “a very ill patient” only for EMS personnel to find the patient dead. 17 FDNY Vital Statistics, Fiscal Year 2014 Page 60 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths During a biological incident, FDNY will: • • • • Become a Primary Agency under CIMS, along with NYPD and DOHMH for managing the biological outbreak Consider implementing REMSCO’s recommendations and/or promulgate its own policy regarding the management of patient’s found DOA Determine the Emergency Medical Dispatch Center policy and procedure to manage deaths during a biological incident for all 911 calls requiring EMS assistance Assist in decedent recovery operations in confined spaces, complex/ compromised infrastructure, and contaminated scenes, as necessary New York City Hospital-based, Volunteer, and Private Ambulances There are approximately 14 hospital-based ambulance agencies, 34 volunteer ambulances and 14 private ambulances operating within the City region. Hospital-based ambulances cover approximately 50% of the City’s 911 calls requiring EMS. Like their FDNY counterparts, they are dispatched via the FDNY 911 dispatch system and respond based on information received from FDNY. Like all ambulance agencies operating in the City, they operate under the Regional Emergency Medical Advisory Committee NYC Pre-hospital Treatment/Transport protocols. Volunteer ambulances typically do not provide comprehensive 24 hour/7-day-a-week service, but do provide coverage for their communities. Private ambulance agencies cover contracts with HCFs, performing all levels of inter-facility transport. Both the volunteer and private ambulance sectors participate in the 911 System only when requested by NYCEM or FDNY via the REMSCO Mutual Aid Mobilization System. During a biological incident, hospital-based and private ambulances will: • • Implement REMSCO’s recommendations regarding the management of biological incident deaths for calls outside the 911 system Implement FDNY Emergency Medical Dispatch Center’s policy and procedures when assisting 911 calls involving EMS assistance City of New York Department of Sanitation The Department of Sanitation (DSNY) provides waste removal, recycling and street sweeping services for the City. It has uniformed employees, which the OCME may utilize during an emergency, and has access to over 5,900 vehicles that may be able to support specific OCME tasks. During a biological incident, DSNY will: • • Support OCME by providing employees to enhance METT and recovery operations Support OCME by providing vehicles and/or operators to support logistics Page 61 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths City of New York Department of Citywide Administrative Services The Department of Citywide Administrative Services (DCAS) is made up of more than 2,100 employees, including architects, engineers, carpenters, electricians, plumbers, lawyers, mechanics, procurement specialists, information technology specialists, custodians and managers. DCAS’s various divisions and offices ensure other City agencies have the critical resources and support they need to provide the best possible services to the public. DCAS also has contracts with multiple vendors through which it establishes the cost of goods and services, even during emergencies. OCME may request support via the City’s EOC to obtain assistance from the following DCAS divisions: The Division of Facilities Management and Construction Manages, operates, and maintains over 50 City-owned buildings and provides design and construction services for capital projects in DCAS-managed buildings. This division may be able to support OCME operations by: • Providing construction within surge OCME facilities, including BCPs, RSFs, OSMs, and command posts The Division of Municipal Supply Services Purchases and inspects goods valued in excess of $100,000 for use by City agencies and other governmental entities; manages the City's Central Storehouse in Middle Village, Queens stocked with 2,200 different commodities; transfers, sells, and disposes of City agencies surplus materials and equipment; and manages the requisition, maintenance and disposal of the City's vehicle fleet. This division may be able to support OCME operations by: • • • Providing available supplies Making emergency procurements Providing maintenance contracts for surge OCME facilities, including command posts, BCPs, RSF, and OSMs The Division of Real Estate Services Leases or purchases privately owned properties for City agency use. This division may be able to support OCME operations by: • • Providing temporary use of City properties to establish DPMU and OSM sites Obtaining access to other types of geographical space, if necessary The Office of Transportation Services Supervises the DCAS fleet and provides special transportation services to City agencies. This division may be able to support OCME operations by: • Establishing OCME vehicle service maintenance contracts Page 62 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Obtaining vehicles for use as Residential Recovery Team vehicles County Public Administrators The County Public Administrators for New York (Manhattan), Kings (Brooklyn), Queens, Richmond (Staten Island), and Bronx Counties, among other tasks, are responsible for managing the estate of decedents when NOK cannot be identified or reached. During a biological incident, some residential deaths may only be identified when neighbors or building superintendents notify NYPD of a possible death, in lieu of, or in the absence of, family. Specifically, the County Public Administrator will: • • • Manage unclaimed decedent’s finances, residential property and belongings Liquidate decedent assets to pay for final disposition costs Coordinate with the OCME when decedent’s friends wish to manage and cover the costs of final disposition City of New York Laboratories Within NYC, many hospitals and dedicated laboratories have the capability to perform various tests in order to confirm and/or identify a biological event. For example, the Virology Laboratory with the Wadsworth Center oversees the Influenza Program within New York State. The Influenza Program participates with the World Health Organization’s Influenza Surveillance System in the effort to monitor seasonal flu trends, including monitoring for local activity of an identified pandemic strain18. Specifically, laboratories approved to perform pathogen testing: • • Perform rapid polymerase chain reaction or culture testing to support diagnosis of influenza strain Submit sentinel specimens to reference labs, such as the CDC and/or the NYS DOH laboratory, to determine differences, if any, between influenza strains which cause illness versus death State Supporting Agencies New York State Department of Health (NYS DOH) Among its other responsibilities, NYS DOH regulates all hospitals, nursing homes, EMS agencies, including those in NYC, and the Bureau of Funeral Directing. Specifically, the NYS DOH is responsible for facilitating City HCF requests for support when staffing the City EOC ESF #8 Health Medical Desk. The NYS DOH working with 18 Virology Laboratory, Wadsworth Center, NYS DOH. http://www.wadsworth.org/divisions/infdis/virology/influenza.htm Page 63 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths City DOHMH, GNYHA, and Health + Hospitals will facilitate HCF requests with City NYCEM and other agencies as appropriate, to include the OCME. During a biological incident, the NYS DOH will utilize its Health Emergency Response Data System (HERDS) as a means of tracking key resource availability. HERDS, managed through a Health Provider Network, provides a secure means for health care systems to exchange pertinent information – such as patient admissions, the number of similar cases, bed status, provider status, vaccine supply status, and key supply status (i.e. ventilators). HERDS provides a mechanism for hospitals to report resource needs to NYS DOH and other agencies during an event. Though health care providers must enter data manually, NYS DOH and health care systems are able to monitor key asset availability and City and state planners can review, prioritize and arrange for the transfer of resources to HCFs. Bureau of EMS The NYS Bureau of EMS is responsible for general oversight of the statewide EMS system. It provides coordination and contracts with relevant agencies to assist in the development of local EMS systems; approves all EMT certification courses, and assists in development of curricula; approves county EMS plans supported by state aid; conducts examinations and issues individual EMT certifications. The Bureau also issues agency certifications, conducts periodic inspections of ambulance services and investigates complaints regarding the conduct of certified providers or services. Bureau of Funeral Directing The Bureau of Funeral Directing is responsible for establishing funeral directors licensing requirements, education and continuing education requirements, and associated fees to maintain state certification as a funeral director. A funeral director is licensed to engage in the business and practice of funeral directing in New York State. Funeral directors arrange and direct the care and disposition of the body of a deceased person, by preserving, disinfecting, embalming and preparing the body for transportation, funeral services, burial or cremation and final disposition. Funeral directors are responsible for authenticating and verifying that bodies sent to cremation or burial are in fact the individual listed on the death certificate and corresponding cremation/burial permit. Moreover, if bodies are disinterred, funeral directors are responsible for overseeing this process. During a biological incident, NYS DOH will: • • • • Monitor and share information obtained via HERDS with DOHMH Represent HCFs at the City EOC ESF #8 Health and Medical Desk to coordinate actions between the OCME and HCFs regarding BCPs for pick up and/or replacement, among many other activities Provide the NYC REMSCO guidance regarding EMS providers’ responsibility to stay on-scene to secure decedents until NYPD, OCME, and/or a licensed funeral director arrives Distribute key information to licensed funeral directors regarding safe practices of managing decedents, via the Bureau of Funeral Directing Page 64 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Distribute key information to families requesting information about funeral practices during a biological incident, via the Bureau of Funeral Directing New York State Department of Homeland Security and Emergency Services (NYS DHSES) The mission of the New York State Department of Homeland Security and Emergency Services (NYS DHSES) is to protect the lives and property of the citizens of NYS from threats posed by natural or manmade events. NYS DHSES coordinates EMS with other federal and state agencies to support county and local governments. It also routinely assists local governments, volunteer organizations and private industry through a variety of emergency management programs. These programs involve hazard identification, loss prevention, emergency management planning, training, operational response to emergencies, technical support and disaster recovery assistance. Specific to fatality management, the OCME may request access to public and/or private cemeteries to purchase sizable cemetery space for temporary interment and associated service contracts to support burial, tracking, maintaining records and disinterment, if necessary. The OCME anticipates that many of these resources will not available within the City, although such availability is dependent on the size and magnitude of a biological incident. During a biological incident, NYS DHSES will: • • Facilitate providing assistance to the City, to include, but not limited to, cemetery space, through their representative in the EOC Facilitate obtaining Army National Guard support, as all such requests must be coordinated through DHSES regardless of the event being declared a Citywide or statewide disaster Division of Cemeteries, New York Department of State The Division of Cemeteries, under the supervision of the Cemetery Board, administers New York cemetery law dealing with cemetery corporations. It oversees rules and regulations concerning the sale of burial lots, charges for services, acquisition of lands, and other activities by cemeteries. Within the state, the Division of Cemeteries regulates approximately 1,800 cemeteries, oversees 4,000 religious cemeteries, and regulates 48 crematoria having 100 retort chambers. During a biological incident, the Division of Cemeteries will: • • Coordinate OCME contract requests from DHSES for cemetery space, by requesting that cemeteries provide or allocate space for numerous decedents Disseminate information provided by the OCME, DOHMH, and/or NYS DOH concerning potential health and safety issues related to burial or cremation New York State Army National Guard Page 65 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The New York State Army National Guard is a partner of the federal government’s Total (military) Force, having a federal mission to support and defend the Constitution of the US. It also has the state mission to provide trained and disciplined forces for domestic emergencies, or as otherwise required by state law. The New York Army National Guard maintains 57 armories and 24 additional support facilities. During a disaster, the Governor may activate the National Guard to support local communities, including NYC, should the Mayor request them. The National Guard may be asked to support the OCME, if they have appropriate staff and resources. During a biological incident, the Army National Guard will: • Provide OCME support by enhancing recovery teams Federal Supporting Agencies During a nationwide natural biological incident, OCME does not anticipate receiving significant federal assistance, as a biological incident is likely to affect the entire country and limited federal assets may be allocated to other areas where jurisdictional OCME capabilities do not exist. A bioterrorism incident would likely be localized, and due to the criminal nature, would draw significant federal resources. Department of Homeland Security (DHS) and Federal Emergency Management Agency (FEMA) The US Department of Homeland Security (DHS) and Federal Emergency Management Agency (FEMA) unify the vast national network of organizations and institutions involved in efforts to secure our nation during a disaster event. During a Presidential Declared Disaster, the DHS and FEMA provide oversight of all federal agencies required to mitigate the effects of the hazard. During a biological incident, DHS and FEMA may support OCME requests for personnel or other assets submitted by NYCEM through DHSES. Supporting OCME activities may come from resources belonging to the following federal agencies: United States Departments of Health and Human Services, Transportation, Defense Department, and State Department. United States Department of Health and Human Services US Department of Health and Human Services (DHHS) is the lead federal agency for medical care and mortuary services under ESF 8. During a biological incident, US DHHS will attempt to prevent the further spread of disease by reducing person-to-person transmission and begin treating exposed individuals as quickly as possible. At the onset of a biological incident, US DHHS, in concert with other federal agencies and partners, will work with the pharmaceutical industry to procure and distribute appropriate vaccines, antibiotics, antivirals, and other supportive care essential supplies per local emergency response plans. Initially, if supplies are limited, delivery of antiviral or antibiotic drugs from public stockpiles will go to local and state health departments for distribution based on predetermined recommended patient priority groups. Page 66 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths US DHHS is the parent agency of the CDC and DMORT. Whereas CDC will help identify the specific pathogen and facilitate vaccination (if applicable and available) and proper medical treatment, DMORT, part of the National Disaster Medical System, acts as a specialized mortuary unit comprised of local and regional volunteers, who are federalized at the time of deployment to a disaster event. During a biological incident: • • • US DHHS may establish a mortuary fund in order to enable NOK to pay for the burial or cremation of their loved one CDC provides guidance regarding health concerns of the disease outbreak DMORT provides specialized personnel capable of performing various morgue operation tasks including, but not limited to, establishing identification of human remains Centers for Disease Control and Prevention (CDC) During a disaster, the CDC will provide subject matter expertise and may assist in coordinating specialized personnel or resources. During a biological incident, the CDC may provide: • • • • Subject matter expertise with regards to the specific pathogen Assistance with coordinating transportation of remains via the CDC Emergency Operations Center Guidance for handling of contaminated remains Federal PPE recommendations United States Department of Transportation During a disaster, US Department of Transportation provides transportation assets for state and local use. During a biological incident, US Department of Transportation may provide: • • Refrigerated units, CONEX refrigerated boxes, trailers, and other vehicles Transportation of contaminated remains across state lines may need to be coordinated with DOT o Under §173.134(b)(14) of US Federal Regulations, human remains (including those contaminated with a pathogen) are considered exempt from regulatory transportation measures United States Department of Defense As part of the National Response Plan, the Department of Defense supports most ESFs, including ESF 8 with regard to mortuary affairs. Though the Department of Defense does not have a robust mortuary affairs capability, specific assets may be available for the OCME to use during a biological incident. These include: Page 67 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • The Dover Port Mortuary at the Dover Air Force Base in Dover, Delaware as an alternate location to process remains Armed Forces Institute of Pathology/ Armed Forces Medical Examiner to process identification samples and pathology specimens The 54th, 311th, and 246th Quartermasters to help recover and track bodies General troop support to help recover, track, and transport bodies United States Army Medical Research Institute for Infectious Diseases to process laboratory samples and specimens, including those requiring BioSafety Level 3 or 4 labs United States Department of State During a disaster, the United States Department of State (DOS) helps the City manage foreign national decedents by contacting next of kin (NOK) and by facilitating some of the coordination required to transport a body to another country. In most cases, DOS works through embassies to contact NOK. Non-Governmental Supporting Agencies Funeral Directors Funeral directors, including members of the Metropolitan Funeral Directors Association and others, are associated with private funeral businesses. They support NOK by providing funeral services, which include managing myriad details regarding final disposition of remains. Services often include retrieving the death certificate from the signing physician, filing the death certificate and obtaining the disposition permit from the Office of Vital Records, retrieving the body from the place of death or the OCME, preparing the body for an open casket ceremony such as a wake, placing the body in a casket, transporting the body to the cemetery and recommending crematoria or cemeteries upon request. The funeral director’s role is to provide comprehensive funeral services at the family’s request. Most funeral directors have little ability to expand their capacity to accommodate a large influx of decedents. Funeral directors should establish their own plans to manage large numbers of decedents, but do so in a manner that does not compete with the OCME for resources. As the OCME has access to many resources and can hold bodies for extended periods, funeral directors will be able to process decedents in a more traditional manner. During a biological incident, funeral directors will maintain their private sector business of arranging and providing funeral services. Additionally, the MFDA will disseminate information to its members in a timely fashion and may be able to provide personnel to support Family Assistance Center (FAC) activities. During a biological incident, the MFDA will: • Distribute information regarding infection control and proper handling measures to funeral directors Page 68 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • Distribute information regarding the OCME’s current management of remains, so that funeral directors know where to retrieve bodies, file death certificates (if applicable), and obtain burial permits Coordinate funeral director support at the FAC, by gathering antemortem data and/or assisting those grieving the loss of a loved one, and by providing timely information regarding the final disposition process During a biological incident, funeral directors will be contacted directly by the family to obtain their services, as usual When a decedent dies at a residence and is still there, funeral directors can maintain their normal practice regarding collecting the body When NOK releases the body to the OCME, funeral directors can contact the BOCME office or the main office at 520 First Avenue to locate the decedent’s remains When a death occurs at an HCF, funeral directors will call the HCF to find out if they still have possession of the body or if the decedent has been released to the OCME Private Sector Cemetery Owners Cemetery and crematorium owners provide burial plots or crematorium services, respectively. They are managed by a municipal entity, are a national cemetery owned by the Veterans Administration, or are privately owned or owned by a religious organization. There are 35 regulated cemeteries within New York City, and 100 cemeteries within the greater metropolitan area owned by religious entities. Typically, cemetery services include in-ground or mausoleum burial, memorializing the burial location with a headstone/footstone, maintaining office records, and managing the land. Cemetery capacity, described as the total amount of land in acres, is identified as sold acres, developed with ready property, and as undeveloped acres. If cemetery owners need to expand their capacity, they may need to prepare undeveloped acres, which may take several weeks. There are approximately 1,000 traditional burial plots per acre. Although not all cemeteries are regulated by the state, owners must file their burial plot pricing with the State Division of Cemeteries. Families can purchase a burial plot within a day, but obtaining burial rights from the state can take three to four additional days, unless the state regulation is suspended by a Governor’s Emergency Order. During a biological incident, cemetery owners will: • • • Provide information to the State Division of Cemeteries regarding space available for use as traditional burial plots Coordinate their efforts with funeral directors to accommodate family member requests Provide space and burial services for the OCME to purchase, if necessary Page 69 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Private Sector Crematoria Owners Within the five boroughs, three crematoria exist having a total of 18 retorts and capable of processing approximately 36 cases during normal business hours. Cremations on average take approximately 2 to 21/2 hours. The National Funeral Directors Association has projected a cremation rate of 41% in 2015 in the state of New York; crematorium owners suspect this practice is likely to remain constant or increase during a biological incident. During a biological incident, crematoria owners: • • • Coordinate their efforts with funeral directors to accommodate family member requests Coordinate their efforts with the OCME, as any final disposition involving cremation requires the OCME authorization Work with NYCEM, the OCME, and Department of Environmental Protection to modify restrictions, through a Mayoral Emergency Order so as to accommodate a large influx of decedents State Funeral Director Association The New York State Funeral Directors Association frequently answers questions related to arranging and prearranging funerals; cremation/burial options; use of Medicaid; consumer’s rights pertaining to funerals and preplanning; death and funeral statistics; and embalming and viewing decedents. Additionally, this association provides a searchable membership listing to assist NOK when looking for a funeral home in New York State, and lists resources for dealing with grief and bereavement. During disaster events, the State Funeral Director Association can: • • Provide support in the FAC, as funeral directors are adept at dealing with grief, assisting the NOK and obtaining antemortem data Disseminate information to members regarding the OCME and DOHMH’s recommendations concerning modification of the final disposition process during a biological incident American Red Cross The American Red Cross focuses on meeting people’s immediate emergency disastercaused needs, such as shelter, food and health and mental health services. In addition to these services, the core of Red Cross disaster relief is the assistance given to individuals and families affected by a disaster, enabling them to independently resume their normal daily activities. During a biological incident, the American Red Cross may support OCME operations in the FAC as well as by: Page 70 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • Providing food and drinks at the FAC, when available Providing food and drinks to OCME personnel at surge locations Providing mental health care to OCME personnel and/or family members in the FAC or other facilities The Salvation Army The Salvation Army is officially recognized as a disaster relief organization by the federal government, and provides basic needs to both survivors of, and first responders to, a disaster. Specifically, it offers material, physical, emotional and spiritual comfort. During a biological incident, the Salvation Army will: • • Provide food service to OCME locations, when available Provide family counseling at the FAC, if requested New York Disaster Interfaith Services NY Disaster Interfaith Services works to address the concerns of faith communities and the needs of present and future disaster victims. Although they do not speak for all religious groups, they acts on behalf of the faith community to help disaster victims recover through community-based programs, by advocating for the rights of victims; working to ensure victim short- and long-term financial, mental, and spiritual stability; and supporting caregivers. The goal is to increase community resilience and promote healthy coping skills. To achieve this, the New York Disaster Interfaith Services has organized five specific focus groups. Advocacy Working Group Comprised of different faith- and community-based agencies; this group meets on a regular basis to share information, advocate aid for the recovery of disaster victims and address the needs of residents in impacted communities. Caseworker Support Group The Caseworker Support Group supports caregivers (e.g., mental health professionals, clergy, and caseworkers whose professional lives become dominated by the disaster) by providing them counseling. Clergy Council Comprised of spiritual community leaders, this group works to ensure that local religious communities have input into the rebuilding of their disaster-damaged neighborhoods. Conferences New York Disaster Interfaith Services facilitates interagency conferences and workshops to educate faith-based providers on emerging unmet needs, and to address the Page 71 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths concerns of local clergy, religious leaders and faith-based providers. Interfaith Discussion Groups Representatives of different faiths come together to establish common ground and increase mutual understanding and resilience during the aftermath of a disaster. During a biological incident, New York Disaster Interfaith Services can support OCME operations by: • Disseminating guidance to faith-based communities regarding City recommendations for decedent final disposition modifications. For example, during a biological incident, large gatherings may be limited or prohibited, hindering traditional religious ceremonies. Recommendations may include: o Graveside services with limited family members in attendance o Virtual memorial ceremonies o Closed casket ceremonies o Avoidance of embalming, which may preclude having the body present during funeral services o Taking part in a religious group council, organized by the OCME, to discuss final disposition options relevant to the biological incident Other Private and Commercial Entities Private entities include all types of associations and businesses that may support specific OCME operations. In some instances, professional associations may be able to provide specific types of skilled professionals to assist the OCME (e.g., American Society for Forensic Odontology). In other cases, the OCME may require support from private DNA labs to process identification samples or from anthropological groups to assist with identification of decedents. In other instances, private sector businesses may support OCME operations by providing trained call operators and virtual FACs, or providing specific services to include decedent packaging and storing assistance, burial, transportation and PE depot management. During a biological incident, the OCME may require any or all of these types of support or services. Page 72 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths III. Emergency Support Function Coordination This segment of the document lists potential tasks and decisions organized by Emergency Support Functions (ESF) and related to fatality management operations during a biological incident. ESF Coordinators may need to implement some, all, or other tasks to effectively support fatality management operations during a biological incident. 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Page 74 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ESF #1: Transportation During a biological incident resulting in numerous decedents, the Transportation ESF Coordinator will support MFM operations in the following manner: ❑ Obtain vehicles having refrigerated capability for OCME to use to retrieve decedents at residential locations ❑ Obtain 18-wheeler refrigerated units suitable for the OCME to use as BCPs) ❑ Obtain CONEX refrigerated units suitable for the OCME to use as BCPs ESF #2: Communications During a biological incident resulting in numerous decedents, the Communications ESF Coordinator will support MFM operations in the following manner: ❑ Supports the establishment of a Victim Information Center (actual or virtual) if established ❑ Assists in providing technological support and expertise to the 311 Call Center and OCME Communications Unit, including increasing call capacity ❑ Supports the establishment of telephone, network, UVIS-CMS, and internet connectivity at all mass fatality field locations during the response ❑ Support New York City Intranet, CityNet, and UVIS-CMS connectivity ❑ Ensures OCME, DOHMH, and hospital computer networks are fully operational in order to efficiently process decedent reports ❑ Provide data entry into UVIS-CMS ❑ Provide computer server support at OCME locations to enable the Office of Vital Statistics to establish their Electronic Death Registration System (EDRS) ESF #3: Public Works and Engineering During a biological incident resulting in numerous decedents, the Public Works and Engineering ESF Coordinator will support MFM operations in the following manner: ❑ Establish infrastructure and infrastructure restoration of MFM field sites and OCME offices during a disaster event Page 75 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ❑ Establish engineering services and construction management particularly with regard to establishing off-site morgues, body collection points, and remains storage facilities ❑ Coordinates involvement of NYC Department of Environmental Protection in supporting OCME operations managing CBRNE-contaminated human remains, as applicable ❑ Coordinates with DoITT to establish telecommunications support at OCME field and office locations as necessary ESF #5: Information and Planning During a biological incident resulting in numerous decedents, the Information and Planning ESF Coordinator will support MFM operations in the following manner: *Note: Regional Coordination will fall under this function ❑ Notifies OCME of a biological incident that is or can be categorized as an MFI ❑ Notifies city agencies of the activation of appropriate citywide plans ❑ Coordinates agencies participation in interagency MFM subcommittees, as appropriate, when executing multiagency MFM operations ❑ Works with OCME PIO and other key agencies to formulate a statement regarding the City’s plan to manage decedents for the incident ❑ Coordinates uniform messaging regarding decedent management between OCME and 311 ❑ Ensures MFM operations are appropriately documented ❑ Coordinates involvement of the New York State Emergency Management, Federal Emergency Management Agency (FEMA), and surrounding area emergency management agencies to obtain required MFM assets ❑ Develops disaster site and city maps identifying key MFM locations, including: − Body collection points − OCME Borough offices − Off-site morgues − Remains storage facilities − Temporary interment sites − Decedent Decontamination Isolation/Collection Points − Mobile Sifting Platform operations  Notify local, state, and federal elected officials in the affected areas regarding the number of decedents resulting from the biological incident Page 76 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Notify District Managers of Community Boards, in concert with the Community Assistance Unit representative in the EOC, regarding specific MFM operations − Locations and procedures for FACs − Recovery operations − Temporary interment locations and procedures ❑ Gather information to share with elected officials regarding decedent management and the appropriate means of planning and establishing public and/or private memorials ❑ Organize conference call(s) with appropriate public and elected officials regarding management of decedents and support required by the next of kin (NOK) ESF #6: Mass Care, Emergency Services, Temporary Housing, and Human Services During a biological incident resulting in numerous decedents, the Mass Care, Emergency Services, Temporary Housing, and Human Services ESF Coordinator will support MFM operations in the following manner: ❑ Project future impact that management of decedents will have on the community and recommend allocating appropriate financial resources, as management of decedents extends months and potentially years past the disaster event ❑ Obtain grant funding to disperse to NOK to conduct final disposition of their loved one when community’s banking infrastructure is inoperable ❑ Provide citizens human services support at the FAC for those who have missing loved ones or believe their loved one perished in the disaster event. [*Note: See NYC FAC Plan for more information about the types of services the FAC will provide and how NYC Human Resources Administration will support the FAC’s Victim Information Center. The Victim Information Center within the FAC is the location where the OCME and other investigative agencies gather antemortem data to support decedent identification tasks.] ❑ Coordinates involvement of American Red Cross (ARC) and Salvation Army to provide food and beverages to those supporting MFM activities ❑ Coordinates involvement of Human Resources Administration (HRA) to establish the FAC, which supports families who believe their loved one perished in the disaster event ESF #7: Logistics Management and Resource Support Page 77 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths During a biological incident resulting in numerous decedents, the Logistics ESF Coordinator will support MFM operations by obtaining equipment, supplies, PPE, IT connectivity, and IT equipment in the following manner: *Note: See Appendix D: Suggested Equipment and Supplies for detailed listings ❑ Support the establishment of OCME disaster response entities, including: − Borough OCME facilities − OCME Point of Dispensing − Scene operations − Postmortem Processing operations − Antemortem Processing operations − Remains Storage Facilities − Body Collection Points − Command Posts − OCME Operations Center ❑ Assist in locating necessary support personnel and/or subject matter experts ❑ Assist in establishing contracts or support for OCME disaster response operations, including: − Facility maintenance − Equipment maintenance − Vehicle maintenance − Equipment/vehicle operators − BCP/RSF equipment rental − Fueling − Additional equipment − IT support − Temporary interment ESF #8: Public Health and Medical Services During a biological incident resulting in numerous decedents, the Public Health and Medical Services ESF Coordinator will support MFM operations in the following manner: ❑ Support decedent management operations by arranging for the recovery; transport; temporary storage; tracking, post- and antemortem processing; temporary interment, if warranted, and release to final disposition of all decedents during a biological incident ❑ Provide OCME as the lead agency for MFI with technical information regarding the public health effects of the biological incident and any necessary precautions to implement for staff health and safety ❑ Coordinate with OCME regarding health care facility (HCF) requests for establishing and maintaining BCPs at their location Page 78 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ❑ Coordinate HCF requests for additional human remains pouches (HRPs) with OCME ❑ Coordinates involvement of appropriate occupational health agencies to ensure safety of those supporting MFM tasks ❑ Provides mental health support to those supporting MFM operations ❑ Coordinate with FDNY and Regional Emergency Medical Services Council (REMSCO) to assess how pre-hospital care agencies will manage patients designated as dead-on-arrival, or to determine what to do when providers pronounce death with the permission of an on-line Medical Control Physician ❑ Communicate with HCFs to request NYPD investigations of decedents brought directly to HCFs ❑ Coordinate with Joint Information Center, located at the Emergency Operations Center, to make public statements advising NOK against dropping off decedents at HCFs ESF #9: Search and Rescue During a biological incident resulting in numerous decedents, the Search and Rescue ESF Coordinator will support MFM operations in the following manner: ❑ Support decedent recovery efforts by providing technical consultation in hazardous environment ❑ Support MFM operations when conducting search and recovery operations ESF #12: Energy During a biological incident resulting in numerous decedents, the Energy ESF Coordinator will support MFM operations in the following manner: ❑ Establish, repair, and restore energy to any MFM operational locations ESF # 13: Public Safety and Security During a biological incident resulting in numerous decedents, the Public Safety and Security ESF Coordinator will support MFM operations in the following manner: ❑ Investigate reports of deaths called in to the 911 Center and secure the body until OCME or other appropriate entity arrives to take custody Page 79 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ❑ Investigate missing persons utilizing UVIS-CMS reports initiated at the 311 Call Center with OCME support ❑ Activates the UVIS-CMS Missing Persons module via the 311 call center to gather missing persons reports ❑ Coordinates involvement of appropriate investigation entities when processing the scene and decedents for evidence ❑ Conducts antemortem interviews with OCME personnel with family members at the Victim Information Center within the FAC (actual or virtual) ❑ Notifies NOK of death, as appropriate ❑ Disseminates information from One Police Plaza to precincts citywide regarding any changes in law enforcement’s approach to managing citizen reports of death ❑ Secures decedent’s estate, as is customary, and contacts the County Public Administrator to safeguard possessions until arrangements can be made with the NOK ❑ Provides security at specific MFM operational locations, as necessary ❑ Provides finger/footprinting technical resources to Postmortem Processing operations ❑ Investigates cases when NOK bring decedents to the OCME, HCFs, FDNY, NYPD, or other governmental locations ❑ Coordinates Department of Correction involvement to support decedent recovery, temporary interment, and city burial of decedents ESF #14: Long-Term Community Recovery During a biological incident resulting in numerous decedents, the Long-Term Community Recovery ESF Coordinator will support MFM operations in the following manner: ❑ Assists in coordinating any long-term operations, including decent recovery, as necessary ❑ Assists in mitigation and federal reimbursement efforts by OCME ❑ Project future impact that management of decedents will have on the community and recommend allocating appropriate financial resources, as management of decedents extends months and potentially years past the biological incident ESF #15: External Affairs Page 80 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths During a biological incident resulting in numerous decedents, the External Affairs ESF Coordinator will support MFM operations in the following manner: ❑ Liaises with the following private sector agencies to identify impacts: − Funeral directors − Cemetery owners − Crematorium owners − Religious entities − Casket and urn manufacturers − Embalming suppliers ❑ Coordinates public messages from primary response agency Public Information Officers ❑ Support the NYC Joint Information Center ❑ Assist in coordinating news conferences and organizing conference call(s) with appropriate NYCEM officials and elected officials regarding management of inand out-of-hospital deaths ❑ Respond to calls from elected officials ❑ Work with the private sector to disseminate public information ❑ Notify District Managers of Community Boards, in concert with the Community Assistance Unit representative in the EOC, regarding: − Locations and procedures for FACs − Residential Recovery Operations − BCPs Operations at HCFs − OSM Operations − RSFs − Temporary interment locations and procedures − Distributive Death Registration System (DDRS) locations and procedures Page 81 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 82 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths IV. OCME Command Operations This segment of the document provides an executive summary of disasterrelated responsibilities for Command operations and functions that the Office of Chief Medical Examiner would stand up in response to a biological incident. Page 83 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 84 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Command Operations during a Biological Incident The OCME will surge operations in order to manage daily operations (i.e. non-biological incident deaths) and disaster cases (biological incident deaths) in order to coordinate its activities, resources, and personnel. The OCME Agency Operations Center at 421 E. 26th Street will be surged in order to assist in managing the incident. Depending on the magnitude of the event, off-site morgues (OSM) may be established in the Bronx and Staten Island, in addition to OCME fixed facility morgues (FFM) in Manhattan, Brooklyn, and Queens. This plan is designed to be scalable depending on the specifics of the biological incident. The OCME Executive Team will maintain oversight and authority over all OCME operations (daily vs. disaster) and will assign leadership positions as necessary to operations. Core operations, such as planning, logistics, and finance operations will remain centralized during a biological incident response, so borough operations do not duplicate OCME functions that are best centralized during a biological outbreak having distributive characteristics. OCME disaster operations will fall under the Operations Section in the Citywide Incident Management System (CIMS). As mentioned previously, internal OCME operations do not follow traditional ICS staffing models. The OCME will provide representatives to the DOHMH Operations Center during a biological incident to gather and relay information between OCME and DOHMH regarding OCME-processed fatalities; and OCME will provide a representative to the New York City Emergency Operations Center (EOC) to obtain HCFs’ requests for body collection points (BCP); gather other relevant information related to the biological incident; inform New York City Emergency Management (NYCEM) of the status of OCME’s response activities; and request additional resources supporting fatality management operations. Depending on the size and scale of the incident, certain positions may not be necessary for the operation. Staffing plans are designed to be scalable and responsibilities may be merged or eliminated due to specific needs. Agency Command Element Disaster Response Coordinator The Disaster Response Coordinator (DRC) is responsible for analyzing the event to determine the breadth and scope of the situation and responding appropriately. The DRC will meet with the executive and senior leadership in order to manage the agency’s response to the incident. Page 85 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The DRC is responsible for the overall direction of the OCME incident response. The DRC is responsible for ensuring that incident objectives are established and that these objectives do not conflict with each other or Agency policy. The DRC will also ensure that strategies are selected for the use of critical resources and issue directives regarding the following topics during the initial operational period, and will report the agency’s length of the operational period to the command staff and the Executive Team, so that OCME agency information is prepared to disseminate to the EOC. As the event unfolds, the OCME DRC will continue to issue directives, update the Mobilization Level, and publish directives and guidance regarding safety, personnel allocation, and mobilization of facilities, etc. Public Information Officer The OCME Public Information Officer (PIO), a member of the OCME Executive Team, is responsible for relaying information between the OCME and the news media, via coordination with the New York City Joint Information Center and visitors, including families, as approved by the OCME Disaster Response Coordinator. During a biological incident, the OCME Public Information Officer must be prepared to provide information to the Joint Information Officer at NYCEM, so that appropriate and accurate information is released to the public via the JIC. The PIO will relay information regarding the OCME’s plan to manage decedents, including the establishment of BCPs at HCFs, reports of death to 911, holding of bodies pending funeral director pickup, and recommended modifications to final disposition processes should the DOHMH prohibit large gatherings. Additional topics will include OCME’s interaction with next of kin (NOK), minimizing large gatherings during final disposition and what to do should a loved one die at home. Public messaging in a disaster incident, particularly one that is geographically widespread and easily transmissible, will be crucial to the success of the operation. Expectations of family members, the public, other agencies, and politicians must be well- Page 86 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths managed by the PIO. Correct information and thorough policy explanations must be provided on a timely basis in order to reduce the risk of misdirected political pressure negatively impacting operations. This need for information and explanations must be balanced with privacy and family needs. The Joint Information Officer with NYCEM will be the primary point of contact for much of the city, although the media and politicians will likely direct more inquiries to the OCME as the death toll increases. Safety Officer The OCME Safety Officer is responsible for directing, supervising, and coordinating safety measures for the City of New York Office of Chief Medical Examiner in all five boroughs and to ensure staff safety and health promotion during a biological incident. The Safety Officer has the authority to halt any operation posing immediate threat to life and health. During a biological incident, the OCME Safety Officer will establish Health and Safety Plans (HASP) regarding safe operations. The Safety Officer will also develop guidelines regarding the use of personal protective equipment (PPE) for specific tasks, such as handling of decedents, autopsy activities, and disinfecting facilities, equipment and vehicles. Specifically, these guidelines should address: • Potential physical and mental health risks • Infection control precautions, specific to the disease • Specimen gathering and packaging techniques • Treatment priority groups, should medications be available • Monitoring personnel for signs of disease symptoms • Monitoring personnel’s mental and emotional health • Monitoring personnel’s usage of PPE • Advising staff to stay home for appropriate number of days if household member has disease symptoms Additionally, the OCME Safety Officer should develop HASPs for key OCME operations including Scene Operations, Postmortem Processing, and Antemortem Processing. These HASPs should cover all relevant activities within these operations. Other agencies coordinating their activities with the OCME may be interested in obtaining a copy of OCME’s HASPs, to use as a model for their own safety practices; such agencies may include HCFs with BCPs and private sector businesses such as funeral directors, and crematoria, and cemetery owners who process the body for final disposition. The OCME Safety Officer may choose to utilize the City HASP developed by the City Incident Management Team if it is sufficient and appropriate for OCME operations. Page 87 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Agency Planning Agency Operations Center Coordinator The Agency Operations Center Coordinator’s primary objective is to be fully aware of the incident situation, particularly as it affects agency operations. The Operations Center Coordinator will also develop a common operating picture, which all command staff can use as a tool for developing situation reports and objectives for the next operational period. The OCME Operations Center Coordinator is supported by the following functional areas: Planning, Logistics, Disaster Operations, Finance/Administration, Information Technology, Facilities, Representatives at external agencies, and Daily Operations (Tour Commander, Administrator on Duty, Transportation, Communications, and any other OCME department). These functional areas are scalable and may be adjusted based on the needs of the incident. Personnel should be from the department they are representing when possible. According to OCME policy, finance/administration personnel are not considered “essential staff”. Therefore, a special request will need to be made for personnel to work additional hours or weekends in response to an emergency. Daily operations will continue to be managed per normal protocol during an incident, as OCME must continue to respond to non-disaster cases. The Operations Center Coordinator will communicate with these departments with regards to the intersection between daily and disaster operations, as well as to collect information for OCME Situation Reports. Page 88 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The Operations Center Coordinator communicates with OCME representatives at other facilities, including NYCEM’s Emergency Operations Center. NYCEM Operations Center Representative The OCME Emergency Operations Center Representatives (NYCEM Rep) is responsible for representing the OCME at the New York City Emergency Operations Center (EOC) at New York City Emergency Management (NYCEM) during a biological incident to coordinate decedent management needs between appropriate NYC agencies. This position specifically coordinates with Healthcare facilities (HCF) via the Health and Medical Desk, New York City Emergency Management, and other NYC agencies that need either the OCME’s support or can provide support. It is likely that one of the main duties for the NYCEM Rep will be coordinating body collection points (BCP) placed at health care facilities, including the initial deployment, notification to OCME that a BCP is ready for pick-up, and coordinating with private contractors to deploy a replacement. DOHMH Operations Center Representative The NYC Department of Health and Mental Hygiene (DOHMH) Operation Center Representative (DOHMH Rep) is responsible for representing the OCME at the New York City DOHMH Operations Center during a biological incident to coordinate decedent management needs and facilitate information between the agencies. Planning Personnel assigned to Planning in the Operations Center will be responsible for the following functions: • Documentation: Collect all relevant documentation regarding incident operations. This will include all forms, situation reports (internal and external), Incident Action Plans, communications, etc. • Situation Report: Complete and distribute an OCME Situation Report to response personnel and agency managerial staff. • Task Forces: Coordinate with subject matter experts on highly specialized or technical aspects of the incident response, as necessary. • Resource Tracking: Coordinate with relevant departments (Logistics, Fleet, Facilities, etc) to complete all resource tracking forms. Typically these include consumable tracking (such as the number of snow chains used during a winter storm) and equipment usage hours. • Just-in-Time Training: Determine based on incoming information when and in what capacity just-in-time trainings are required and work with the associated department to coordinate training opportunities for response personnel. Logistics Personnel assigned to Logistics in the Operations Center will be responsible for the following functions: Page 89 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • Resource Requests: Coordinate between Logistics and operational personnel and OCME Finance personnel regarding any resource requests, including supplies, equipment, additional personnel, or contract support. This will include assisting OCME Finance with developing specifications or other required documentation for the procurement of the requested resources. Resource Request personnel will also monitor and ensure proper distribution of supplies and equipment based on specific operational needs. Vendor Management: If external vendors are involved with an incident response, personnel will assist in coordinating vendor activities with OCME operations. This may include coordinating arrival times, delivery times, etc. Operations Personnel assigned to Operations in the Operations Center will be responsible for the following functions: • Scene: Coordinate with the Deputy FM Branch Director – Scene to collect documentation, convey needs or resource requests, and report on operational updates. • Postmortem Processing: Coordinate with the Deputy FM Branch Director – Postmortem to collect documentation, convey needs or resource requests, and report on operational updates. • Antemortem Processing: Coordinate with the Deputy FM Branch Director – Antemortem to collect documentation, convey needs or resource requests, and report on operational updates. Finance/Administration Personnel assigned to Finance/Administration in the Operations Center will be responsible for the following functions: • Human Resources: Develop and distribute employee guidance as related to the incident, providing CityTime support • Contracts: Establish emergency contracts for required supplies, equipment, or personnel for the incident response • Procurement: Purchase any needed supplies and equipment necessary for the incident response, including providing food for operational personnel. • Budget: Ensure the proper budget is used for incident-related procurements; Establish a proper budget structure for incident-related procurements • Audits and Accounts: Ensure all emergency procurements are properly paid • Receiving: Coordinate receipt of incident-related procurements • Materials Management: Ensure all OCME operations are fully stocked with equipment and supplies available through the Store Room Information Technology Personnel assigned to Information Technology in the Operations Center will be responsible for the following functions: • IT Support: Provide IT support to the Operations Center for all audio/visual, computer, telephone, and radio issues; Coordinate with other IT personnel Page 90 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • assigned to field/operational locations and communicate needs and updates, including the Microwave Communications System UVIS-CMS Support: Provide UVIS-CMS Support to users in the Operations Center, additional users, and external agencies Facilities Personnel assigned to Facilities in the Operations Center will be responsible for the following functions: • Building Maintenance Requests: Respond to all building maintenance requests, including cleaning schedules, outages, etc. Agency Logistics Agency Logistics Chief The Agency Logistics Chief oversees the provision of resources to sustain OCME’s disaster response activities. During an incident, the Logistics Chief will obtain and provide the facilities, services, and materials necessary to support command operations. The Logistics Chief will oversee the Operational and Administrative Logistics Support Teams. The Logistics Chief should be able to anticipate the general type and quantities of resources required based on the mobilization level. The Logistics Chief should work with staff to utilize NIMS-Typed Resources as available. National Mass Fatality Management specific typed resources are currently under development. Page 91 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths As the incident continues, the Disaster Response Coordinator and FM Branch Director will require more resources to accomplish their tasks. The Logistics Chief must be prepared to continue to build key infrastructure components. This might include obtaining BCPs for placement at the scene, acquiring RSFs for placement near OCME facilities, and establishing the Disaster Portable Morgue Unit (DPMU), if required. There may be multiple requests for each of these types of assets, thus the Logistics Chief will need to determine if there are enough resources to accommodate all the facility, supply/equipment and personnel requirements associated with each of these assets. During the course of operations, it is possible that specific assets may need to be demobilized and reorganized in a different manner, in order to accommodate unforeseen circumstances in staff and resource availability. The Logistics Chief must determine the best way to downsize certain operations and to establish other assets, without negatively impacting OCME’s ability to process decedents. To manage logistics demands, the Logistics Chief may need to identify the agency’s needs in two ways. The first format is to have a simple inventory list of facility, communication, supply/equipment, vehicle, personnel, and service contracts. The second format is to type resources as an entire asset having a particular capability. Simple inventory and resource typing support each other. Simple inventory lists can be reviewed and resources can be organized into an effective asset. Similarly, resource typing: identifying resource name, category, kind, components, metrics, type and any additional information, facilitate how resources should be packaged to maintain a specific capability. The Logistics Chief will manage delivery schedules and make accommodations for various types of deliveries. After obtaining requested supplies, the Logistics Chief must develop a means of distributing items to the appropriate facilities. Operations Logistics Support The Operations Logistics Support personnel are responsible for coordinating all logistics needs, including supplies, equipment, additional personnel, and technical expertise, for Scene, Postmortem Processing, and Antemortem Processing operations. Administrative Logistics Support The Administrative Logistics Support personnel are responsible for assisting the Logistics Chief with documentation during the incident response, contacting vendors, tracking resources and requests, and coordinating with other OCME departments (such as Finance/Administration) on any incident-related purchasing. This position may fill the Logistics function in the Operations Center. Page 92 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Operations Fatality Management Branch Director The Fatality Management Branch Director is responsible for directing OCME operations, including Scene Processing, Postmortem Processing, and Antemortem Processing. Key priorities for the FM Branch Director include integrating OCME within the interagency response and managing expectations regarding OCME operations. The FM Branch Director is responsible for staffing all disaster operations and reporting outcomes to the Disaster Response Coordinator. Decentralized Operations Due to the distributive nature of a biological incident, it is likely that there will be a need to establish decentralized disaster operations at OCME borough locations. The Fatality Management Branch Director will oversee all decentralized borough operations. It may be manageable to have single Deputy FM Branch Directors for Scene, Postmortem, and Antemortem Operations, but the scale of the incident may require borough specific Deputies, i.e., the Queens Deputy FM Branch Director – Postmortem Processing). Scene Operations Deputy Fatality Management Branch Director – Scene The Deputy Fatality Management Branch Director – Scene is responsible for overseeing all aspects of the scene operation. The Deputy Fatality Management Branch Director – Scene supervises the Scene Safety Officer, the Scene Security Officer, the Search Group Supervisor, Investigation/Recovery Group Supervisor, the Remains Storage/Transport Group Supervisor, the Scene Support Group Supervisor, and the Contamination Control Group Supervisor. Page 93 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Safety Officer The Scene Safety Officer is responsible for directing, supervising, and coordinating safety measures for scene operations to ensure staff safety and health promotion during a biological incident. The Scene Safety Officer has the authority to halt any scene operation posing immediate threat to life and health and is responsible for coordinating actions with the Agency Safety Officer. Scene Security Officer Page 94 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The Scene Security Officer is responsible for coordinating security measures for scene operations to ensure staff safety during a biological incident. The Scene Security Officer will work with the Deputy Fatality Management Branch Director – Scene to determine the personnel needing access to scene. The Scene Security Officer has the authority to remove any individual without proper clearance from the scene. Search Group Supervisor The Search Group Supervisor is responsible for managing the search for decedents or human remains within a scene for the operation. The Search Group Supervisor oversees the Search Team Leader and the Mapping Team Leader. Search Team Leader The Search Team Leader is responsible for conducting a thorough search of their assigned area for all human remains. Mapping Team Leader The Mapping Team Leader is responsible for documenting the location of all human remains located during the search. Investigation/Recovery Group Supervisor The Investigation/Recovery Group Supervisor is responsible for managing the investigation and recovery of remains within a scene for the operation. The Investigation/Recovery Group Supervisor oversees the Investigation/Recovery Team, the Recovery Unit, the Scene Photography Unit, the Excavation Unit, and the Scribes. Investigation/Recovery Team The Investigation/Recovery Team is responsible for conducting the medicolegal death investigation of the scene and oversees the recovery of the remains. Recovery Unit The Recovery Unit is responsible for packaging and removing remains from the scene and transporting them to the appropriate body collection point. Scene Photography Unit The Scene Photography Unit is responsible for documenting the scene investigation and recovery of remains and uploading the photos into UVIS-CMS for later use. Excavation Unit The Excavation Unit is responsible for excavating any remains that are not readily accessible (i.e. buried beneath or within soil or debris). The Excavation Unit will ensure operations are conducted according to forensic archaeological standards. Page 95 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scribe(s) The Scribes are responsible for assisting in the scene investigation by taking notes regarding the details of the investigation and entering the information into UVIS-CMS. Remains Storage/Transport Group Supervisor The Remains Storage/Transport Group Supervisor is responsible for managing the intake of remains from the scene and coordinating transportation of the BCP from the scene to the morgue. The Remains Storage/Transport Group Supervisor oversees the Remains Storage/Transport Team. The Remains Storage/Transport Group Supervisor will coordinate with the Investigations/Recovery Group Supervisor and the Morgue Remains Storage Group Supervisor. Remains Storage/Transport Team The Remains Storage/Transport Team is responsible for coordinating and managing the storage of remains in the body collection point (BCP) and transportation of the BCP to the morgue facility. Responsibilities include maintaining chain-of-custody and tracking of all remains and monitoring the temperature of the remains storage facility. Scene Support Group Supervisor The Scene Support Group Supervisor is responsible for providing logistical support for scene operations. The Scene Support Group Supervisor will coordinate with the Agency Logistics Chief and the Deputy Fatality Management Branch Director – Scene. Contamination Control Group Supervisor The Contamination Control Group Supervisor is responsible for ensuring all scene operations involving contaminated areas and remains are conducted safely and appropriate to the specific contaminant. Postmortem Processing Operations Deputy Fatality Management Branch Director – Postmortem Processing The Deputy Fatality Management Branch Director – Postmortem Processing is responsible for overseeing all aspects of morgue operations and conducting morgue operations in accordance with established forensic standards. The Deputy Fatality Management Branch Director – Postmortem Processing supervises the Morgue Security Officer, the Morgue Safety Officer, the Remains Storage Group Supervisor, the Forensic Group Supervisor, the Morgue Support Group Supervisor, the Postmortem Quality Assurance/Quality Control Group Supervisor, and the Contamination Control Group Supervisor. Page 96 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Morgue Security Officer The Morgue Security Officer is responsible for coordinating security measures for morgue operations to ensure staff safety during a biological incident. The Morgue Security Officer will work with the Deputy Fatality Management Branch Director – Postmortem Processing to determine the personnel needing access to morgue facility. The Morgue Security Officer has the authority to remove any individual without proper clearance from the morgue. Morgue Safety Officer The Morgue Safety Officer is responsible for directing, supervising, and coordinating safety measures for morgue operations to ensure staff safety and health promotion during a biological incident. The Morgue Safety Officer has the authority to halt any operation posing immediate threat to life and health and responsible to coordinate their actions with the Safety Officer. Page 97 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Remains Storage Group Supervisor The Remains Storage Group Supervisor is responsible for managing and tracking the storage of remains from accessioning into the disaster morgue through their release for final disposition or into a remains storage facility (RSF). The Remains Storage Group Supervisor will coordinate with the Scene Remains Storage/Transport Group Supervisors to ensure an appropriate and efficient transfer of remains from the scenes to Page 98 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths the disaster morgue is maintained. The Remains Storage Group Supervisor will also coordinate with the HCF Morgue Manager and private contractors to coordinate delivery of HCF BCPs to the RSF. The Remains Storage Group Supervisor oversees the Remains Intake Team, the Remains Storage Team, the Remains Release Team, and the Remains Escort Team. Remains Intake Team The Remains Intake Team is responsible for accessioning remains into the RSF from the scene to maintain chain-of-custody. Responsibilities include entering the remains recovery tag number and date and time received into UVIS-CMS and transferring the case to the either the Remains Storage Team or the Triage Team in the morgue if they are able to process the remains immediately. Remains Storage Team The Remains Storage Team is responsible for coordinating and managing the storage of remains prior to the postmortem examination process. Responsibilities include maintaining chain-of-custody and tracking of all remains and monitoring the temperature of the remains storage facility. The Remains Storage Team will need to coordinate with the Forensic Group Supervisor to ensure remains are being released into the morgue at a rate that does not create a bottleneck during processing. Remains Release Team The Remains Release Team is responsible for releasing remains to final disposition (i.e. funeral home, city burial) upon identification and final approval from the Postmortem Quality Assurance/Quality Control Group Supervisor. Responsibilities include completing all necessary paperwork and checkout procedures in UVIS-CMS prior to the physical release of the remains. Remains Escort Team The Remains Escort Team is responsible for accompanying remains through the complete postmortem examination process in order to ensure chain-of-custody. These team members will escort the remains to each assigned morgue station and ensure all required documentation is completed and logged appropriately. Forensic Group Supervisor The Forensic Group Supervisor is responsible for overseeing all morgue operations. Responsibilities include maintaining proper work flow and eliminating bottlenecks and coordinating staff scheduling to ensure maximum efficiency. The Forensic Group Supervisor oversees the Triage Team, the Radiography Team, and the Pathology Team Triage Team The Triage Team is responsible for evaluating all incoming remains for commingling and/or the presence of non-osseous materials and non-human remains. The Triage Page 99 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Team is also responsible for assigning an ME disaster case number to each remain. The Triage Team is supported by the Triage Evidence Unit and the Triage Photography Unit. Triage Evidence Unit The Triage Evidence Unit is responsible for collecting and accessioning any unassociated evidence and personal effects that are recovered at the Triage Station. All evidence and personal effects should be properly documented in order to maintain chain-of-custody. Triage Photography Unit The Triage Photography Unit is responsible for documenting the passage of remains through the Triage Station and uploading the photos into UVIS-CMS for later use. Radiography Team The Radiography Team is responsible for capturing all applicable radiographs of remains that may be needed in the identification process and uploading the images into UVIS-CMS for later use. Page 100 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 101 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Pathology Team The Pathology Team is responsible for conducting the complete external and internal examinations of remains in order to determine cause and manner of death and identification. The Pathology Team is supported by the Autopsy Unit, the Fingerprint Unit, the Dental Unit, The DNA Unit, the Pathology Photography Unit, the Pathology Evidence Unit, the Anthropology Unit, the Histology Unit, and the Toxicology Unit. Autopsy Unit The Autopsy Unit is responsible for conducting the external and internal exam of remains in order to determine cause and manner of death. Fingerprint Unit The Fingerprint Unit is responsible for acquiring quality fingerprints (or footprints, if applicable) from remains for use in identification and comparison to antemortem fingerprint records. Forensic Odontology Unit The Forensic Odontology Unit is responsible for collecting dental radiographs and analyzing postmortem dental evidence for use in identification and comparison to antemortem dental records. DNA Unit The DNA Unit is responsible for collecting tissue samples for use in identification and comparison to either direct or indirect (familial) samples. Pathology Photography Unit The Pathology Photography Unit is responsible for documenting the passage of remains through the Pathology Station and uploading the photos into UVIS-CMS for later use. Pathology Evidence Unit The Pathology Evidence Unit is responsible for collecting and accessioning any associated evidence and personal effects that are recovered during the examination. All evidence and personal effects should be properly documented in order to maintain chain-of-custody. Anthropology Unit The Anthropology Unit is responsible for augmenting the examination of remains as necessary by analyzing sex, stature, ancestry, and age of the remains. This augmentation of the exam will be necessary if remains are sufficiently decomposed, damaged (i.e. burned), or fragmented. Page 102 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Histology Unit The Histology Unit is responsible for collecting histological samples for further analysis as requested by the Pathology Team. Toxicology Unit The Toxicology Unit is responsible for collecting toxicological samples for further analysis as requested by the Pathology Team. Morgue Support Group Supervisor The Morgue Support Group Supervisor is responsible for providing logistical support for morgue operations. The Morgue Support Group Supervisor will coordinate with the Agency Logistics Chief and the Deputy Fatality Management Branch Director – Postmortem Processing. Postmortem Quality Assurance/Quality Control Group Supervisor The Postmortem Quality Assurance/Quality Control (QA/QC) Group Supervisor is responsible for managing all aspects of postmortem data quality assurance and quality control. The Postmortem QA/QC oversees the Exit Review Team. Exit Review Team The Exit Review Team is responsible for performing a quality assurance/quality control check on all morgue processing prior to a decedent being released from the morgue facility. Responsibilities include ensuring all appropriate documentation has been completed and filed in the appropriate locations, including photographs and radiographs. Contamination Control Group Supervisor The Contamination Control Group Supervisor is responsible for ensuring all postmortem operations involving contaminated remains are conducted safely and appropriate to the specific contaminant. Antemortem Processing Operations Deputy Fatality Management Branch Director – Antemortem Processing The Deputy Fatality Management Brach Director – Antemortem Processing is responsible for establishing and managing all antemortem operations. The Deputy Fatality Management Brach Director – Antemortem Processing supervises the Medical Examiner/Coroner Liaison, the Interview Group Supervisor, the Antemortem Records Group Supervisor, the Antemortem Quality Assurance/Quality Control Group Supervisor, and the Victim Information Center Support Group Supervisor. The Deputy Fatality Page 103 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Management Branch Director – Antemortem Processing will directly liaise with the Joint Family Support Operations Center Representative and the Manifest Group Supervisor. If the pathogen associated with the biological incident is communicable, a decision may be made to establish a Virtual VIC. Certain positions may not be required in the event of a Virtual VIC, however operations will run in a similar manner. OCME Liaison The OCME Liaison will act as a subject matter expert to provide investigative updates during Family Briefings and answer case-specific questions from family members. Joint Family Support Operations Center (JFSOC) Representative The JFSOC Representative will serve as the liaison between OCME and the JFSOC, as applicable. Manifest Group Supervisor The Manifest Group Supervisor is responsible for developing a victim manifest that encompasses all deaths attributed to the pandemic event. The Manifest Group Supervisor oversees the Missing Persons Liaison, the Call Center Liaison, and the Hospital Liaison. This position is not staffed by OCME personnel, but there will be direct communication with the Deputy Fatality Management Branch Director – Antemortem Processing regarding development of the manifest. VIC Security Officer The VIC Security Officer is responsible for coordinating security measures for Victim Information Center operations to ensure staff safety during a biological incident. The VIC Security Officer will work with the Deputy Fatality Management Branch Director – Antemortem Processing to determine the personnel needing access to a VIC facility. The VIC Security Officer has the authority to remove any individual without proper clearance from the VIC. VIC Safety Officer The VIC Safety Officer is responsible for directing, supervising, and coordinating safety measures for antemortem operations to ensure staff safety and health promotion during a biological incident. The VIC Safety Officer has the authority to halt any operation posing immediate threat to life and health and responsible to coordinate his/her actions with the Safety Officer. Page 104 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 105 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Interview Group Supervisor The Interview Group Supervisor is responsible for coordinating antemortem interviews and ensuring the efficient and effective flow of families and friends through the antemortem data-gathering process. The Interview Group Supervisor oversees the Reception Team and the Interview Team. Reception Team The Reception Team is responsible for directing family members as they arrive at the Victim Information Center. Interview Team The Interview Team is responsible for conducting interviews with family members and accurately and efficiently acquisitioning antemortem data to facilitate the victim identification process. Antemortem Records Management Group Supervisor The Antemortem Records Management Group Supervisor is responsible for managing the collection, documentation, and analysis of antemortem data as part of the Victim Identification Center operation. The Antemortem Records Management Group Supervisor oversees the Antemortem DNA Team, the Antemortem Dental Records Team, the Medical Records Team, the Records Management Team, the Evidence Team, and the Fingerprint Team. Antemortem DNA Team The Antemortem DNA Team is responsible for obtaining and preserving DNA evidence to support disaster victim identification. Antemortem Dental Records Team The Antemortem Dental Records Team is responsible for collecting and evaluating antemortem dental records for comparison to postmortem records in support of victim identification. Medical Records Team The Medical Records Team is responsible for collecting and evaluating antemortem medical records for comparison to postmortem records in support of victim identification. Records Management Team The Records Management Team is responsible for managing all antemortem data provided by families and friends of victims. Antemortem Evidence Team Page 106 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The Evidence Team is responsible for collecting antemortem reference materials/samples provided by families and friends of victims and maintaining the chainof-custody throughout the Victim Information Center operation. Antemortem Fingerprint Team The Antemortem Fingerprint Team is responsible for collecting and evaluating antemortem fingerprint records for comparison to postmortem records in support of victim identification. Antemortem Quality Assurance/Quality Control Group Supervisor The Antemortem Quality Assurance/Quality Control (QA/QC) Group Supervisor is responsible for managing all aspects of antemortem data quality assurance and quality control. Victim Information Center Support Group Supervisor The Victim Information Center Support Group Supervisor is responsible for providing logistical support for morgue operations. The Victim Information Center Support Group Supervisor will coordinate with the Agency Logistics Chief and other logistics personnel and the Deputy Fatality Management Branch Director – Antemortem Processing. This position oversees the VIC Facilities Team, the VIC Supplies Team, the VIC Equipment Team, and the VIC Information Technology Team. Page 107 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 108 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths V. Operational Strategies and Components Page 109 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 110 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Introduction Please reference the OCME All-Hazards Mass Fatality Management Plan for the complete text of operational strategies and components. Please see below the listing of operational strategies and components. Command and Control Operational Strategies Scene Processing Postmortem Processing Antemortem Processing OCME Operations Center OCME Communications Unit MFM Asset Staging Area Unified Victim Identification System – Case Management System (UVIS-CMS) Microwave Communications System Assessment Team Decedent Investigation/Recovery Team Operational Components Body Collection Point Decedent Transport Operations Mobile Sifting Platform Operation Remains Storage Facilities Fixed Facility Disaster Mortuary Off Site Mortuary Decedent Decontamination/Isolation Collection Point (DDICP) Victim Information Center Reconciliation Final Disposition The additional operational components presented in this plan are unique to biological incident responses. Page 111 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Component: Trigger Point - Mobilization Level Response Activity Agencies: • OCME • DOHMH • NYCEM Purpose: The purpose of this component is to direct the response strategy based on predetermined thresholds of fatalities. Overview: To manage the anticipated additional deaths, the OCME has developed a general response strategy based on hazard trigger points (see OCME Decision Making Strategy for further details). Each hazard trigger point is associated with an asset mobilization level and specific response activities, to enhance the OCME’s overall response. The various mobilization levels guide the OCME response, in order to modularly increase its capabilities in anticipation of increased incident-related deaths. The key response activities will reveal how usual processing methods will change to accommodate an increased caseload. These key activities include: ▪ ▪ ▪ ▪ ▪ ▪ ▪ Recovering decedents from health care facilities (HCFs) and residences Conducting scene investigations Remains storage at OCME facilities Morgue operations Death certificate registration Burial/cremation permit application process Temporary interment Criteria: • OCME response to a confirmed mass fatality incident meeting the relevant trigger point. Process: 1. OCME Executive Leadership and operational personnel will monitor daily case loads and consistencies between cases for indications that response activities must be altered to maintain agency responsibilities. 2. OCME personnel will communicate with DOHMH regarding surveillance indicators, including hospital admissions information. 3. Based on current information about the current state of the biological incident, OCME will adjust its operations based on the trigger point and corresponding mobilization level requirements. Page 112 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Agency Responsibilities: Agency Responsibilities • OCME • • Provides statistics regarding the scale of the potential or confirmed biological incident, including but not limited to the number of confirmed or suspected cases, hospitalization rates, and • Provide information and interagency communication as necessary DOHMH NYCEM Monitors daily cases for affects from the potential or confirmed biological incident Determine and implement necessary changes to procedures in order to manage the incident Considerations: • The Trigger Point – Mobilization Level – Response Activities matrix is only relevant to biological incidents without postmortem cross contamination risks (i.e. ebola or other viral hemorrhagic fevers). • The Trigger Point – Mobilization Level – Response Activities matrix is most likely to be applied during biological incidents with communicable pathogens. • The specific characteristics of the incident will determine the ranges for trigger points and the associated mobilization and response. Page 113 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Component: Biological Incident In-Hospital Fatality Surge Agencies: • OCME • HCFs • GNYHA • H+H • NYCEM Purpose: The purpose of this component is to provide OCME assistance to HCFs to manage the fatality surge resulting from a biological incident. Overview: The OCME will arrange to have body collection points (BCPs) placed at eligible HCFs, to temporarily increase their storage capacity. These refrigerated units can hold approximately 9-44 bodies. The BCPs placed at HCFs should be used for all decedents suspected of having died as a result of the biological incident. HCF personnel will be required to manage BCP operations in both natural and criminal incidents. Storage Location Case Type Criminal Incident Natural Incident Incident case HCF BCP HCF BCP Non-incident Claim Case Regular HCF Morgue *Regular HCF Morgue Non-incident ME Case Regular HCF Morgue Regular HCF Morgue *Note: HCFs generally should not commingle ME cases and Claim Cases in the BCP. OCME will provide notice if non-incident claim cases may be stored in the HCF BCP during natural biological incidents. HCFs must provide appropriate facility infrastructure and staff to oversee bodies being placed into the BCPs, to load bodies into the BCPs and to perform security and maintenance. The OCME will coordinate through the NYCEM EOC to obtain, deliver and move BCPs (both full and empty); to provide basic supplies such as human remains pouches (HRP); and to arrange for contract support to refuel and provide maintenance on BCP units. Increasing HCFs’ refrigerated storage capacity will help to decrease the number of overall time-critical tasks associated with managing human remains. In addition, coordinating fatality management assets centrally will help NYC agencies avoid competing for limited resources during a disaster event. Please note: This operational component is discussed in detail in Annex1 of this plan. Page 114 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Component: Out-of-Hospital Fatality Investigation / Recovery Agencies: • OCME • NYPD Purpose: The purpose of this operational component is to detail the changes to the normal medicolegal death investigation and residential and public view (out-of-hospital) recovery processes. Overview: The OCME will recover decedents from residential and public view locations should the normal process of managing non-medicolegal deaths become overwhelmed. It is probable that funeral directors, cemeteries, and crematoria may be unable to process remains at the same rate as the OCME, due to the large number of deaths during a biological incident. In such instances, the OCME will: enhance its normal Medical Examiner Transport Teams (METT), establish recovery protocols, and sort biological incident cases requiring scene investigations by phone, based on NYPD findings. These teams will primarily recover decedents from residential locations, but can also be used to recover decedents from HCFs when BCPs are not full, or recover decedents from smaller HCFs (i.e., assisted living facilities that lack facility infrastructure to accommodate placement of BCP). Criteria: • • The rate of residential and public view recoveries outpaces the standard investigative process in criminal and natural incidents. Funeral homes are unable to keep up with the rate of recovery for natural biological incident deaths. Agency Responsibilities: Agency Responsibilities • OCME • • • NYPD • Conduct medicolegal death investigations at the scene or over the phone Effectively determine when a full scene investigation is required Recover decedents from case location as soon as possible Maintain scene security until funeral home or OCME METT arrives to recover the decedent** Communicate scene information to OCME MLI via telephone, as requested Page 115 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Considerations: • • • • Standard OCME protocol is to conduct a full medicolegal death investigation at the scene of any non-natural death or in situations where the decedent’s primary physician is unavailable to sign a death certificate. Should the rate of recovery outpace these standard protocols, MLIs will conduct a modified scene investigation over the phone with NYPD officers on scene to gather relevant information. Non-natural deaths not suspected to be related to the incident will be investigated per standard protocol. Deaths suspected to be related to the incident will be investigated as deemed necessary. In criminal incidents resulting in homicides, every effort will be taken to maintain the standard scene investigation process by OCME MLIs. **In criminal incidents, funeral homes should never be granted authority to recover decedents from the residence or public view location. Larger refrigerated vehicles (such as refrigerated box trucks) may be used to increase the recovery capacity per shift. Page 116 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Component: Biological Incident Virtual Victim Information Center Agencies: Government Agencies • OCME • Department of Information Technology and Telecommunications (DoITT) • New York City Police Department Missing Persons (NYPD) • New York City Emergency Management • 311 Call Center Non-government Agencies • American Red Cross Purpose: The purpose of this operational component is to provide an alternate mechanism for collecting antemortem information in the event public gatherings are restricted due to the nature of the incident. The VIC facilitates the exchange of timely and accurate antemortem information between OCME and family and friends of deceased disaster victims and investigative authorities. Overview: During a biological incident, the City may establish a virtual FAC rather than a physical FAC to avoid large public gatherings, which may increase the risk of continued transmission of the pathogen. The FAC Lead Team is comprised of representatives from NYCEM, OCME, NYPD, Human Resource Administration, Mayor’s Office, and the American Red Cross – Greater New York. Should the decision be made to open a virtual FAC, UVIS-CMS via the 311 Call Center will be activated and staffers will enter the relevant caller data. From workstations established at 421 E. 26th (location may be incident specific), OCME FAC personnel and NYPD Missing Persons detectives will contact reporters and conduct the antemortem interview. Family members will be advised as to specific procedures for providing antemortem medical and dental records, which may include mailing the records or dropping them off at a designated location. Criteria: • OCME response to a confirmed biological incident resulting in mass fatalities, where the pathogen in question is communicable. Components: • UVIS-CMS: A database software system used by several city agencies, including 311, NYPD, and OCME, to gather key information to facilitate decedent tracking from the time missing persons report is generated until decedents are released to licensed funeral directors at the request of NOK. Specifically, the UVIS application supports: − Compiling an accurate missing persons and decedent list − Tracking decedents, antemortem information, and postmortem findings to facilitate decedent identification Page 117 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths − • • • • • • • Notifying OCME to hold bodies for claim on behalf of HCFs, which may also require processing them for identification or city-directed burial Virtual Antemortem Interview Areas: This area will have private spaces in which VIC personnel will conduct telephone interviews with families to collect information that may be useful in identifying victims. Family members may also be asked to provide records, photos, dental x-rays, DNA samples, and other items to aid the identification process. In the case of a virtual VIC, OCME personnel will mail DNA kits to family members and provide instructions to family members regarding the mailing of other antemortem records and/or samples. Separate rooms are preferred; if separate rooms are not available, partitions for privacy are needed as the highest degree of confidentiality should be maintained. It is estimated that the average family interview time will be at least one hour. Antemortem Records Management Area: In this area, OCME technical specialists will process information, records, and evidentiary items provided by families to assist in victim identification. Separate stations will be required for several different technical disciplines. OCME will provide the necessary specifications for this area, and manage the set-up and break-down of these areas. Manifest Development Area: A multiagency group will work to develop an accurate decedent manifest based on missing persons reports, passenger manifests (if available), and family reports. Evidence Storage: Secure storage for all antemortem records and samples must be included in the antemortem records management area. Rehabilitation Area: Location where staff can rest and eat. IT Requirements: Full connectivity (phone, internet, program access) should be maintained in all areas, with staff available to support and troubleshoot as necessary Security Requirements: Access to the VIC must be strictly controlled and all staff must be issued proper credentials by security personnel Process: 1. The Disaster Response Coordinator will participate in the citywide FAC Lead Team call to determine if a FAC will be established and if it will be physical or virtual. In biological incidents involving a communicable pathogen, such as pandemic influenza, it is likely a virtual FAC and/or VIC will be established to mitigate the transmission of the disease. As with typical FAC activations, OCME may decide to stand up VIC operations independent of the FAC. This is likely during a virtual VIC operation. 2. The Logistics Chief will begin equipment deployment to the determined site(s). The City and OCME have several pre-identified FAC locations that may be utilized, although it is likely that a virtual VIC would be established at the OCME main facility at 421 E. 26th Street. The Logistics Chief and Deputy Fatality Management Branch Director – Antemortem Processing should visit and approve any new or additional FAC locations. The VIC will be fully operational within 48 hrs. 3. The Deputy Fatality Management Branch Director – Antemortem Operations will develop a reduced staffing plan for the VIC. Page 118 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths 4. The Security Manager will examine the chosen area and ensure all security requirements are met, including credentialing. 5. OCME IT will coordinate with DoITT to establish all network connectivity and support. 6. OCME Logistics will complete the set up for interview rooms and all other support areas (including manifest development and antemortem records management areas). 7. Once all VIC equipment is set up and operational, antemortem interviews and manifest and record review will begin. Record review and evidence maintenance will likely be delayed as people will need to mail materials into the VIC. Agency Responsibilities Agency OCME NYCEM DoITT NYPD American Red Cross Responsibilities • Supports VIC by identifying requirements associated with this operation and coordinating the needs through appropriate city agencies • Staffs VIC positions • Gathers antemortem data as appropriate • Supports FAC Critical Services Area by coordinating with city agencies to obtain specific capabilities • Supports VIC by providing network connectivity, so that all antemortem data collected can be controlled and distributed through a central network • Supports VIC by conducting missing persons interviews • Supports VIC by notifying the NOK of their loved one's death • Provides support and assistance for VIC staff members Staffing The organizational chart below identifies the potential persons required to establish the VIC. Additional positions or agencies may be required based on the type and magnitude of the disaster event. Page 119 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Organizational Chart Page 120 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Staffing Requirements Staff Position Fatality Management Branch Director Deputy FM Branch Director – Antemortem Processing Manifest Group Supervisor OCME Liaison JFSOC Liaison VIC Safety Officer VIC Security Officer Interview Group Supervisor Reception Team Interview Team Antemortem Records Management Group Supervisor Antemortem DNA Team Position Description • Reports to Disaster Response Coordinator • Manages all MFM operations • Reports to the Fatality Management Branch Director • Oversees, directs, and coordinates all antemortem processing operations related to the disaster response • Coordinates agencies involved in developing the decedent manifest • Reports to the Deputy FM Branch Director – Antemortem Processing • Coordinates OCME and VIC activities with the general FAC organizational structure • Reports to the Deputy FM Branch Director – Antemortem Processing • Coordinates with the Joint Family Support Operations Center • Reports to the Deputy FM Branch Director – Antemortem Processing • Ensures safety of all personnel operating in the VIC • Reports to the Deputy FM Branch Director – Antemortem Processing • Manages credentialing for personnel and visitors approved to be in the VIC • Secures access points to VIC • Reports to the Deputy FM Branch Director – Antemortem Processing • Responsible for coordinating and managing the scheduling of family phone interviews • Reports to the Interview Group Supervisor • Responsible for contacting families in order to schedule interviews • Reports to the Interview Group Supervisor • Responsible for conducting antemortem interviews in conjunction with NYPD • Reports to the Deputy FM Branch Director – Antemortem Processing • Responsible for managing the collection and storage of all decedent medical records and other samples • Reports to the Antemortem Records Management Group Supervisor • Responsible for mailing DNA kits to family members to collect antemortem and/or familial samples • Responsible for processing DNA kits mailed in by family members • Responsible for managing direct DNA samples mailed in by family members Page 121 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Staff Position Antemortem Dental Team Medical Records Team Records Management Team Antemortem Evidence Team Antemortem Fingerprint Team Antemortem QA/QC Group Supervisor VIC Support Group Supervisor Facilities Team Supplies Team Equipment Team Information Technology Team Leader Position Description • Reports to the Antemortem Records Management Group Supervisor • Responsible for examining antemortem dental records and uploading the information to the decedent’s case file • Reports to the Antemortem Records Management Group Supervisor • Responsible for uploading information from decedent antemortem medical records • Reports to the Antemortem Records Management Group Supervisor • Responsible for managing all antemortem records provided by family members • Reports to the Antemortem Records Management Group Supervisor • Responsible for maintaining chain of custody for all items brought in by family members for decedent identification • Reports to the Antemortem Records Management Group Supervisor • Responsible for managing latent finger and/or foot- prints of decedents, as appropriate • Reports to the Deputy FM Branch Director – Antemortem Processing • Responsible for ensuring proper quality assurance and quality control measures are followed during VIC operations • Reports to the Deputy FM Branch Director – Antemortem Processing • Responsible for coordinating logistical needs within the VIC • Reports to the VIC Support Group Supervisor • Responsible for managing all facilities requests related to VIC operations • Reports to the VIC Support Group Supervisor • Responsible for coordinating the procurement and delivery of any supplies needed for VIC operations • Reports to the VIC Support Group Supervisor • Responsible for coordinating the procurement and delivery or repair of any equipment needed for VIC operations • Reports to the VIC Support Group Supervisor • Responsible for setting up and maintaining all connectivity within the VIC, including telephones and UVIS-CMS VIC Equipment Cache The VIC Equipment Cache is a cache of equipment OCME personnel use to schedule and perform antemortem family interviews and manage all antemortem records collected during interviews for use in the identification of decedents. The VIC Equipment Cache contains all the equipment necessary to establish a fully equipped VIC, including interviews and back-office operations. The VIC Equipment Page 122 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Cache can be scaled to support a small and independent VIC or a full multiagency FAC depending on the needs of the incident. Components: • Registration Stations: - IT Requirements: Desktop and dual monitors with network connectivity, label printer for VIC credentialing - Other Requirements: Table and chairs near power source • Antemortem Interview Stations: - IT Requirements: Desktop with network/UVIS-CMS connectivity and dual monitors for review. - Other Requirements: Evidence bags, DNA kits (buccal swab). Table and chairs near power source • Antemortem Records Management: Each modality requires a desktop with network/UVIS-CMS connectivity. Some stations may require additional specialized equipment – see Appendix D for a full list. • Evidence Storage: A secure location is required for all evidence storage. This may be a secured mobile storage cage, but may also be a secured room in the VIC facility. • Microwave Communications System: If necessary, the Microwave Communications System can be deployed to support network connectivity at a FAC / VIC location. Description of Equipment The VIC Equipment Cache is able to be deployed and fully operational within 48 hours. The number of stations deployed can be determined based on the scale of the incident. The specific layout of the Victim Information Center will depend on the incident. In general, the Antemortem Interview should take place in private rooms. The Antemortem Records Management Area should be secured and separated from other functions. If the VIC is embedded within a FAC, the VIC registration area should be separated from any general registration areas. Please see Appendix D for suggested equipment and supply lists for each function. Considerations Manifest Development Establishing an accurate decedent manifest is critical for the OCME to positively identify decedents during an incident and for law enforcement agencies to effectively investigate deceased persons. An incident is likely to result in one of two situations with regard to the decedent manifest—either the population of those who perished is known (closed manifest) as is the case in most airline incidents or the population is unknown (open manifest) because of the location where the incident occurred and/or the type of disaster. Family Management Page 123 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME should be prepared to support families throughout the identification process, including incidents with extended recovery and identification operations. The Chief Medical Examiner will make a determination for each incident regarding identification objectives, which may differentiate between the identification of each victim and the identification of each remain. Notification of identification may extend past the activation of the VIC. The NOK’s preference for further notification should be documented and carried out per their wishes. Options may include • Notify NOK for every new identification • Never notify NOK of an identification • Notify NOK at the end of the identification process • Notify a NOK-elected proxy (typically clergy) Family members are always welcome to call and request updates in the identification process of their loved one, regardless of their stated preference. Page 124 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Component: Temporary Interment Strategy Agencies: • OCME • NYCEM • Department of Correction (DOC) • Private sector funeral directors, cemetery owners, crematoria owners Purpose: The purpose of this operational component is to augment storage capabilities in the event of large numbers of fatalities. Overview: During a biological incident, OCME anticipates significant storage concerns due to the increased processing time and system wide delays with final disposition. OCME will primarily utilize remains storage facilities (RSFs) at OCME facilities for longterm storage, but temporary interment may be necessary depending on the scale of the incident and delays in final disposition. OCME and DOC will surge normal City Burial operations to accommodate temporary interment. There are an estimated additional 30,000 to 50,000 additional plots available. The decision to implement temporary interment as a decedent storage strategy will be made by the Chief Medical Examiner in conjunction with the Mayor’s Office. Criteria: • OCME response to a confirmed mass fatality incident • Extreme delays in postmortem processing and release to final disposition Components: • Decedent Transport: OCME will coordinate the transport of decedents to and from OCME mortuary facilities to Hart Island for temporary interment and subsequent disinterment. • Decedent Tracking: OCME will strictly document the status of all decedents temporarily interred at Hart Island, including exact interment location. • Interment/Disinterment Operations: DOC will provide personnel to conduct interment/disinterment operations per standard protocol. • Public Messaging: OCME Public Affairs will work with NYCEM JIC and the Mayor’s Office to develop and distribute appropriate messaging if temporary interment is utilized. Agency Responsibilities: Agency Responsibility • OCME NYCEM • • • Manage decedent manifest for temporary interment Coordinate transport of decedents to Hart Island Coordinate disinterment, as necessary Assist in coordinating temporary interment operations Page 125 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • Assist in public messaging strategies Fulfill OCME resource requests DOC • • Coordinate access to Hart Island Coordinate burial and disinterment operations Funeral Industry • Take custody of decedents as soon as possible Considerations: • • • Weather conditions may increase difficulty or delay temporary interment operations. OCME personnel should monitor potential need for caskets during the course of operations and make purchases as necessary. Should temporary interment operations increase beyond the availability of caskets, disaster human remains pouches are suitable for temporary interment. Should the rate of death outpace available space on Hart Island, the City may need to establish contracts with public and/or private cemeteries to accommodate additional temporary interment for decedents. Contracts must specify the cemetery’s services, including in-the-ground interment, tracking, case record management and the ability to disinter. Contracts may also recommend that cemeteries utilize the Department of Defense’s temporary mass interment method. This method avoids stacking decedents and minimizes hand digging as part of initial interment and disinterment. (Ten bodies in caskets are placed lengthwise in a long narrow section in the ground. The foot end of one casket is placed in close proximity to the head end of the next casket.) Page 126 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths VI: Incident Specific Demobilization Actions This segment of the document identifies Office of Chief Medical Examiner demobilization and immediate post-response actions. Page 127 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 128 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths General Demobilization Just as the OCME will increase its capacity to manage the large influx of decedents, it will also decrease its response upon notification from DOHMH that the biological incident is slowing or weakening, and that the fatality rate has begun to ease. In general, the OCME will reduce its operations in association with the Trigger Point – Mobilization Level – Response Activities Strategy, which applies to both increasing OCME capabilities and decreasing them to fit the needs of the incident. Demobilization will occur in all areas – Command Operations, Planning, Logistics, and Finance/Administration. Agency Command Demobilization: General The Disaster Response Coordinator will not order reductions in OCME activities until the event is no longer considered a disaster and OCME operations are ready to return to normal. The DRC will shift activities from building up Command Operations, Planning, Logistics, and Finance/Administration to determining how they will de-escalate appropriately. Some boroughs may experience more activity than others, creating the need for different demobilization schedules. It is important to synchronize the deescalation among all B-OCMEs, as outside agencies are involved in certain fatality management operations based on the OCME Mobilization Level. During a biological incident, other issues requiring the DRC’s focus include, but are not limited to: • • • Obtaining surveillance information from DOHMH regarding the phase of the outbreak, and if the current slowdown is temporary and another outbreak wave is expected Obtaining information from DOHMH and NYCEM regarding the City’s isolation/quarantine practice, specifically with regard to isolation/quarantine statistics or trend analyses Performing OCME surveillance and monitoring to obtain comparative data regarding the number and types of cases OCME personnel are managing Agency Command Demobilization: Operations Center Surge and Planning Once the Disaster Response Coordinator determines what biological incident activities will be demobilized, the DRC with the assistance of the FM Branch Director and deputies must address the best means of downsizing operations without compromising OCME operations Other functional areas may not slow down, such as Distributed Death Registration (DDR) method, Remains Storage Management, and Family Management, until most decedents undergo final disposition. During the downsizing effort it is possible that borough operations may convert from a distributed system to a centrally managed one, allowing all borough offices, with the exception of the Manhattan office and Agency Operations Center, to return to normal. The demobilization approach must be capable of growth and response to a sudden increase in deaths, should an unexpected wave of infection or influenza outbreak occur. Page 129 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Agency Command Demobilization: Logistics The Agency Logistics Chief will focus on closing ad hoc facilities such as the OSMs, RSFs, and BCPs. With the closure of these locations, the Logistics Chief will also need to alter service and/or support contracts like refueling BCPs. The Logistics Chief will provide direction to OCME personnel at each location, regarding management cleanup and return of equipment and durable supplies. Agency Command Demobilization: Finance/Administration While monitoring time/labor, costs, budget and purchasing becomes less challenging during the Demobilization Phase of a disaster, it is likely that the OCME Finance/Administration personnel will maintain a steady operational pace for some time. The Finance/Administration staff will need to reconcile expenses from all operations to predict what future expenses may tally and to analyze the impact the event has on the agency, in order to obtain local, state and/or federal disaster funds. Decentralized Command Activities during Demobilization Decentralized Command Demobilization: General The Fatality Management Branch Director will identify operations that can be deactivated, in order to downsize the number of resources dedicated to biological incident cases. In most instances, the operations will start by decreasing the number of recovery teams, BCP, OSM, and RSF as necessary. Demobilization of borough operations may occur independently depending on the rate of new incident-related cases. As operational activities decrease, the FM Branch Director will begin to centrally locate its capabilities near their borough location, to accommodate an unexpected future surge in decedents, should another wave occur. Demobilization: Scene Operations Scene Operations will also begin to decrease as fewer residential and HCF deaths occur. It is unlikely that the funeral industry will be able to immediately return to its normal practice, particularly if they are processing final disposition for decedents held in RSFs, or who have been temporarily interred. As such, it is likely that non-incident deaths usually never seen by the agency will become the OCME’s responsibility. As entities are able to return to normal practice, Recovery Operations will revert to the METT method of holding bodies for claim. Demobilization: Postmortem Processing Postmortem Processing operations will be the last component to be downsized due to the need for extended storage. As the number of cases drop, each borough location will Page 130 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths gradually be able to accommodate its regular caseload, as well as biological incident cases. Remains Storage Facility (RSF) Operations may not wane for several months after the biological incident has passed. The OCME will continue to hold bodies until they can be appropriately released to NOK for final disposition. The Disaster Response Coordinator in conjunction with the Chief Medical Examiner will determine how long bodies will remain in RSFs, based on available resources and body decomposition, which naturally occurs within six months even when the body remains in Demobilization: Antemortem Processing Antemortem Processing operations will begin to decrease as unidentified decedents are identified through scientific means and family interviews. Some individuals will likely not be identified within the time frame of the incident and a decision will need to be made regarding the length of time OCME will hold the remains before they are sent to City Burial. Page 131 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 132 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths VII. Incident Specific Mitigation Activities This segment of the document identifies Office of Chief Medical Examiner after action and mitigation activities. Page 133 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 134 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Internal Post Agency Response Assessment After OCME activities return to normal, the Disaster Response Coordinator and the senior leadership in the agency will perform a Post Response Assessment. The assessment will focus on several key aspects to include, but not limited to, staff roles and responsibilities, just-in-time training, safety, process flow, bottlenecks in the process, recommendations for improving bottlenecked areas, use of technological advances, intra and interagency communication, use of ad hoc staff, recommended management improvements and recommended staff improvements. Each section will quantify its activities and, if possible, provide a comparison to normal operation figures for the same categories, and a comparison to biological incident operations at the highest influx of decedents. Some examples of the type of quantifiable categories include, but are not limited to, the following: • • • • • • • • • • Time it took to process remains in each functional area Time it took to contact NOK Employee injury and illness, both incident-related and non-incident related Storage capacity of types of units actual and projected Delivery time for supplies/equipment and BCPs Maintenance turnaround time Time to notify specific groups - funeral directors, religious groups, etc. Number of remains processed through OCME Number of cases where OCME managed final disposition Length of time in storage The goal is to help the agency and staffs assess the magnitude of their response and to gain perspective regarding what similar future efforts may entail. After Action Report (AAR) Following a biological incident, the agency command staff will conduct verbal briefings with their staffs and will formalize lessons learned, based on their experience of managing biological incident cases. An After Action Report will be written, recommending potential solutions to enhance efforts and identifying successful techniques used during the response. Recommendations accepted by the City of New York Chief Medical Examiner will be reflected in the OCME All Hazards Mass Fatality Management Plan. The OCME will train personnel modularly on any modifications made to the plan, during regularly scheduled in-house training and symposiums, so that staff is prepared to respond to a biological incident. FEMA Reimbursement Based on the anticipated global magnitude of a biological incident, it is likely emergency declarations will be made on the local, state, and federal level, especially if terrorism is involved. The governor may make a request to the President of the United States for an Page 135 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths emergency declaration that will allow for federal reimbursement through the Federal Emergency Management Agency of disaster related expenses. The Agency Recovery Planning Specialist will work with OCME responders across the operations to collect documentation that will be necessary for this reimbursement process, including equipment use logs, employee hours and task logs, and documentation of any damaged equipment. Identification of Relevant Industry Issues In addition to identifying internal agency issues, the OCME will work with NYCEM and other agencies to refine external involvement in managing decedents. In some instances, external agency laws, practices, procedures or use of technology, will affect OCME operations. The OCME will always work with all City agencies to synchronize their response effort, for the purpose of improving interagency interaction during an actual event. Page 136 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Supporting and Technical References Page 137 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 138 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths A. General Information Page 139 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 140 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Acronyms A AAR After Action Report B BCP Body Collection Point B-OCME NYC Borough Office of Chief Medical Examiner C CDC Centers for Disease Control and Prevention CFR Case Fatality Rate CIMS Citywide Incident Management System CMS Case Management System D DCAS NYC Department of Citywide Administration Services DDRP Distributed Death Registration Process DDRS Distributed Death Registration System DEP NYC Department of Environmental Protection DHHS US Department of Health and Human Services DHS US Department of Homeland Security DMORT Disaster Mortuary Operational Response Team DNA Deoxyribonucleic acid DOC NYC Department of Correction Page 141 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths DOHMH NYC Department of Health and Mental Hygiene DoITT NYC Department of Information Technology & Telecommunications DRC Disaster Response Coordinator DPMU Disaster Portable Morgue Unit DSNY NYC Department of Sanitation DVI Disaster Victim Identification E EDRS Electronic Death Registration System EMS Emergency Medical Service EMT Emergency Medical Technician EOC NYC Office of Emergency Management Emergency Operations Center ER Emergency Room ESF Emergency Support Function F FAC Family Assistance Center FDNY NYC Fire Department FEMA Federal Emergency Management Agency G GNYHA Greater New York Hospital Association H HASP Health and Safety Plan Page 142 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Healthcare Facility HERDS Health Emergency Response Data System H+H NYC Health + Hospitals HRP Human Remains Pouch I IAP Incident Action Plan K K-OCME NYC Brooklyn Office of Chief Medical Examiner (Kings County) M METT NYC Medical Examiner Transport Team MFI Mass Fatality Incident MLI Medicolegal Investigator M-OCME NYC Manhattan Office of Chief Medical Examiner (New York County) N NIMS National Incident Management System NOK Next of Kin NYC New York City NYCEM NYC Office of Emergency Management NYPD New York City Police Department NYS DHSES New York State Department of Homeland Security and Emergency Services NYS DOH New York State Department of Health Page 143 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths O OCME NYC Office of Chief Medical Examiner OSM Off-Site Morgue P PIO Public Information Officer PE Personal Effects PPE Personal Protective Equipment Q QA/QC Quality Assurance/Quality Control Q-OCME NYC Queens Borough Office of Chief Medical Examiner (Queens County) R REMSCO NYC Regional Emergency Medical Services Council RSF Remains Storage Facility U US United States UVIS-CMS Unified Victim Identification System – Case Management System V VIC Victim Information Center W WHO World Health Organization Page 144 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Glossary Glossary of Terms 311 – 311 is New York City’s (NYC’s) phone number for government information and non-emergency services. Calls are answered 24 hours a day, seven days a week. NYC’s 311 operations provide immediate access to translation services in more than 170 languages, as well as access to a state-of-the-art database of information and services about city government. This database is updated in real-time, and can be reviewed quickly to meet demands in an emergency situation. During disasters, 311 functions to gather missing persons’ information to support the New York Police Department (NYPD) and the Office of Chief Medical Examiner (OCME) investigations. 911 – 911 is the official emergency number for NYC. Dialing 911 quickly connects the caller with a dispatcher trained to route calls to local emergency medical, fire, and law enforcement agencies, as appropriate. Calls are answered 24 hours a day, seven days a week. Autopsy – An autopsy is a medical procedure consisting of a thorough examination of a corpse to determine the cause and manner of death, and to evaluate any disease or injury present. It is usually performed by a specialized medical doctor called a pathologist. Autopsies are performed for legal or medical purposes. Body Collection Point (BCP) – A BCP is a temporary storage location used to expand refrigerated storage capacity. BCPs are intended to provide temporary refrigerated storage of remains while decedent recovery operations are ongoing or, if at a HCF, until OCME personnel approve of transport to an OCME facility. Casualty – A casualty is an individual who is injured or becomes ill following an incident. This term does not typically include the deceased, who are labeled “fatalities.” City Burial – This refers to disposition of unidentified or unclaimed remains managed by the OCME and Department of Correction (DOC). The OCME and DOC are responsible for managing in-ground burial of unidentified bodies, bodies having been identified but not having been claimed by the next of kin (NOK), and decedents for whom the NOK does not have the resources to administer final disposition. CityNet - This is the New York City’s Intranet, which is used by city governmental agencies. City of New York Counties and Boroughs - Five of New York State’s 62 administrative counties – New York, Kings, Queens, Richmond, and Bronx – are within NYC. These counties do not have functioning county governments, although they each have a borough president. They are coextensive with the five boroughs. Two, Queens and Bronx, share the same name as the borough. Richmond County is known as the Borough of Staten Island, Kings County is the Borough of Brooklyn, and New York County is the Borough of Manhattan Claim Only Case – A claim only case is a death that does not meet the criteria for a reportable death (see www.nyc.gov/ocme); typically a natural death certified by a Page 145 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths treating physician. Because OCME serves as the city’s mortuary, it is obligated to assist HCFs in long-term storage of decedents. These cases do not require a medicolegal investigation, and will either be released to a funeral director per family instructions or released for City Burial, if appropriate. Department of Health and Mental Hygiene Emergency Operations Center – DOHMH will establish an emergency operations center during a disaster event, including a biological incident, to coordinate planning and response activities. Disaster Response Coordinator – The Disaster Response Coordinator (DRC) is a senior official within the NYC OCME who will oversee the response to a biological incident. The DRC will be responsible for staffing the appropriate command positions, communicating with the OCME Executive Team, and coordinating OCME response with external city agencies and politicians. Distributed Death Registration Process (DDRP) – This is a decentralized method used by the Office of Vital Records, part of the Department of Health and Mental Hygiene’s (DOHMH’s) Bureau of Vital Statistics, to register death certificates and obtain burial/cremation permits. DDRP may entail either posting Office of Vital Records staff at B-OCMEs and OSMs, or establishing the electronic death registration system (EDRS) at B-OCMEs, OSM and HCFs. EDRS is a secured Internet application enabling hospital and medical examiner staff to electronically submit death certificates to the Office of Vital Records for registration. EDRS can also be used by funeral directors to check on the status of registered death certificates and print burial/cremation/transportation permits at their funeral home location. Disaster Portable Morgue Unit (DPMU) – The DPMU is a depository of equipment and supplies that can be deployed to an identified morgue site to support postmortem operations. The DPMU includes pre-packaged inventories to enable trained personnel to complete the processing of remains. Emergency/Disaster Declarations – These are official emergency declarations made by specified elected officials – at the local, state or federal level – authorizing the use of equipment, supplies, personnel and resources as may be necessary to cope with a disaster or emergency. Formal declarations are made when the event requires more assets and resources than exist within the jurisdiction. A declaration, on the local level, may result in funding, support and access to additional state or federal assets. Family Assistance Center (FAC) – A FAC facilitates the exchange of timely and accurate information with family and friends of injured, missing, or deceased disaster victims, the investigative authorities, and the medical examiner/coroner. Types of services generally include grief counseling, childcare, religious support, facilitation of family needs, antemortem data collection, and notification of death to the NOK. Although FACs can differ from one another, the OCME’s role at the FAC includes gathering antemortem data and notifying the NOK regarding the deceased. FACs can be physically or virtually established sites. Health and Safety Plan (HASP) – A HASP formally identifies the potential health and safety risks and countermeasures associated with operational unit practices. It addresses practices put in place to help prevent illness or injury. HASPs generally Page 146 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths include identification of potentially unsafe environments, the use of personal protective equipment (PPE), health or medical countermeasure practices, ingress and egress practices, and method for assessing unsafe situations. Health Care Facilities (HCFs) – HCFs include public and private hospitals, nursing homes, retirement facilities, prison health clinics, public health clinics, and mental health hospitals. For the purposes of this planning document, HCFs refer to the 67 hospitals within the five boroughs. Incident Action Plans (IAPs) – IAPs identify objectives that personnel must strive to accomplish during the next operational periods. IAPs help an agency maintain coordination between all functional areas and tasks during an operational period. IAPs: (1) specify the objectives for the next operational period; (2) define the work assignments for the next operational period, including site-specific safety messages; (3) define the resources needed to accomplish the work order; (4) depict how all response personnel are to be organized; (5) list radio and telephone communications for all incident personnel; (6) specify a medical plan to follow in case of a responder emergency; and (7) identify resources at risk. Incident Command System (ICS) – ICS is a method of command, control, coordination, and communication that enhances agency operations when responding to a disaster event. Typically, ICS refers to management of people performing specific functions within a leader’s span of control. Mass Fatality Incident (MFI) – A MFI is defined as an incident which produces fatalities of a sufficient number or complexity that special operations and organizations are required. The following criteria are for an incident to be defined as an MFI; (1) An incident with the potential to yield 10 or more fatalities; (2) An incident involving a protracted or complex decedent recovery operation; (3) An incident that has yielded more decedents than can be recovered and examined by the OCME and its associated resources; (4) An incident involving decedents contaminated by chemical, biological, radiological, nuclear, or high-yield explosive agents or materials; (5) An incident involving special circumstances that requires multi-agency support of MFM operations. Medical Examiner – A medical examiner is a physician who is appointed by the government to oversee and/or perform medicolegal death investigations. Medical Examiner Case – A medical examiner case includes any deaths of persons in the City of New York occurring from criminal violence, by accident, by suicide, suddenly when in apparent health, or in any unusual or suspicious manner. Deaths included in these categories must undergo a complete medicolegal investigation. Additionally, all cases must be investigated and obtain approval prior to release for cremation. Medicolegal – Pertaining to medicine and law. Medicolegal investigation – The medicolegal investigation includes the collection of data, photographs, evidence, witness interviews, external examination of the body at the scene, and other forensic information and analysis that will contribute to the determination of cause and manner of death, reconstruction of the accident or crime scene, and support the provision of survivability factors. The medicolegal investigation Page 147 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths falls within the exclusive purview of the medicolegal authority operating at the scene of an incident. Medicolegal Investigator (MLI) – A medicolegal investigator is an individual with the training and experience to conduct a competent, thorough, and independent investigation into the circumstances surrounding a death in accordance with the legal requirements of the jurisdiction. Missing & Unidentified Persons – Missing persons are those persons whose whereabouts are unknown to family or friends following an incident. Unidentified persons include those persons, both injured and deceased, who require the application of scientific methods to verify their identification. Scientific methods for identification include DNA, fingerprints, dental, radiographs, or medical record examination. Mortuary Affairs – Mortuary affairs is synonymous with fatality management, which is a general term referring to the provision of necessary care and disposition of missing and decedent persons, including their personal effects (PE). It is a term used by the Department of Defense (DOD) that encompasses the search, recovery, evacuation, tracking, tentative and confirmatory identification, processing, and temporary and/or final interment and/or re-interment of human remains. Off-Site Morgue (OSM) – An OSM is a temporary OCME facility where staff can process decedent identification and perform an external examination. In some cases, an OSM may have a full complement of equipment, supplies and personnel to perform all aspects of an internal examination/autopsy. Operational Period – The Disaster Response Coordinator (DRC) establishes the operational period as a length of time during a disaster event in which response personnel execute predetermined Situation Reports. During each operational period agency commanders identify and execute key objectives. These agency objectives are generally coordinated with other agencies’ objectives, to successfully mitigate the effects of a disaster. Typically, operational periods are shorter during initial occurrence of a disaster and grow longer as less complex coordination is required. New York City Emergency Management Emergency Operations Center (NYCEM EOC) – The New York City Emergency Management will stand up a city-wide Emergency Operations Center with representatives from each city agency involved with the pandemic response. Pandemic – A pandemic is a global outbreak of a contagious illness or disease. Personal Effects (PE) – This refers to property, including clothing, jewelry, wallets or other items found on a decedent’s body. Such items are often categorized as durable or non-durable, and are used to help identify casualties and decedents. Point of Dispensing (POD) – A POD is a specific location where appropriate medical or trained staff dispenses medications to large numbers of people in order to prevent them from contracting a specific infection, illness, or disease. Page 148 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Remains Storage Facility (RSF) – An RSF is a cold storage unit established at a fixed facility or off-site morgue (OSM) that augments decedent and PE storage capacity. RSFs can be refrigerated CONEX boxes, 18-wheeler trailer units, tents, or permanent facilities. Resource Typing – A uniform method for requesting resources that includes details such as specific equipment, supplies, personnel, services, and facilities to ensure the required capability is met. Resource typing involves identifying the name, category, kind, components, metrics, type, and additional information. The United States Department of Homeland Security is currently developing a national resource typing model specific to fatality management as part of the National Incident Management System. Standard Precautions – Public health agencies provide this official guidance regarding basic clothing and equipment that health care workers must wear to protect themselves from cross-contamination with a patient’s blood, body fluids and/or respiratory droplets. Standard Precautions involve: • Performing hand hygiene before and after all patient contact or contact with items potentially contaminated with blood or body fluids • Wearing gloves, gowns, masks and eye and/or facial protection to prevent contact with mucous membranes, non-intact skin, blood and other moist body substances as determined by the nature and extent of the anticipated exposure • Removing all PPE and discarding it immediately after completion of a task; and performing hand hygiene Staging Area – This is a designated location where OCME personnel gather equipment and assignments before responding to an incident. OCME has pre-designated 421 E. 26th Street as the location where command staff personnel will report. FDR Drive at East 18th Street is the designated location for field response teams (i.e. MLI, METT, and Medical Examiner Special Operations Response Team) to report before going to an incident site. The OCME will determine alternate staging locations as dependent on disaster operations and environmental constraints. Unified Victim Identification System – Case Management System (UVIS-CMS) – A database system used by 311 NYC operators, NYPD, and OCME to document daily caseload and gather key information to facilitate compiling an accurate list of missing persons thereby enhancing missing persons’ investigation efforts during and after disaster events. UVIS-CMS is also used by the OCME to track decedents, collect antemortem information, and collect postmortem findings to facilitate the identification process during a disaster event. UVIS-CMS will also include a HCF module application so that HCFs may “self-report” decedents requiring the OCME to hold a body for claim and/or process decedents for identification or City-directed burial. HCFs will be able to communicate their needs to obtain a BCP, exchange a BCP, or refuel or obtain maintenance support via the UVIS-CMS application in addition to reporting their needs through the Emergency Support Function (ESF) #8 Health and Medical Desk at the NYC EOC. Victim Information Center (VIC) – The VIC is the component of the Family Assistance Center (FAC). The VIC is established by OCME to conduct antemortem interviews and Page 149 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths collect information, evidence, and samples from families and friends to support the disaster victim identification (DVI) process. Page 150 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Internal Contact List COMMAND & CONTROL Chief ME Dr. Sampson 917-682-8465 Disaster Response Coordinator DePaolo 917-440-7489 Public Information Officer Bolcer 347 374 0133 Operations Center Coordinator Carroll 646-706-3850 Regional MFM Coordinator Carroll 646-706-3850 E-Team Feit 917-217-6136 Security Kirkpatrick 917-217-6002 Information Technology Ullah 347-413-1474 Housekeeping Behrens 212-323-1651 FM Branch Director Cooney 646-235-5803 Assessment Team Leader Tour Commander 212-323-1892 METT Ruggiero 212-323-1891 Logistics Chief Quintanilla 917-572-7620 Tour Commander Rotating Position 212-323-1892 OPERATIONS CENTER SCENE VEHICLES 212-323-1614 212-323-1615 212-323-1616 Command Vehicles-OCME Page 151 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths MOURGUE Disaster Morgue Manager Graham 347-682-0703 Mortuary Director Ruggiero 347-386-9754 Health & Safety Dick 212-323-1406 Intake Ruggiero 347-386-9748 Triage Adams 646-879-7873 X-Ray Higham 917-855-9156 Pathology Slone 212-447-2403 Fingerprint Bocanegra 347-668-1545 Odontology Dobrin 908-307-2289 DNA Dennis 917-807-5355 Evidence (Unassoc / Assoc) Feit 917-731-6136 Photography Rainwater 347-245-8330 Anthropology Consult Adams 646-879-7873 Body Escort Ruggiero 347-386-9748 Facilities Behrens 631-495-0357 Supply Williams 347-556-8980 Exit Review Conlon 347-865-2187 DVI Entry Hutson 646-306-3961 Field HS Coordinator Maniotis 646-612-0866 VIC Manager Desire 917-295-1532 DVI Coordinator Hutson 646-306-3961 MORGUE FORENSIC UNIT MORGUE SUPPORT UNIT MORGUE DVI UNIT FAC Page 152 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths EMERGENCY PHONE LINES LOCATION PHONE TYPE PHONE NUMBER 421, 6th Floor Red phone, Copper Wires (212) 779-3054 Red phone, Copper Wires (212) 779-3108 Red phone, Copper Wires (212) 779-3120 Red phone, Copper Wires (212) 779-1846 Red phone, Copper Wires (212) 689-0710 Red phone, Copper Wires (212) 252-8633 Red phone, Copper Wires (212) 779-3102 Red phone, Copper Wires (212) 779-3064 Red phone, Copper Wires (212) 252-8631 Red phone, Copper Wires (212) 689-0547 Red phone, Copper Wires (212) 252-8330 Red phone, Copper Wires (212) 252-8632 Red phone, Copper Wires (212) 252-8636 Red phone, Copper Wires (212) 252-8634 Red phone, Copper Wires (212) 252-8635 Red phone, Copper Wires (212) 252-8640 Red phone, Copper Wires (212) 252-8643 VoIP (212) 323-1533 Red phone, Copper Wires (212) 779-3165 VoIP (212) 323-1440 Red phone, Copper Wires (212) 779-3198 VoIP (212) 323-1539 Communications Desk #1 421, 8th Floor Communications Desk #2 421, 8th Floor Communications Desk #3 421, 8th Floor Communications Desk #4 421, 8th Floor Communications Desk #5 421, 8th Floor Communications Desk #6 421, 8th Floor Communications Supervisor Desk 421, 8th Floor 801C Desk 421, 8th Floor 801D Desk 421, 8th Floor 801 General Desk 421, 8th Floor 801 Transportation Desk 421, 8th Floor 801 Tour Commander Desk (Standing) 421, 8th Floor 801 Tour Commander Desk 421, 8th Floor 801 AOD Desk 421, 8th Floor 801 Ops Center Coordinator Desk 421, 8th Floor Back Room Tour Commander Desk 421, 8th Floor Back Room Tour Commander Desk 421, 8th Floor Back Room Communications Desk #2 421, 8th Floor Back Room Communications Desk #2 421, 8th Floor Back Room Communications Desk #3 421, 8th Floor Back Room Communications Desk #3 421, 8th Floor Page 153 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths EMERGENCY PHONE LINES PHONE TYPE PHONE NUMBER Red phone, Copper Wires (212) 252-8641 VoIP (212) 323-1595 Red phone, Copper Wires (212) 252-8642 VoIP (212) 323-1559 VoIP, Spider (212) 323-1592 VoIP, Spider (212) 323-1897 421, 10th Floor Red phone (212) 689-0413 421, 10th Floor Red phone (212) 689-0507 421, 8th Floor Cell Phone #2 (347) 844-0806 421, 8th Floor Cell Phone #3 (646) 761-3854 421, 8th Floor Cell Phone #4 (347) 844-1005 421, 8th Floor Cell Phone #5 (347) 844-0466 421, 8th Floor Cell Phone #6 (347) 844-0794 421, 8th Floor Cell Phone #7 (347) 844-0793 421, 8th Floor Cell Phone #8 (347) 844-0795 Queens Conference Room Red phone, Copper Wires (718) 557-8751 Queens Conference Room Red phone, Copper Wires (718) 557-8737 Queens Conference Room Red phone, Copper Wires (718) 557-8716 LOCATION Back Room Communications Desk #4 421, 8th Floor Back Room Communications Desk #4 421, 8th Floor Back Room Communications Desk #5 421, 8th Floor Back Room Communications Desk #5 421, 8th Floor Back Room Conference Line #1 421, 8th Floor Back Room Conference Line #2 421, 8th Floor Page 154 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths External Agency Contact List New York City Emergency Management (NYCEM) NYCEM OCME Desk 718-422-8769 NYCEM Situation Room 718-422-8900 NYCEM Podium 718-422-8800 NYCEM Watch Command 718-422-8700 NYCEM Logistics Center 718-422-1770 NYCEM Health & Medical 718-422-8904 NYCEM First Deputy Commissioner 718-422-4615 Air National Guard - Fatality Search and Recovery Team (ANG-FSRT) Command Readiness 301-836-8169 American Red Cross (ARC) Regional Sr. Director Support Services 212-875-2257 Director of Response, NYC 212-875-2140 Center for Disease Control and Prevention (CDC) Health Physicist 404-406-7378 Department of Corrections (DOC) Special Operations Division 718-646-1567 Department of Education (DOE) Emergency Management 718-610-0266 Department of Environmental Protection (DEP) Division of Emergency 718-595-6444 NYC Department of Health (DOHMH) Administrator On Call 347-723-1976 Emergency Preparedness and Response 347-396-2722 Communicable Diseases 347-396-2656 Department of Information Technology and Telecommunications (DoITT) Emergency Planning and Coordination 212-788-6460 Page 155 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths NYC Department of Transportation (DOT) Emergency Response 718-707-3529 Fire Department (FDNY) FDNY Planning Unit 718-999-2957 FDNY EMS 718-999-2772 Greater New York Hospital Association (GNYHA) Executive Management, Corporate Communications 212-506-5423 NYC Health + Hospitals (H+H) Emergency Preparedness 212-788-3648 Mayor’s Office Community Affairs Unit 212-788-3037 Immigrant Affairs 212-788-6779 Metropolitan Funeral Directors Association President 877-652-7326 Executive Director 800-763-8332 National Transportation Safety Board (NTSB) Disaster Assistance 202-314-6185 Medicolegal Operations 800-683-9369 New York State Bureau of Funeral Directors Director 518-402-0785 New York State Department of Health (NYS DOH) Emergency Preparedness 212-417-5458 MARO Regional 212-417-5480 MARO Regional 212-471-5550 Wadsworth Center 518-474-7592 518-281-6216 New York State Division of Homeland Security and Emergency Services (DHSES) Office of Emergency Management 518-292-2275 Region I 631-952-6322 Page 156 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Police Department (NYPD) NYPD Operations 646-610-5580 Missing Persons Unit 212-694-7781 Regional Emergency Medical Services Council (REMSCO) General 212-870-2215 Sanitation Department (DSNY) Operations, Equipment 646-885-4856 Operations 646-885-4534 United States Department of Health and Human Services (US DHHS) Region II 212-264-4494 Region II 212-264-2745 Page 157 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 158 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths B. Pathogen Information This information is intended for reference and educational purposes only. Page 159 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 160 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Anthrax (Bacillus anthracis)19,20 Pathogen Type Bacteria • • Natural Reservoir Infection Pathway Primary MFI Threat Cutaneous Working with infected animal products Gastrointestinal Consumption of undercooked infected meat Inhalation Exposure to aerosolized spores Injection Emerging – correlated with IV drug use Bioterrorism – aerosolized dispersal [inhalation] • • Scale/Magnitude Epidemic Curve Endemic to animal populations Spores remain dormant in soil for decades Dependent on dispersal method and exposed population National Planning Scenario estimates dispersal in populated area could result in over 300,000 exposures and 13,000 fatalities21 Point common source (bioterrorism) • • Timeframe Majority of cases present within typical incubation period Death occurs approximately two days after illness without treatment Transmission Direct exposure; No person-to-person Infectious Dose22 LD50: 8,000 – 50,000 spores Incubation Period 1 – 7 days; Up to 60 days in rare cases Illness Duration 3 – 5 days • • Symptoms • • • Fever and chills Chest discomfort and shortness of breath Confusion or dizziness Cough • • • • Nausea, vomiting, and stomach pain Head and body aches Sweating Extreme fatigue • Presence of mediastinal widening or pleural effusion, as seen on chest x-ray or CT scan Laboratory/culture confirmation Treatment • • Antibiotics General supportive care Case Fatality Rate • • 90% without treatment 55% with aggressive and prompt treatment Findings23 • • • • Hemorrhage of the mediastinum Enlarged hilar and peribronchial lymph nodes Hemorrhage along trachea and mediastinal lymph nodes Bacili may be sparse in samples of patients who have received treatment PPE Recommendations • • Standard Protection Prophylaxis (if possible) Final Disposition Recommendations24 • • Cremation preferred to burial due to concerns about spore dormancy Burial methods should seek to reduce potential for soil contamination Diagnosis Autopsy 19 Centers for Disease Control and Prevention: Anthrax, 2015. National Response Team Quick Reference Guide: Bacillus anthracis (Anthrax). 2008. 21 National Planning Scenario #2. United States Department of Homeland Security. 22 LD 50 refers to the median lethal dose of a pathogen 23 Gill, JR and Melinek, J. 2002. Inhalational Anthrax: Gross Autopsy Findings. Arch Pathol Lab Med, Vol 126; 993-994. 24 Anthrax in humans and animals, Fourth Edition. 2008. World Health Organization. 20 Page 161 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Pandemic Influenza (Influenzavirus A subtypes)25 Pathogen Type Virus Natural Reservoir Animal influenza virus mutates to allow for human-to-human transmission Infection Pathway Direct exposure to droplets from contagious individual Primary MFI Threat Naturally occurring pandemic • • Scale/Magnitude Epidemic Curve Dependent on CFR for pandemic viral subtype 2% CFR in NYC would produce over 50,000 fatalities26 Propagated • • Timeframe Typically 8 – 12 weeks Multiple peaks of cases Transmission Large-particle respiratory droplet; Person-to-person Infectious Dose Variable Incubation Period 1 – 4 days Illness Duration 1 – 2 weeks • • • • • Symptoms Diagnosis 100ºF or higher fever Cough and/or sore throat Acute respiratory distress Nasal congestion Head and body aches • • • • Chills Fatigue Nausea, vomiting, and/or diarrhea Pneumonia Laboratory confirmation via subtyping • • • Treatment General supportive care Antivirals Treatment for secondary infections (such as bacterial pneumonia) Variable – see Pandemic Severity Index below • Category 1: CFR < 0.1% • Category 2: CFR 0.1% - 0.5% • Category 3: CFR 0.5% - 1% • Category 4: CFR 1% - 2% • Category 5: CFR > 2% Case Fatality Rate Autopsy Findings27 • • • Diffuse alveolar damage (DAD) Hemorrhage and acute bronchopneumonia Hemophagocytosis (histological) PPE Recommendations Standard Precautions Final Disposition Recommendations None 25 Centers for Disease Control and Prevention: Influenza (Pandemic). 2015. Internal estimate based on NYC demographics 27 Harms, PW et al. 2010. Autopsy findings in eight patients with fatal H1N1 influenza. American Journal of Clinical Pathology. 134:27-35. 26 Page 162 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Plague (Yersinia pestis)28,29 Pathogen Type Bacteria Natural Reservoir Fleas and wild rodents • • • • Infection Pathway Bite from infected fleas Direct contact with infected animals Inhalation of respiratory droplets from infected person Primary location of infection determines form o Bubonic: lymphatic system o Pneumonic: respiratory system o Septicemic: blood stream Primary MFI Threat Bioterrorism – intentional aerosol dispersal [pneumonic] Scale/Magnitude Dependent on exposed population Epidemic Curve Mixed; Initial direct exposure from point common source, Propagated with person-toperson transmission Timeframe Dependent on extent of transmission Transmission Respiratory droplet from infected person; Person-to-person Infectious Dose LD50: 1,000 - 100,000 microorganisms Incubation Period 1 – 3 days Illness Duration Variable • • • • Symptoms Diagnosis High fever Chills Headache Hemoptysis • • • • Toxemia Shortness of breath Difficulty breathing Cyanosis Laboratory testing of samples Treatment • • General supportive care Antibiotics (streptomyocin, doxycycline) Case Fatality Rate • • >90% if untreated <5% with prompt treatment Autopsy Findings30 • • Consolidation and hemorrhagic fluid in lungs Heavy intra-avleolar inflammation PPE Recommendations • • Standard precautions Respiratory droplet protection Final Disposition Recommendations31 • • Use of chlorine solution or other medical disinfectant No preference for burial or cremation 28 Centers for Disease Control and Prevention: Plague. 2015. National Response Team Quick Reference Guide: Yersinia pestis. 2011. 30 Wong, D. et al. 2009. Primary pneumonic plague contracted from a mountain lion carcass. Clinical Infection Diseases. 49:e33-38. 31 Disposal of dead bodies in emergency conditions. WHO Technical Note for Emergencies No. 8. World Health Organization. 29 Page 163 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Glanders and Melioidosis (B. mallei, B. psuedomallei)32,33 Pathogen Type Bacteria Natural Reservoir Soil and surface water; Typically infects horses, mules, and other mammals • • Infection Pathway Direct contact with infected tissues or bodily fluids Inhalation of aerosols or dust associated with infected organism Primary MFI Threat Bioterrorism – aerosolization dispersal [B. pseudomallei] Scale/Magnitude Dependent on exposed population Epidemic Curve Point Common Source (bioterrorism) • • Timeframe Majority of cases present within typical incubation period Death occurs approximately 7 – 10 days after illness without treatment Transmission Rare person-to-person with close contact Infectious Dose Unknown – low Incubation Period 1 – 21 days Illness Duration Varies; Acute (7 – 10 days) or chronic • • • • Symptoms Diagnosis Pneumonia Pulmonary abscesses Pleural effusion Cough • • • • Chest pain Shortness of breath High fever Rapid heart rate Laboratory testing of samples Treatment • • General supportive care Antibiotics Case Fatality Rate • • Estimated 100% without treatment Estimated 50% with treatment Autopsy Findings34,35 • • • • • Bronchopneumonia Acute necrotizing pneumonia Multiple abscesses on lungs, liver and kidney Fulminant sepsis Multiorgan system failure PPE Recommendations Final Disposition Recommendations Variable; Dependent on dispersal and function • Care should be taken during burial as B. pseudomallei is persistent in moist soils 32 Centers for Disease Control and Prevention: Burkholderia mallei (Glanders) and Burkholderia pseudomallei (Melioidosis). 2012. 33 National Response Team Quick Reference Guide: Burkholderia mallei and Burkholderia pseudomallei. 2011. 34 Miralles, IS et al. 2004. Burkholderia pseudomallei: A case report of a human infection in Ceará, Brazil. Rev. Inst. Med. Trop S. Paulo. 46(1):51-54. 35 Laboratory Exposure to Burkholderia pseudomallei – Los Angeles, CA, 2003. 2004. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. 53(42):988-990. Page 164 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Hantavirus36,37 Pathogen Type Virus Natural Reservoir Rodents • • Infection Pathway Primary MFI Threat Epidemic Curve Dependent on exposed population Long incubation period could allow for extended dispersals prior to knowledge of dispersal Point Common Source (bioterrorism) • • Timeframe Transmission Infectious Bioterrorism – aerosolization dispersal • • Scale/Magnitude Bite from infected rodent Inhalation of particles from infected rodent urine, feces, saliva, and nesting materials Majority of cases present within typical incubation period Death occurs approximately 7 – 10 days after illness without treatment Person-to-person transmission rare with close contact with infected bodily fluids Dose38 Unknown Incubation Period 1 – 5 weeks Illness Duration 3 – 8 days • • • • Symptoms Diagnosis Fever Head and body aches Abdominal pain Nausea • • • • Rapid heart rate Decrease in blood pressure Hemorrhagic fever with renal syndrome Cardiopulmonary syndrome Laboratory testing of samples • • Treatment36 Ribavirin IV (hemorrhagic fever with renal syndrome only) Supportive care Case Fatality Rate Up to 50% Autopsy Findings39 • • • Pleural effusions Alveolar edema and fibrin Interstitial mononuclear cell infiltrate PPE Recommendations Standard precautions Final Disposition Recommendations No specific recommendations 36 Centers for Disease Control and Prevention: Hantavirus. 2012. National Response Team Quick Reference Guide: Hantavirus. 2012. 38 Hantavirus spp. Pathogen Safety Data Sheet – Infectious Substances. 2010. Public Health Agency of Canada. 39 Nolte, KB et al. 1995. Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent. Hum Pathol. 26(1):110-120. 37 Page 165 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Smallpox (Variola)40,41,42 Pathogen Type Virus Natural Reservoir Eradicated Infection Pathway • Inhalation of respiratory droplets Primary MFI Threat Bioterrorism – aerosolization Scale/Magnitude Dependent on exposed population / dispersal mechanism Epidemic Curve Mixed / Propagated • • Dependent on dispersal mechanism and degree of person-to-person transmission Single wave approximately two weeks to one month • • Inhalation Physical contact with infect bodily fluids Timeframe Transmission Infectious Dose 10 -100 viral particles Incubation Period 7 – 19 days Illness Duration 8 – 14 days • • • Symptoms Diagnosis High fever Malaise Body aches • • • Headaches Rash in mouth and throat Raised bumps over body Laboratory testing of samples Treatment • • Antivirals may be effective General supportive care Case Fatality Rate • • 30% without treatment Usually occurs in second week Autopsy Findings43,44 • Raised bumps on surfaces of internal organs PPE Recommendations • • • Vaccination Standard precautions HEPA-filtered breathing apparatus or SCBA for unvaccinated workers • • Cremation recommended For burial or processing, body should be double-bagged with zippers sealed with airtight tape in negative-pressure room Disaster pouches should be used in place of standard day-to-day human remains pouches Final Disposition Recommendations • 40 Centers for Disease Control and Prevention: Smallpox. 2007. National Response Team Quick Reference Guide: Smallpox (Variola major, Variola minor). 2012. 42 Medical Management of Biological Causalities Handbook – 7th Edition. United States Army Medical Research Institute of Infectious Diseases. 2011. 43 Reardon, S. 2014. Smallpox Watch. Nature. 509:22-24. 44 Personal communication with Scott Warnasch. (see 42) 41 Page 166 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Viral Hemorrhagic Fevers45,46,47 Pathogen Type Virus Natural Reservoir Variable; Most have animal source • • Infection Pathway Direct contact with bodily fluids or contaminated surfaces Airborne transmission or re-aerosolization Primary MFI Threat Bioterrorism – aerosolized dispersal Scale/Magnitude Dependent on number of Epidemic Curve Propagated Timeframe Variable Transmission Person-to-person via contact with bodily fluids Infectious Dose 1 – 10 viral particles Agentine (Junin) 7 – 14 days Bolivian (Machupo) 9 – 15 days Venezuelan (Guanarito) 7 – 14 days Brazilian (Sabia) 7 – 14 days Lassa 5 – 16 days Lymphocytic Choriomeningitis 8 – 13 days Crimean-Congo 3 – 12 days Rift Valley Fever 2 – 5 days Filoviridae Ebola / Marburg 3 – 16 days Flaviviridae Dengue Fever 3 – 5 days Arenaviridae Incubation Period Bunyaviridae 7 – 14 days Illness Duration • • • • • Symptoms Diagnosis Fever Eye redness Fatigue Muscle aches Bleeding from orifices • • • • • Internal bleeding Shock Nervous system malfunction Delirium Seizures Laboratory testing of samples • • Treatment Case Fatality Rate Autopsy Findings General supportive care Limited effectiveness of some antivirals on certain types of viruses Arenaviridae 15 – 30% Filoviridae 20 – 80% Bunyaviridae 20 – 50% Flaviviridae 20 – 50% Autopsy not recommended • PPE Recommendations48 • • Final Disposition Recommendations • • Disposable scrubs (undergarments) Impermeable coverall with hood (Tychem F) Gloves (triple layer – cotton, nitrile, and heavy) • • • • • HazMat boots Powered air purifying respirator with full facepiece Chem tape Impermeable apron with sleeves Face shield Cremation recommended Burial in standard metal casket in heat-sealed pouch 45 National Response Team Quick Reference Guide: Hemorrhagic Fever Viruses. 2012. Medical Management of Biological Causalities Handbook – 7th Edition. United States Army Medical Research Institute of Infectious Diseases. 2011. 47 Centers for Disease Control and Prevention: Ebola (Ebola Virus Disease). 2015. 48 OCME EVD Protocol, 2014. 46 Page 167 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Botulinum Toxin (Clostridium botulinum)49,50 Pathogen Type Biotoxin produced by bacteria Natural Reservoir Widespread in soil and aquatic sediments • • Infection Pathway Ingestion of contaminated food/water Inhalation of weaponized toxin or through laboratory contamination Primary MFI Threat Bioterrorism – aerosolization dispersal; food/water contamination Scale/Magnitude Dependent on exposed population Epidemic Curve • • Common source; May vary with dispersal mechanism Reaerosolization a concern Timeframe • • Several months Patients can survive for weeks prior to death Transmission • • No person-to-person Reaerosolization possible during some autopsy procedures Infectious Dose • • Inhalation: 0.70 – 0.90 µg Ingestion: 70 µg Incubation Period • • Inhalation: 24 hours to several days Ingestion: 6 hours to 10 days; typically 12 – 36 hours 2 – 8 weeks Illness Duration • • • • • Descending paralysis Difficulty with swallowing, vision, and speaking Diagnosis • • Clinical Laboratory testing of samples may be inconclusive Treatment • • • General supportive care Respiratory support Antitoxin Case Fatality Rate • • 50 – 60% without treatment 10% with treatment Autopsy Findings51,52 • • Diffuse muscular atrophy of skeletal muscle Autopsy not recommended due to risks of reaerosolization or splashes PPE Recommendations • Standard precautions • • Consider delayed release Toxin present on surfaces denatures after approximately 2 days (heat, dessication) Toxin detected in serum samples up to 11 days after exposure Symptoms Final Disposition Recommendations53 • Cranial nerve palsies Neurological symptoms Respiratory failure 49 National Response Team Quick Reference Guide: Botulinum Toxin. 2011. Medical Management of Biological Causalities Handbook – 7th Edition. United States Army Medical Research Institute of Infectious Diseases. 2011. 51 Devers, KG and Nine, JS. 2010. Autopsy findings in botulinum toxin poisoning. Journal of Forensic Sciences. 55(6):1649-1651. 52 Clostridium botulinum – Pathogen Safety Data Sheet. 2010. Public Health Agency of Canada. 53 Fagan, RP, McLaughlin, JB, and Middaugh, JP. 2009. Persistence of botulinum toxin in patients’ serum: Alaska, 1959 – 2007. Journal of Infectious Diseases. 199:1029-1031. 50 Page 168 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths C. Religious Considerations Page 169 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 170 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Religious Considerations Religious traditions surrounding death should be accommodated as much as feasibly possible during mass fatality incidents without impacting OCME operations or placing individuals at increased risk of contracting an illness. All major religions have some precedent (although in many cases it is not unanimous among leadership) and considerations for suspending traditional practices when decedents fall under medical examiner jurisdiction. The potential delayed release of remains in a mass fatality incident will be the primary conflict with most religious traditions. Generally full autopsies are not conducted following a mass fatality incident, but if the decision is made to do so, OCME personnel must be prepared to communicate these requirements to families and religious leaders. Certain religions require the complete body for proper burial – severe fragmentation along with delayed recovery or identification may be a conflict. Many religions do not allow cremation. Should cremation be mandated due to the presence of contamination, OCME personnel must be prepared to communicate this requirement to families and religious leaders. OCME personnel should ensure that any religious considerations that are not undue burden on disaster operations are met, if they are requested. For instance, Judaism and Hinduism require decedents to be accompanied prior to burial. OCME may consider having a religious leader from these faiths allowed near the disaster morgue or remains storage facility (RSF) to fulfill this requirement. Please see the below summary of potential conflicts between OCME MFM operations and major religions. Religions not listed do not have theological conflicts with medicolegal processes, including autopsy. • • Judaism54 Islam55 Catholicism56 • • • • • • • • • • • Autopsy forbidden, except when required by local law Burial should occur as soon as possible, preferably within 24 hours Decedent should not be left alone prior to burial Rabbinical presence during autopsy Cremation forbidden Whole body should be present for burial Autopsy forbidden, except when required by local law Burial should occur as soon as possible Cremation forbidden Autopsies allowed Cremation permitted Cremated remains should not be scattered Some interpretations require whole body for traditional burial 54 Guide to Jewish Funeral Practice (2016). United Synagogue of Conservative Judaism. Sheikh, Aziz. Death and dying – a Muslim perspective. 56 Catechism of the Catholic Church, Part Three: Life in Christ. The Vatican. 55 Page 171 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 172 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths D. Special Considerations and Guidance The following information serves only as guidance. Any operational decisions must be made based on the actual incident characteristics and by the appropriate subject matter experts. Page 173 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 174 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Biological Incident – Autopsy Considerations General Information During a mass fatality incident, victim identification takes precedence over determination of cause and manner of death, as these are usually known based on the context of the incident. Deaths resulting from biological incidents will largely be classified as either natural (in the case of pandemic influenza) or homicide (in the case of a bioterror attack). In both instances, autopsy policy will differ based on whether or not the individual has been identified, as the manner of death will be known and cause of death is secondary to identification. Confirmed Incident-Related Cases Identified and unidentified confirmed incident-related cases will not be autopsied and examinations will be limited to the identification modalities (Fingerprint, DNA, Odontology, and Anthropology, as necessary). Identifications will be confirmed prior to release to final disposition. Unconfirmed Incident-Related Cases Unconfirmed incident-related cases will be given complete autopsies in order to confirm whether or not the biological incident was the cause of death. Examinations will be performed by the Fingerprint, DNA, Odontology, and Anthropology teams in the attempt to identify the individual. Testing of tissue samples may occur in order to confirm illness if gross morphological signs are not clear or present. Page 175 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Biological Incident - Contaminated Specimens General Information Decedents in a biological incident will be biologically contaminated. The risk of postmortem transmission varies by pathogen. The Health and Safety Plan should address postmortem transmission risks. All efforts must be made to render samples (toxicological, histological, DNA, or other samples) safe or determine that specimens pose no threat to personnel prior to further examination. Subject matter experts will determine the allowable methodologies for determining the safety of or for rendering specimens safe (such as irradiating specimens contaminated with anthrax spores) based on the specifics of the incident. Specimens that cannot be determined or rendered safe will not be processed by OCME personnel. If processing the specimen is a necessity for fully examining the case and identifying the decedent, OCME will work to establish a contract with a laboratory or facility with the appropriate capabilities to conduct the required analyses. Page 176 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Biological Incident – Identification Considerations General Information During a biological incident, positive identification remains a priority for NYC Office of Chief Medical Examiner operations. Due to the nature of a biological incident, a large proportion of decedents are likely to have sought health care and whose identities are known prior to their death. Identified Decedents All identifications will be confirmed during the postmortem examination or autopsy (if conducted) prior to a decedent being released for final disposition. Unidentified Decedents Unidentified decedents will undergo examinations from the following forensic modalities in an attempt to identify them: • Fingerprint analysis • DNA • Forensic Odontology • Forensic Anthropology • Forensic Radiography All identification information will be collected and stored in OCME’s UVIS-CMS for potential future identification. When an unidentified decedent’s case has been reviewed and approval for final disposition, the individual will be temporarily interred at Hart Island per City Burial policy. The requirement for the body to be held in an OCME facility prior to burial is likely to be suspended due to the anticipated resource strain during a biological incident. Page 177 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Biological Incident – Burial/Cremation Considerations General Information In the event of a biological incident resulting in significant numbers of fatalities, burial and cremation practices and requirements are not likely to be altered. With the majority of pathogens capable of causing a widespread biological incident, scientific studies do not support mandatory cremation of individuals whose death was attributed to the incident, as these decedents do not pose a public health risk after death. Cremation is preferred with certain pathogens, including anthrax, smallpox, and viral hemorrhagic fevers, but burial may be allowed if additional precautions are in place (such as heat-sealed decedent pouches). Releasing of Remains During a biological incident, funeral directors will continue to be required to obtain release documentation in order to claim the decedent for burial from the NYC Office of Chief Medical Examiner. This can be requested through the OCME Communications Department. Obtaining Cremation Approval During a biological incident, funeral directors will continue to be required to obtain a “Cremation Approval” from the NYC Office of Chief Medical Examiner. This can be requested through the OCME Communications Department. Anticipated Delays in Processing Due to the large number of fatalities anticipated during a biological incident, delays in obtaining burial and cremation approvals will likely occur. Decedents will only be released to the funeral home once the postmortem examination or autopsy, identification, and case review has been completed. OCME will have appropriate temporary storage for all biological incident decedents, with refrigerated facilities preferred over temporary interment. Unidentified/Unclaimed Remains Biological incident decedents who are unidentified or unclaimed will be buried per City Burial policy at the city facility, Hart Island. Unidentified or unclaimed decedents will not be cremated, unless there is a compelling public health risk. Page 178 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Biological Incident – Temporary Interment Considerations General Information Large numbers of fatalities are anticipated during a biological incident. As postmortem examination and positive identification policies will not be compromised, the speed at which decedents can be processed will be decreased. Appropriate storage of these decedents awaiting approval for final disposition is paramount. NYC Office of Chief Medical Examiner will utilize refrigerated storage distributed across all five boroughs and the numerous hospital facilities, although the possibility exists for fatalities to outpace the available refrigerated storage. Temporary Interment If NYC cannot properly store decedents in refrigerated storage, the need for temporary interment on Hart Island may arise. Temporary interment is not to be confused with a final burial. Disinterment Decedents will be disinterred in an organized manner as the incident response operations continue and postmortem examinations and identifications can be performed. Decedents may be temporarily interred again if there is a backlog in releasing remains to funeral homes or approving cremation requests. Page 179 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 180 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths E. Suggested Equipment and Supply Lists Page 181 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 182 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Command and Control Equipment and Supplies by Function Function Equipment and Supplies ▪ ▪ ▪ ▪ Communication equipment (i.e., radios) Tables/chairs/tent structures (to establish the FM Scene Command Post) Office supplies (i.e., pencils, pens, notepads, clipboards, etc.) IT support (i.e., laptops/tablets, printers, etc.) Credentials Trash receptacles ▪ See General ▪ Communication needs (i.e., radios, phones, and video surveillance) Credentialing system and supplies (including any computers, printers, cameras, etc.) Signage supplies Perimeter/road blocking equipment and supplies Office supplies PPE See General ▪ General ▪ Health & Safety ▪ Security ▪ ▪ ▪ Public Information Liaison Planning ▪ ▪ ▪ ▪ ▪ Logistics ▪ Finance/Administration ▪ ▪ See General See General See OCME Vehicles (page 00) See General Access to OCME financial programs See General Page 183 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Equipment and Supplies by Function Function Equipment and Supplies ▪ ▪ ▪ General ▪ Health & Safety ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Investigation & Recovery ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Photography ▪ ▪ ▪ ▪ ▪ ▪ Remains Storage ▪ ▪ ▪ ▪ Security ▪ ▪ ▪ ▪ ▪ Communication equipment (i.e., radios) Tables/chairs/tent structures (to establish the FM Scene Command Post) Office supplies (i.e., pencils, pens, notepads, clipboards, etc.) IT support (i.e., laptops/tablets, printers, etc.) Credentials Tyvek suits in various sizes Gloves in various types (i.e., chem, nitrile, etc.) and sizes Hardhats Work boots/appropriate footwear Goggles/eye protection Appropriate clothing for inclement weather Copies of the Investigation/Recovery Form Measuring tapes Documentation supplies (i.e., clipboards, markers, pencils, etc.) Paper bags of varying sizes Plastic baggies of varying sizes Duct tape Bins for storing small bags of remains Human remains pouches (HRPs) of varying sizes Skeds/backboard Remains recovery tags and labels Zip ties Cameras Copies of the Photograph Log Form Compass Labels Neutral background material Measuring tape Copies of the Remains Storage Inventory Form HRPs of varying sizes Shelving units Generator and Fuel Lifting equipment Communication needs (i.e., radios, phones, and video surveillance) Credentialing system and supplies (including any computers, printers, cameras, etc.) Signage supplies Perimeter/road blocking equipment and supplies Trash receptacle Office supplies PPE Page 184 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Postmortem Processing Equipment and Supplies by Function Function Equipment and Supplies ▪ ▪ ▪ General ▪ ▪ ▪ ▪ ▪ Anthropology ▪ ▪ ▪ ▪ ▪ ▪ ▪ Body Escorts Communications ▪ ▪ ▪ DNA Communication equipment (i.e., radios) Tables/chairs/tent structures (to establish the FM Scene Command Post) Office supplies (i.e., pencils, pens, notepads, clipboards, etc.) IT support (i.e., laptops/tablets, printers, etc.) Credentials CMS Anthropology Station Barcode printer and scanner Anthropology tools and supplies − Calipers − Cloth measuring tape − Male/Female public symphysis cast set − Male/Female sternal rib cast set − Osteometric board − Shears − Large zip ties − Bench paper − American Board of Forensic Odontology (ABFO) scale − Sharps container − T-bars − Disposable scalpels Photography equipment and supplies Trash receptacle/red biohazard bins and bags Office supplies PPE Gurneys PPE Sufficient number of mobile telephones, fax machines, and computers capable of remote data transmission must be provided to operational units at each disaster morgue operation CMS DNA Station Barcode printer and scanner DNA sampling tools and supplies − 10% Bleach − Ethanol − Water − Autopsy saw and/or Dremel saw and replacement parts − Buccal swabs − Storage envelopes for buccal swabs − Evidence tape Page 185 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Function Equipment and Supplies DNA (cont) ▪ ▪ ▪ ▪ ▪ ▪ ▪ Dental ▪ ▪ ▪ ▪ − DNA kits − Falcon tubes (50 mL) − Forceps − Portable morgue table − Disposable scalpels − Specimen cups − Sharps container Photography equipment and supplies Trash receptacle/red biohazard bins and bags Office supplies PPE CMS Odontology Station Barcode printer and scanner Dental tools and supplies − Aribex NOMAD (charged) − Aribex NOMAD battery pack − DEXIS digital x-ray hardware (sensor and components) and software − Dental impression materials − Radiographic flatbed scanner (unlocked and placed in non-transport mode) − Disposable scalpels − Tweezers − Spreaders − Dental picks − Mirrors − Wooden tongue depressors − Plastic mouth guards − Shears − Mouth props silicon/rubber − Tooth brushes − Blunt needles − Extracting/lower/angled/straight forceps − Retractors − Periosteal elevator (7mm and 11mm) − Narrow spatula − Crowbar − Screwdriver − Oral rinse − Sharps container Photography equipment and supplies Trash receptacle/red biohazard bins and bags Office supplies PPE Page 186 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Function Equipment and Supplies ▪ ▪ ▪ Evidence (all stations) ▪ ▪ ▪ Exit Review Fingerprint ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ CMS Evidence Station Barcode printer and scanner Evidence supplies and equipment − Barrels for evidence (secure storage) − Evidence tape − Tamper-evident, self-sealing envelopes and bags − Paper evidence bags (various sizes: S, M, L) Photography equipment and supplies Trash receptacle/red biohazard bins and bags Office supplies − Chain of custody forms/Receipts/Vouchers PPE CMS Exit Review Station Barcode printer and scanner Trash receptacle/red biohazard bins and bags Office supplies File storage/container PPE CMS Fingerprint Station Barcode printer and scanner Fingerprint tools and supplies − Acetone − Alcohol pads − Black fingerprint powder − Camel/squirrel hair fingerprint brushes − Dermafil tissue builder − Evidence bags/cans − Example cards/forms/examination quality fingerprint scale − Fingerprint ink pad − Fingerprint spoon − Large adhesive lifters − Magnetic brushes − Magnifiers − Mikrosil containers − Dish soap − Quickprint trace evidence lifters fingerprint − Rubbing/isopropyl alcohol − Disposable scalpels − Scissors − String − Syringe and needles − Tissue builder − Tweezers − Weigh boats − Zip Ties Page 187 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Function Equipment and Supplies Fingerprint (cont) ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Forensic Radiography ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Health & Safety ▪ ▪ Photography equipment and supplies Trash receptacle/red biohazard bins and bags Office supplies PPE CMS Radiography Station Barcode printer and scanner Complete computed radiography (CR) system: CR reader, computer, monitor, CR cassettes (5), functioning software, and a functioning upload capability with connectivity hardware Portable x-ray unit, preferably digital − Note: If a CR system is used, a regular x-ray portable unit is required Portable developing unit (if not using a digital x-ray) − Developing supplies • Water • Chemicals (developer/fixer) • Film • Film bin • Cassettes • Darkroom • Film identification flasher • Film case folder Portable protective radiation shields Radiation dosimeters Photography equipment and supplies Trash receptacle/red biohazard bins and bags Office supplies PPE Qualitative fit testing equipment Eye/hand wash stations Cleaning/sanitizing/decontamination supplies Trash receptacle/red biohazard bins and bags PPE and other supplies necessary to promote personnel health and safety − N95 masks − Shoe covers − Plastic gowns − Goggles − Splash shields − Buffont caps − Safety glasses − Gloves in various sizes − Heavy duty gloves − Tyvek in various sizes Signage supplies Office supplies Page 188 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Function Equipment and Supplies ▪ ▪ ▪ ▪ ▪ Information Technology ▪ ▪ ▪ ▪ ▪ ▪ Intake ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Pathology Case management system Computers for each forensic specialty work area Data gathering tools/hardware Network access Communications equipment and supplies − Telephones, fax machines, and computers − 800 MHz radios Supplies to alter the IT infrastructure (e.g., extension cords, etc.) Office supplies PPE CMS Intake Station Barcode printer and scanner Intake supplies and equipment: − Shears − Large zip ties − Disposable scalpels Trash receptacle/red biohazard bins and bags Office supplies − Additional remains recovery tags (if needed to replace incoming tags) PPE CMS Pathology Station Barcode printer and scanner Autopsy lights Autopsy tables Sink Pathology tools and supplies: − Portable scale − Specimen containers − Scalpels (long and short handles) − Amputation knives − Dental picks − Scissors (various sizes) − Probes − Head blocks − Sharpening steel − Oscillating head saw with blades − Curved scissors − Virchow skull breaker (“T” bar) − Syringes − Curved hemostats (long, medium, small) − Straight hemostats (various sizes) − Forceps (various sizes) − Retractors − Bullet probes − Conical tubes Page 189 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Function Equipment and Supplies ▪ Pathology (cont) ▪ ▪ ▪ ▪ ▪ ▪ Photography ▪ ▪ − Suture and needles for body restoration − Rulers − Adult scale − Red/blue bins − Zip ties − Cutting boards − Alcohol swabs Pathology disposables: − Toxicology bucket/lid − Toxicology bottles (90 ml) − Toxicology jars (120 ml) − Tubes (red, purple, blue) − Stock jars − Histology cassette jar − Cassettes (white, yellow, pink) − Brain buckets − Heart buckets − Sex assault kits − RNA later tubes − Aerobic blood culture bottles − Anaerobic blood culture bottles − Viral culture swab kits − Bacterial culturettes Evidence equipment and supplies [see evidence list] Photography equipment and supplies [see photography list] Trash receptacle/red biohazard bins and bags Office supplies PPE One camera per station (also, one per autopsy table, one for evidence at the Triage Station, and one for evidence at the Pathology Station) that is accompanied by the following: − Battery charger − Spare batteries for each camera − Flash with batteries for each camera − Photo application installed and configured − Spare memory cards − Macro lens − Zoom lens − Strap for each camera − Tripod (optional) Adhesive scales to which the specimen barcode label can be printed or affixed Neutral-colored paper background for photographing objects removed from the body Page 190 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Function Equipment and Supplies ▪ Photography (cont) ▪ ▪ ▪ ▪ ▪ Remains Storage ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Security Triage ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Optional: One MC70 or MC75 per station, or other wireless enterprise digital assistant (EDA) with advanced data and image capture capabilities (it must be able to scan barcodes and instantly capture and transmit image and data files to a designated file location), each accompanied by the following: − Battery charger for each wireless EDA − Cables to attach the unit to the camera for each wireless EDA − Photo application installed and configured on each wireless EDA Photo log materials Trash receptacle/red biohazard bins and bags Office supplies PPE Refrigerated trailer unit or CONEX cold storage unit − Can be established in tent structures, trucks/vans, or body storage facilities Ramp(s) or lift gate for refrigerated trailer Remains trays Remains tracking mechanism/inventory form Body bags Carts/gurneys to move the remains PPE Communication needs (i.e., radios, phones, and video surveillance) Credentialing system and supplies (including any computers, printers, cameras, etc.) Signage supplies Perimeter/road blocking equipment and supplies Trash receptacle Office supplies PPE CMS Triage Station Barcode printer and scanner Triage supplies and equipment: − Shears − Large zip ties − Disposable scalpels Trash receptacle/red biohazard bins and bags Office supplies Photography equipment and supplies Trash receptacle Office supplies PPE Page 191 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Antemortem Processing Equipment and Supplies by Function Function Equipment and Supplies ▪ ▪ ▪ General ▪ ▪ ▪ ▪ ▪ ▪ ▪ VIC Reception ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ VIC Waiting Room ▪ ▪ ▪ ▪ ▪ ▪ ▪ Antemortem Interview Rooms ▪ ▪ ▪ ▪ Communication equipment (i.e., radios) Tables/chairs/tent structures (to establish the FM Scene Command Post) Office supplies (i.e., pencils, pens, notepads, clipboards, etc.) IT support (i.e., laptops/tablets, printers, etc.) Credentials Case management system with scheduling capability Desktop PC Phones with connectivity to all VIC functions Printer/scanner/copier/fax machine Credentialing system and supplies (including any computers, printers, cameras, etc.) Signage supplies Comfort items − Water and Tissues Trash receptacles Office supplies Adequate, comfortable seating Phone bank (landline telephones at a rate of 3 lines per 50 victims) Refreshments (e.g., water, coffee, etc.) Comfort items − Water and Tissues Informational literature regarding the DVI and antemortem interview process Signage supplies Lists of available resources for grief counseling, clergy, mental health, etc. Trash receptacles Desktop PC Dual PC screens (to allow the family to observe the data entry process) Case management system with Antemortem Interview Forms − Printed Antemortem Interview Forms as backup copies Phones with connectivity to all VIC functions Printer/scanner/copier/fax machine Barcode printer/barcode scanner (to scan/print case number labels for collected evidence, DNA, etc.) Evidence collection supplies − Evidence tape − Tamper-evident, self-sealing evidence envelopes and bags Page 192 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Function Equipment and Supplies − Antemortem Interview Rooms (cont) − Paper evidence bags (various sizes: S, M, L) − Chain-of-custody forms ▪ DNA collection kits − DNA Reference Sample Consent Form ▪ PPE (gloves for DNA collection) ▪ Informational literature regarding the DVI process, antemortem interview process, and DNA collection ▪ Comfort items − Water and Tissues ▪ Trash receptacles ▪ Office supplies The antemortem records management function will require that stations be established for each of the teams. ▪ ▪ ▪ ▪ ▪ ▪ Antemortem Records Management ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Security ▪ ▪ ▪ ▪ ▪ Desktop PC Case management system Phones with connectivity to all VIC functions Printer/scanner/copier/fax machine Barcode printer/barcode scanner (to scan/print case number labels for collected evidence, DNA, etc.) Evidence collection supplies − Evidence tape − Tamper-evident, self-sealing evidence envelopes and bags − Paper evidence bags (various sizes: S, M, L) − Chain-of-custody forms DNA collection kits − DNA Reference Sample Consent Form PPE (gloves for DNA collection) Record/file storage units Shipping materials and log books (if it is necessary to ship DNA kits to relatives who are not at the VIC, or to ship DNA samples to the laboratory) Trash receptacles Office supplies Communication needs (i.e., radios, phones, and video surveillance) Credentialing system and supplies (including any computers, printers, cameras, etc.) Signage supplies Perimeter/road blocking equipment and supplies Trash receptacle Office supplies PPE Page 193 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 194 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Vehicles Refrigerated Box Trucks – CME 66, 68 ..................................................... 196 Command Vehicles – CME 53, 54, 55, 69 ................................................. 197 Regional Command Vehicles – CME 88, 89, 90, 92, 93 ............................ 198 Emergency Support Unit (ESU) Truck – CME 63 ...................................... 199 Emergency Support Unit (ESU) Truck – CME 21 ...................................... 200 LDV Mobile Command Center – CME 51 .................................................. 201 Pickup Truck – CME 64 ............................................................................. 202 Response Cargo Van – CME 47................................................................ 203 Response Personnel Van – CME 91 ......................................................... 204 Security Command Vehicle – CME 116 ..................................................... 205 Tractor – CME 83 ...................................................................................... 206 Evidence Vehicle – CME 120 .................................................................... 207 Evidence Vehicle – CME 100 .................................................................... 208 Facilities Vehicle – CME 74 ....................................................................... 209 Facilities Vehicle – CME 107 ..................................................................... 210 Fleet Vehicle – CME 131 ........................................................................... 211 Fleet Vehicle – CME 40 ............................................................................. 212 IT Vehicle – CME 94 .................................................................................. 213 MLI Vehicles – CME 77, 78, 79 ................................................................. 214 MLI Vehicles – CME 108, 109, 110 ........................................................... 215 MLI Vehicles – CME 103, 104, 105 ........................................................... 216 MLI Vehicles – 128,129,130 ...................................................................... 217 Mortuary Vehicles – 37, 45 ........................................................................ 218 Mortuary Vehicles – CME 71, 72, 73; 80,82 .............................................. 219 Mortuary Vehicles – CME 102,119 ............................................................ 220 Mortuary Vehicle – CME 112 ..................................................................... 221 Receiving Vehicle - CME 101 .................................................................... 222 Page 195 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Vehicles Refrigerated Box Trucks – CME 66, 68 Purpose: The Refrigerated Box Trucks can deliver equipment to a disaster scene or be used as a temporary, refrigerated remains storage unit that can each hold approximately 30 bodies without shelving. Capabilities: The Refrigerated Box Trucks are equipped with a motorized lift gate, metal floor, refrigeration, and interior lights. Specifications: ▪ Make: Ford F650 ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White ▪ Four doors ▪ Dimensions: o Length: ▪ Box: 22’ ▪ Total: 34’ o Width: 8’ o Clearance: 11’6” ▪ Engine: o 6.7L o 220hp ▪ Fuel o Diesel o 100 gal ▪ Total Empty Weight: 19,460 lbs. o Includes full tank of gas ▪ Maximum Capacity: 26,000 lbs. o Includes cargo and passengers Equipment: ▪ Straps ▪ Braces Driver Requirements: ▪ None Page 196 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Command Vehicles – CME 53, 54, 55, 69 Purpose: These vehicles function as rapid deployment mobile command centers in the event of a New York City mass fatality incident. Capabilities: These vehicles can seat five people and provide rapid response and onscene communications. Specifications: ▪ Make: Ford Escape ▪ Quantity: 4 ▪ Year: 2007 ▪ Color: − 3 white marked − 1 black unmarked ▪ Four doors ▪ Dimensions: − Length: 14’5” − Width: 5’9” − Height: 5’5” ▪ Engine: − Size: 2.5L, I-4, − Horsepower: 171 ▪ Fuel: − Type: Regular − Capacity: 17.5 gal − 20 MPG ▪ Automatic transmission ▪ Front and side airbags Equipment: ▪ Regular Body Bags ▪ Disaster Pouches ▪ Toughbooks ▪ GPS unit ▪ Portable radios ▪ Hard hats ▪ Latex gloves ▪ Disaster tags ▪ Zip Ties ▪ Assorted PPE ▪ Biohazard bags ▪ Lights and Sirens Driver Requirements: ▪ None Page 197 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Regional Command Vehicles – CME 88, 89, 90, 92, 93 Purpose: These vehicles function as rapid deployment mobile command centers in the event of a regional mass fatality incident. Capabilities: These vehicles can seat five people and provide on-scene communications. Specifications: ▪ Make: Ford Expedition ▪ Quantity: 5 ▪ Year: 2010 ▪ Color: Black ▪ Four doors ▪ Dimensions: − Length: 18’4” − Width: 7’6” − Height: 6’5” ▪ Fuel: − Type: Regular − Capacity: 18.6 gal − 20 MPG ▪ Engine − Size: V-8, 5.35L − Horsepower: 290 ▪ Automatic transmission ▪ Front and side airbags ▪ Rear storage cabinets ▪ Pop-up awning Equipment: ▪ Regular Body Bags ▪ Disaster Pouches ▪ Toughbooks ▪ NetGear routers ▪ GPS unit ▪ Portable radios ▪ NYCWIN wireless connectivity ▪ Latex gloves ▪ Disaster tags ▪ Zip ties ▪ Assorted PPE ▪ Biohazard bags ▪ Hard hats Driver Requirements: ▪ None Page 198 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Emergency Support Unit (ESU) Truck – CME 63 Purpose: The ESU Truck quickly provides crucial investigation and recovery equipment to a mass fatality incident. Capabilities: The ESU Truck can be quickly deployed to deliver personnel and equipment to a mass fatality incident of 30 victims or provide support for a larger incident. The ESU truck can tow asset trailers. Specifications: ▪ Make: Ford F-550 ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White Marked ▪ Four doors ▪ Dimensions: − Length: 26’ − Width: 8’ − Height: 9’6” ▪ Engine: − Size: 6.0L/8 cylinder − Horsepower: 362 ▪ Fuel: − Type: Diesel − Capacity: 45 gal ▪ Hitch: 25/16” Ball Equipment: ▪ PPE ▪ Hard hats ▪ Human Remains Pouches ▪ Skeds ▪ Investigation equipment ▪ Recovery tools ▪ Radios Driver Requirements: ▪ None Page 199 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Emergency Support Unit (ESU) Truck – CME 21 Purpose: The ESU Truck can be deployed to deliver personnel and equipment, as needed, to a mass fatality scene. Capabilities: The ESU Truck can be quickly deployed to deliver personnel and equipment to a mass fatality incident of 30 victims or provide support for a larger incident. The ESU truck can tow asset trailers. Specifications: ▪ Make: Ford F-550 ▪ Quantity: 1 ▪ Year: 2001 ▪ Color: White Marked ▪ Four doors ▪ Dimensions: − Length: 26’ − Width: 8’ − Height: 9’6” ▪ Engine: − Size: 6.0L/8 cylinder − Horsepower: 362 ▪ Fuel: − Type: Diesel − Capacity: 45 gal ▪ Hitch: 25/16” Ball Equipment: ▪ PPE ▪ Hard hats ▪ HRPs ▪ Skeds ▪ Investigation equipment ▪ Recovery tools ▪ Radios Driver Requirements: ▪ None Page 200 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths LDV Mobile Command Center – CME 51 Purpose: The OCME LDV can quickly respond to a mass fatality incident and serve as an on-site mobile command center. Capabilities: The OCME LDV is fully equipped to serve as a mobile command center, private meeting room or work space. The unit can be run on generator or shore power. It is equipped with air conditioning and heating. The LDV can comfortably accommodate six people while parked. Specifications: ▪ Make: LDV ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White/Marked ▪ Dimensions: − Length: 27’ − Width: 8’6” − Height: 12’8” ▪ Engine: 190 hp ▪ Fuel: − Type: Diesel − Capacity: 45 gal ▪ AC/Heat Equipment: ▪ Two computer work stations ▪ Network printer ▪ Camera monitors and exterior camera ▪ Telephones, radios, and conference bridge ▪ Storage space ▪ Microwave communication transmitter system (BATS) ▪ Flood lights ▪ Crow’s nest Driver Requirements: ▪ None Page 201 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Pickup Truck – CME 64 Purpose: Asset and personnel transport, snow removal, and mobile fuel tank transport. Capability: Provide rapid scene support and asset trailer towing, as well as seating for 5 passengers. Specifications: ▪ Make: Ford F-350 ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White ▪ Crew Cab ▪ Four door ▪ Dimensions: − Length: 22’ − Width: 8’ − Height: 6’8” ▪ Max Bed Weight: 4,000 lbs ▪ Max Tow Weight: 10,000 lbs ▪ Engine: − Size: V10 − Horsepower: 300 ▪ Fuel: − Type: Regular − Capacity: 35 gal ▪ Hitch: 2 5/16” ball ▪ Lights ▪ Heat/AC ▪ 2-way radio ▪ 4-wheel drive Equipment: ▪ Tools ▪ Straps ▪ Radio ▪ Snow plow Driver Requirements: ▪ None, unless towing trailer that weighs 10,000 lbs Page 202 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Response Cargo Van – CME 47 Purpose: This Response Cargo Van can deliver critical response equipment to a mass fatality incident. Capabilities: The vehicle seats two and includes equipment storage shelving. Specifications: ▪ Make: Ford ▪ Model: E350 ▪ Quantity: 1 ▪ Year: 2006 ▪ Color: White ▪ Dimensions: − Length: 18’ − Width: 8” − Height: 7’5” ▪ Engine: − Size: 5.4L, V8 − Horsepower: 255 ▪ Fuel: − Regular − 35 gal ▪ Weight: 9,500 lbs ▪ Maximum Payload: 3,915 lbs Equipment: ▪ Radio ▪ PPE ▪ Hard hats ▪ Hand tools ▪ HRPs Driver Requirements: ▪ None Page 203 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Response Personnel Van – CME 91 Purpose: This vehicle can deliver personnel to Scene, Morgue, or FAC. This vehicle has a limited towing capacity but can be used to transport light towers and other small equipment. Capabilities: Delivers up to 12 critical response personnel to mass fatality incident muster points. May be used to tow small items, such as light towers. Specifications: ▪ Make: Ford ▪ Quantity: 1 ▪ Year: 2010 ▪ Color: Black ▪ Dimensions − Length: 22’ − Width: 6’9” − Height: 7’5” ▪ Engine: − Size: 5.4L, V8 − Horsepower: 255 ▪ Fuel: − Type: Regular − Capacity: 35 gal ▪ Weight: 9,500 lbs ▪ Maximum Payload: 3,915 lbs ▪ Hitch: Pintle Equipment: ▪ Radios Driver Requirements: ▪ None Page 204 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Security Command Vehicle – CME 116 Purpose: This vehicle functions as an agency patrol vehicle that seats six and can be used to clear snow. Specifications: ▪ Make: Ford F-250 ▪ Quantity: 1 ▪ Year: 2010 ▪ Color: White ▪ Four doors ▪ Dimensions: − Length: 19’6” − Width: 8’ − Height: 7’ ▪ Engine: − V-8, 6.2 L − 400 hp ▪ Fuel: − Diesel − 35 gal − 20 MPG ▪ Automatic transmission ▪ Front and side airbags ▪ Towing Capacity: 16,500 lbs Equipment: ▪ Radio ▪ Toughbooks ▪ NetGear Routers ▪ GPS unit ▪ Portable Radios ▪ NYCWIN wireless connectivity Driver Requirements: ▪ None, unless towing trailer over 10,000 lbs Page 205 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Tractor – CME 83 Purpose: This vehicle transports essential logistical assets and equipment. Capabilities: The Tractor can tow flatbed and container trailers capable of transporting large equipment, vehicles, or body collection point (BCP) trailer. Specifications: ▪ Make: Kenworth ▪ Quantity: 1 ▪ Year: 2005 ▪ Color: White ▪ Dimensions: − Length: 23’6” − Width: 8’5” − Height: 10’ ▪ Engine: − 325 hp ▪ Fuel: − Type: Diesel − Capacity: 100 gal ▪ Dual Axel ▪ Standard tractor hitch ▪ Emergency lights ▪ 2-way radio ▪ Single pole hot line (12 volt power) ▪ Wet line kit ▪ 80,000 GRVW ▪ Emergency lighting ▪ Air-ride suspension ▪ Pintle hook Driver Requirements: ▪ Class B license required to operate tractor alone ▪ Class A license required to operate tractor with trailer Page 206 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Evidence Vehicle – CME 120 Purpose: This vehicle is used to transport evidence, supplies, and equipment. Specifications: ▪ Make: Ford E250 Van ▪ Quantity: 1 ▪ Year: 2014 ▪ Color: White ▪ 2 doors ▪ Dimensions: - Length: 18’1’’ - Width : 8’ - Height: 7’1’’ ▪ Engine: - V-8, 4.6 L ▪ Fuel: - 33 gal - 16 MPG (highway) - 13 MPG (city) ▪ 4 Speed Transmission ▪ Towing Capacity: 5,900-6,500 lbs Equipment: • Lift gate 1,200 lbs. capacity Driver Requirements: ▪ None Page 207 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Evidence Vehicle – CME 100 Purpose: This vehicle is used to transport personnel. Specifications: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Make: Ford Passenger Van Quantity: 1 Year: 2010 Color: White Three doors Dimensions: - Length: 19’9’’ - Width: 8’ - Height: 6’10’’ Engine: - V8, 5.4 L Fuel: - 35 gal Driver Requirements: ▪ None Page 208 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Facilities Vehicle – CME 74 Purpose: This vehicle is used to transport supplies and equipment and for building maintenance requests. Specifications: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Make: Ford Model: E250 Cargo Van Quantity: 1 Year: 2008 Color: White 2 door Dimensions: - Length: 19’8’’ - Width: 6’7’’ - Height: 7’1’’ Engine: V-8 225 HP, 4.6 L Fuel: - 35 gal Rear Wheel Drive Front wheel independent suspension Power steering Towing Capacity: 5,900-6,500 lbs Driver Requirements: ▪ None Page 209 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Facilities Vehicle – CME 107 Purpose: This vehicle is used to transport supplies and equipment and for building maintenance requests. Specifications: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Make: Ford F250 Quantity: 1 Year: 2012 Color: White Four doors Dimensions: - Length: 22’ - Width: 8’ - Height: 7’1’’ Engine: V-8 225 HP, 4.6 L Fuel: - 35 gal Four wheel drive Towing Capacity: 10,500 lbs Driver Requirements: ▪ None Page 210 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Fleet Vehicle – CME 131 Purpose: This vehicle is used for response operations and to transport personnel. Specifications: ▪ Make: Toyota Highlander Hybrid ▪ Quantity: 1 ▪ Year: 2016 ▪ Color: White ▪ Four doors ▪ Dimensions: - Length: 15’12’’ - Width: 6’4’’ - Height: 5’9’’ ▪ Engine: - V6, 3.5 L ▪ Fuel: - Regular unleaded - 17. 2 gal - 27 mpg (city) - 28 mpg (highway) ▪ Continuously variable-speed automatic ▪ All wheel drive ▪ Four wheel independent suspension ▪ Front and rear stabilizer bar ▪ Towing capacity: 3,500 lbs Driver Requirements: ▪ None Page 211 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Fleet Vehicle – CME 40 Purpose: This vehicle is used for personnel transport. Specifications: ▪ Make: Ford Crown Victoria ▪ Quantity: 1 ▪ Year: 2004 ▪ Color: Silver ▪ Four doors ▪ Dimensions: - Length: 17’8’’ - Width: 6’7’’ - Height: 4’9’’ ▪ Engine: - V-8, 4.6 L ▪ Fuel: - Regular unleaded - 19 gal - 15 MPG (city) - 23 MPG (highway) ▪ Rear wheel drive ▪ 4-speed automatic transmission ▪ Towing capacity: 1,500 lbs Driver Requirements: ▪ None Page 212 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths IT Vehicle – CME 94 Purpose: This vehicle transports supplies and equipment in support of information technology. Specifications: ▪ Make: Ford Escape Hybrid ▪ Quantity: 1 ▪ Year: 2010 ▪ Color: White ▪ Four doors ▪ Dimensions: - Length: 14’7’’ - Width: 5’11’’ - Height: 5’8’’ ▪ Engine: - 4 cylinder, 2.5 L ▪ Fuel: - Regular unleaded - 15.1 gal - 34 MPG (city) - 31 MPG (highway) ▪ Towing capacity: 0 Driver Requirements: ▪ None Page 213 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths MLI Vehicles – CME 77, 78, 79 Purpose: This vehicle is used by medicolegal investigators to respond to scenes. Specifications: ▪ Make: Toyota Highlander Hybrid ▪ Quantity: 3 ▪ Year: 2008 ▪ Color: White ▪ Four doors ▪ Dimensions: - Length: 15’8’’ - Width: 6’3’’ - Height: 5’9’’ ▪ Engine: - V6, 3.5 L ▪ Fuel: - 19.2 gal - 18 MPG (city) - 24 MPG (highway) ▪ Towing capacity: 0 Driver Requirements: ▪ None Page 214 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths MLI Vehicles – CME 108, 109, 110 Purpose: This vehicle is used by medicolegal investigators to respond to scenes. Specifications: ▪ Make: Toyota Highlander ▪ Quantity: 3 ▪ Year: 2012 ▪ Color: White ▪ Four doors ▪ Dimensions: - Length: 15’9” - Width: 6’3’’ - Height: 5’9’’ ▪ Engine: - 4 cylinder, 2.7 L ▪ Fuel: - Regular unleaded - 19.2 gal ▪ Towing capacity: 0 Driver Requirements: ▪ None Page 215 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths MLI Vehicles – CME 103, 104, 105 Purpose: This vehicle is used by medicolegal investigators to respond to scenes. Specifications: ▪ Make: Ford Expedition ▪ Quantity: 3 ▪ Year: 2012 ▪ Color: White ▪ Four doors ▪ Dimensions: - Length: 17’3’’ - Width: 6’7’’ - Height: 6’5’’ ▪ Engine: - V8, 5.4 L ▪ Fuel: - 28 gal - 14 MPG (city) - 20 MPG (highway) ▪ Four wheel drive ▪ Towing capacity: 6,000 – 8,000 lbs Driver Requirements: ▪ None Page 216 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths MLI Vehicles – 128,129,130 Purpose: This vehicle is used by medicolegal investigators to respond to scenes. Specifications: ▪ Make: Toyota Highlander Hybrid ▪ Quantity: 3 ▪ Year: 2016 ▪ Color: White ▪ Four doors ▪ Dimensions: - Length: 15’ - Width: 6’4’’ - Height: 5’9’’ ▪ Engine: - V6, 3.5 L ▪ Fuel: - Regular unleaded - 17. 2 gal - 27 mpg (city) - 28 mpg (highway) ▪ All wheel drive ▪ Towing capacity: 1,500 lbs Driver Requirements: ▪ None Page 217 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Mortuary Vehicles – 37, 45 Purpose: This vehicle is used by personnel to coordinate OCME borough operations. Specifications: ▪ Make: Toyota Prius ▪ Quantity: 2 ▪ Year: 2004, 2005 ▪ Color: White ▪ Four doors ▪ Dimensions: - Length: 14’7’’ - Width: 5’8’’ - Height: 4’10’’ ▪ Engine: - 4-cylinder, 1.5 L ▪ Fuel: - Regular unleaded - 11.9 gal - 48 mpg (city) - 45 mpg (highway) ▪ Continuously variable-speed automatic ▪ Front wheel drive ▪ Towing Capacity: 0 Driver Requirements: ▪ None Page 218 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Mortuary Vehicles – CME 71, 72, 73; 80, 82 Purpose: This vehicle transports decedents from scenes to an OCME facility. Specifications: ▪ Make: Ford E-350 Van ▪ Quantity: 3; 2 ▪ Year: 2008; 2009 ▪ Color: White ▪ Three doors ▪ Dimensions: - Length: 22’’ - Width: 8’’ - Height: 7’ ▪ Engine: - V-8, 5.4 L ▪ Fuel: - 35 gal ▪ 4 speed automatic ▪ Towing capacity: 0 Driver Requirements: ▪ None Page 219 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Mortuary Vehicles – CME 102,119 Purpose: This vehicle transports decedents from scenes to an OCME facility. Specifications: ▪ Make: Ford E-250 Van ▪ Quantity: 1; 1 ▪ Year: 2011; 2014 ▪ Color: White ▪ Three doors ▪ Dimensions: - Length: 22’ - Width: 8’ - Height: 7’1’’ ▪ Engine: - V-8, 4.6 L - 225 hp ▪ Fuel: - Regular unleaded - 33 gal - 13 mpg (city) - 16 mpg (highway) ▪ 4 speed automatic transmission ▪ Rear wheel drive ▪ Towing capacity: 0 Driver Requirements: ▪ None Page 220 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Mortuary Vehicle – CME 112 Purpose: This vehicle functions as an agency vehicle that seats two and has refrigerated storage cababilities. Specifications: ▪ Make: Ford F-350 ▪ Quantity: 1 ▪ Year: 2014 ▪ Color: White ▪ Crew Cab ▪ Four door ▪ Dimensions: − Length: 22’ − Width: 8’ − Height: 6’8” ▪ Engine: − Size: V10 − Horsepower: 300 ▪ Fuel: − Type: Regular − Capacity: 35 gal ▪ Hitch: 2 5/16” ball ▪ 4-wheel drive Driver Requirements: ▪ None Page 221 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Receiving Vehicle - CME 101 Purpose: This vehicle is used to transport received items and supplies to OCME borough facilities. Specifications: ▪ Make: Ford E-250 Van ▪ Quantity: 1 ▪ Year: 2010 ▪ Color: White ▪ Three doors ▪ Dimensions: - Length: 22’ - Width: 8’ - Height: 7’1’’ ▪ Engine: - V-8, 4.6 L ▪ Fuel: - Flex fuel - 35 gal ▪ 4-speed automatic ▪ Rear wheel drive ▪ Towing capacity: 5,800-6,500 lbs Driver Requirements: ▪ None Page 222 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Equipment 3XB Shelter and Trailer ............................................................................. 224 M Shelter and Trailer ................................................................................. 225 J Shelter and Trailer .................................................................................. 226 J Shelter and Trailer .................................................................................. 226 Light Towers .............................................................................................. 227 Lowe System ............................................................................................. 228 FORTS Systems ........................................................................................ 229 Page 223 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Equipment 3XB Shelter and Trailer Purpose: Provide a climate controlled operational structure such as: command center, morgue, IT center, or decontamination unit. Specifications: ▪ Make: 3XB Shelter ▪ Quantity: 1 ▪ Year: 2012 ▪ Color: White ▪ Weight: 403 lb. ▪ Mobilized Dimensions: − Exterior Length: 23’3” − Exterior Width: 15’3” − Interior Length: 21’6” − Interior Width: 13’6” − Interior Height: 8’8” − Interior Area: 249 ft2 − Total Area: 357 ft2 Equipment: ▪ Tables ▪ Chairs Trailer Specifications: ▪ Make: HP-2C/18 IPT ▪ Color: Green ▪ Dimensions: o Length: 194” o Width: 86” o Height: 78” o Cargo volume: 145 ft3 ▪ Generator: o Fuel Type: Diesel o Fuel Capacity:16 gal o Genset Output: 18kW Page 224 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths M Shelter and Trailer Purpose: Provide a climate controlled operational structures such as: command center, morgue or decontamination unit. Specifications: ▪ Make: DRASH “M” ▪ Quantity: 5 ▪ Year: 2006 ▪ Color: White ▪ Weight: 1600 lb. ▪ Mobilized Dimensions: − Exterior Length: 30’ − Exterior Width: 19’8” − Interior Length: 29’ − Interior Width: 18’ − Interior Height: 9’.7” − Interior Area: 442 ft2 − Total Area: 1,323 ft2 ▪ One M Shelter is packed on a trailer; the remaining four shelters are packed in travel cases. Equipment: ▪ Spec Ops AV System ▪ Tables ▪ Chairs Trailer Specifications: ▪ Make: HP-4/338 IPT ▪ Color: Tan ▪ Dimensions: − Length: 228” − Width: 86” − Height: 78” − Cargo volume: 140 ft3 ▪ Generator: − Fuel Type: Diesel − Fuel Capacity: 26 gal − Genset Output: 33 kW Page 225 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths J Shelter and Trailer Purpose: Provide a climate controlled operational structures such as: command center, morgue or decontamination unit. Specifications: ▪ Make: DRASH “J” ▪ Quantity: 1 ▪ Year: 2014 ▪ Color: White ▪ Weight: 1600 lb. ▪ Mobilized Dimensions: − Exterior Length: 52’9” − Exterior Width: 34’2” − Interior Length: 51’4” − Interior Width: 31’3” − Interior Height: 13’8” − Interior Area: 1,250 ft2 − Total Area: 1,804 ft2 Trailer Specifications: ▪ Make: HP-J4 ▪ Color: Tan ▪ Dimensions: − Length: 209” − Width: 91.5” − Height: 80” − Cargo volume: 270 ft3 ▪ Generator: − Genset Output: 5 kW Page 226 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Light Towers Purpose: The light towers can be rapidly deployed to provide light and power to mass fatality incidents. Capabilities: Four positional lights and power outlets. Specifications: ▪ Make: Wacker ▪ Quantity: 9 ▪ Year: 2007-2016 (varies) ▪ Color: White/Marked ▪ Weight: 2,200 lbs ▪ Dimensions: − Length: 12’ − Width: 4’ − Max Height: 30’ ▪ 4 Adjustable Lights ▪ 250 volt, 30 amp plug, ▪ 120 A – GFCI ▪ 4x 1000 watt lights on a 6KW generator ▪ Fuel: − Type: Diesel − Capacity: 30 Gallon ▪ Single Axel ▪ Hitch: Pintle Page 227 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Lowe System Purpose: Portable refrigerated storage for decedents. Specifications: ▪ Make: Lowe Portable Storage Unit ▪ Quantity: − 1 (One) 8’x16’ unit − 1 (One) 8’x30’ unit ▪ Color: White ▪ Dimensions (8’x16’) − Exterior Length: 16’ − Exterior Width: 8’ − Exterior Height: 8’ − Interior Length: 15’5” − Interior Width: 88” ▪ Dimensions (8’x30’) − Exterior Length: 30’ − Exterior Width: 8’ − Exterior Height: 8’ − Interior Length: 29’5” − Interior Width: 88” ▪ Panel Weights − 3’ Blank: 28 lbs − 4’ Blank: 35 lbs − Floor: 115 lbs − Ceiling: 40 lbs − Standard Door: 145 lbs ▪ Dimensions (Door) − Height: 75” − Width: 59” ▪ Electrical Requirements: − Electric − 230 volt, single phase, 30 amp circuit − Must have pigtail plug NEMA L630P configuration ▪ Operating Temperature between 37-44 F ▪ Palletized ▪ Weatherproof ▪ Modular Equipment: ▪ Cantilever Shelving Page 228 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths FORTS Systems Specifications: ▪ Make: FORTS FFM01 ▪ Quantity: − 2 ▪ Color: Tan ▪ Dimensions: − Exterior Length: 20’ − Exterior Width: 19’ − Exterior Height: 9’ − Interior Length: 19’ − Interior Width: 18’ ▪ Electrical Requirements: − Electric 208V/ 3ph ▪ Operating Temperature between 37-44 F ▪ Weatherproof Equipment: ▪ Cantilever Shelving Page 229 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 230 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Machines Toyota Forklift ............................................................................................ 232 Doosan Forklift........................................................................................... 233 Hyundai Forklift .......................................................................................... 234 Gator Utility Vehicles ................................................................................. 235 JCB 520/40 Loadalls .................................................................................. 236 JCB 525/60 Hi Viz Loadall ......................................................................... 237 Scissor Lift ................................................................................................. 238 Articulating Boom....................................................................................... 239 Page 231 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Machines Toyota Forklift Purpose: Loading and unloading critical equipment at the depot and mass fatality incident scene. Capabilities: The forklift can be used to move and position asset trailers. Specifications: ▪ Make: Toyota ▪ Quantity: 1 ▪ Year: 1991 ▪ Color: Orange ▪ Dimensions: − Length to fork face: 9’6” − Width: 4’4” − Height: 7’2” − Fork lengths: 42” ▪ Weight: 13,000 lbs ▪ Maximum Load: 8,000 lbs ▪ 3-Stage Mast − Max Height: 13’ ▪ Fuel − Type: Diesel − Capacity:15.9 gal ▪ Engine: 59 hp ▪ Transmission: Powershift ▪ LED lights ▪ Max speed: 12.4 mph Operator Requirements: ▪ Forklift certification/training Page 232 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Doosan Forklift Purpose: Loading and unloading critical equipment at the depot and mass fatality incident scene. Capabilities: The forklift can be used to move and position asset trailers. Specifications: ▪ Make: Doosan D70S ▪ Quantity: 1 ▪ Year: 2015 ▪ Color: Orange ▪ Dimensions: − Length to fork face: 11’9” − Width: 6’9” − Height: 9’ − Fork lengths: 6’ ▪ Weight: 25,000 lbs ▪ Maximum Load: 13,500 lbs ▪ 3-Stage Widemast − Max Height: 187” ▪ Fuel: − Type: Diesel − Capacity: 12 gal ▪ Engine: V3800 ▪ Transmission: Three-speed Automatic Power Reversal ▪ LED lights ▪ Brakes: Oil cooled wet disc ▪ Max speed: 20 mph Operator Requirements: ▪ Forklift certification/training Page 233 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Hyundai Forklift Purpose: Loading and unloading critical equipment at the depot and mass fatality incident scene. Capabilities: The forklift can be used to move and position asset trailers. Specifications: ▪ Make: 45D-SA ▪ Quantity: 1 ▪ Year: 2015 ▪ Color: Yellow ▪ Dimensions: − Length to fork face: 10’6” − Width: 5’7” − Height: 7’2 − Fork lengths: 4’ ▪ Weight: 15,000 lbs ▪ Maximum Load: 9,920 lbs ▪ Triple mast with carriage and load back rest − Max Height: 15’7” ▪ Fuel: − Type: Diesel − Capacity: 12 gal ▪ Engine: V3800 ▪ LED lights ▪ Brakes: Hydraulic ▪ Max speed: 16 mph Operator Requirements: ▪ Forklift certification/training Page 234 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Gator Utility Vehicles Purpose: The Gators can facilitate the transportation of personnel and equipment at a mass fatality incident. Capabilities: Each Gator can transport two people and a small amount of equipment. Specifications: ▪ Make: John Deere ▪ Quantity: 4 ▪ Year: 2006, 2014 ▪ Color: Green ▪ Weight: 915 lbs ▪ Dimensions: − Length: 104” − Width: 60” − Height: 43” ▪ Load Capacity: 900 lbs ▪ Engine: 350 cc ▪ Fuel: − Type: Regular − Capacity: 5 gal ▪ Duel Axel ▪ Lights Operator Requirements: ▪ None Page 235 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths JCB 520/40 Loadalls Purpose: Loading and unloading critical equipment at the depot and mass fatality incident, scooping, plowing and moving trailers. Specifications: ▪ Make: JCB 520/40 ▪ Quantity: 2 ▪ Year : 2007 ▪ Color: White ▪ Weight: 12,125lbs ▪ Dimensions: − Length: 11’1” − Width: 5’1” − Height: 6’11” − Fork lengths: 3’6”, 4’, 5’ ▪ Maximum Lift Height: 13’2” ▪ Maximum Lift Load: 3,000 lbs ▪ Maximum Reach Length: 8’5” ▪ Maximum Reach Load: 2,000 lbs ▪ Fuel: − Type: Regular − Capacity: 16 gal ▪ Engine: 50 hp ▪ Max speed: 12.4 mph ▪ Quick attach coupler ▪ Heat ▪ LED lights Equipment: ▪ Multiple attachments including: Forks, Bucket, Trailer hitch and others Operator Requirements: ▪ Loadall certification/training Page 236 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths JCB 525/60 Hi Viz Loadall Purpose: Loading and unloading critical equipment at the depot and mass fatality incident, scooping, plowing and moving trailers. Specifications: ▪ Make: JCB 565/60 Hi Viz ▪ Quantity: 1 ▪ Year : 2015 ▪ Color: White ▪ Weight: 16,100lbs ▪ Dimensions: − Length: 11’ − Width: 6’ − Height: 6’2” − Fork lengths: 4’ – 8’ ▪ Maximum Lift Capacity: 5,500lbs ▪ Maximum Lift Height: 27’ ▪ Maximum Lift Load (Full Height): 3,800lbs ▪ Maximum Reach Length: 11’4” ▪ Maximum Reach Load: 1,700lbs ▪ Fuel: − Type: Regular − Capacity: 19 gal ▪ Engine: 2.5L, 4 cylinder ▪ Max speed: 16 mph ▪ Quick attach coupler ▪ Heat/AC ▪ LED lights ▪ Industrial Tires Equipment: ▪ Forks ▪ Scoop ▪ Trailer hitch Operator Requirements: ▪ Loadall certification/training Page 237 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scissor Lift Purpose: The Scissor Lift can be deployed to facilitate day-to-day maintenance activities or support construction of field morgue structures at a mass facility incident. Specifications: ▪ Make: Genie 2646 ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: Blue ▪ Dimensions: − Length:7 ’11” − Width: 3’10” − Height stowed: 7’5” − Rails folded 5’6” ▪ Working Height: 32’ ▪ Lift Capacity: 1,000 lbs ▪ Battery operated ▪ Front-wheel drive ▪ Zero inside turning radius ▪ 39 in (1 m) roll-out platform ▪ Folding rails with full-height swing gate ▪ Universal 20 amp smart charger ▪ Proportional controls for lift and drive functions ▪ Multiple disc brakes ▪ On-board diagnostics ▪ Emergency stop controls ▪ Solid, non-marking tires ▪ AC power to platform ▪ Manual platform lowering valve ▪ Tilt sensor with an audible alarm ▪ Pothole guards Operator Requirements: ▪ Equipment familiarity Page 238 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Articulating Boom Purpose: The Articulating Boom can be deployed to facilitate day-to-day maintenance activities or support construction of field morgue structures at a mass facility incident. The articulating boom can also increase the efficiency with which personnel and equipment can access a scene due to its wide range of motion and reach. Specifications: ▪ Make: Genie Z-62/40 ▪ Quantity: 1 ▪ Year: 2015 ▪ Color: Blue ▪ Dimensions: − Stowed Length:30’4”” − Transport Length: 24’11” − Stowed Height: 8’6” − Transport Height: 9’6” − Width: 8’2” − Wheelbase: 8’3” − Ground Clearance: 1’3” ▪ Working Height Maximum: 67’11” ▪ Platform Height Maximum: 61’11” ▪ Horizontal Reach Maximum: 40’11” ▪ Up and Over Clearance Maximum: 26’8” ▪ Lift Capacity: 1000 lbs ▪ Fuel: − Type: Gas/LPG − Capacity: 35 gal Page 239 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 240 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Generators G-120 Wacker Generator .......................................................................... 242 G-70 Wacker Generator ............................................................................ 243 G-50 Wacker Neuson Generator ............................................................... 244 Page 241 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Generators G-120 Wacker Generator Purpose: The generator can be rapidly deployed to provide power to field command and other structures during mass fatality incidents. Specifications: ▪ Make: Wacker G-120 ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White ▪ Weight: 3,964 lbs ▪ Dimensions: − Length: 16’ − Width: 6’5” − Height: 7’6” ▪ Voltage: 3 phase @ .8 P.F. ▪ 1 phase @1.0 PF ▪ Two 20 amp, one 30 amp and ▪ Single and 3-phase power ▪ Two 50 amp 120/240, 120/208, 480/277 ▪ Run time (continuous load): 24.8 hours ▪ Fuel: − Type: Diesel − Capacity: 200 gal ▪ Duel Axel ▪ Hitch: Pintle Page 242 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths G-70 Wacker Generator Purpose: The generator can be rapidly deployed to provide power to field command and other structures during mass fatality incidents. Specifications: ▪ Make: Wacker G-70 ▪ Quantity: 1 ▪ Year: 2006 ▪ Color: White ▪ Weight: 3,964 lbs ▪ Dimensions: − Length: 14’ − Width: 6’5” − Height: 6’ ▪ Voltage: 3 phase @ .8 P.F. ▪ 1 phase @1.0 PF ▪ Two 20 amp, one 30 amp and ▪ Two 50 amp 120/240, 120/208, 480/277 ▪ Single and 3-phase power ▪ 20 amp plug ▪ Receptacle: GFCI ▪ Run Time (continuous load): 19.3 hours ▪ Fuel: − Type: Diesel − Capacity:89 gal ▪ Duel Axel ▪ Hitch: Pintle Page 243 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths G-50 Wacker Neuson Generator Purpose: The generator can be rapidly deployed to provide power to field command and other structures during mass fatality incidents. Specifications: ▪ Make: Wacker Neuson G-50 ▪ Quantity: 1 ▪ Year: 2014 ▪ Color: Gray ▪ Dimensions: − Length: 157” − Width: 60” − Height: 84.5” ▪ AC Receptacles: 2 duplex, 3 twist-lock ▪ AC Voltage available: ▪ 120/240 zig-zag ▪ 120/208 low-wye ▪ 277/480 Hi-wye ▪ Standby Output - kW/kVA: 43/54 ▪ Prime Output - kW/kVA: 40/50 ▪ Voltage selector switch: 3 positions ▪ Hard wire or Cam lock ▪ Run Time (continuous load): 100 hours ▪ Fuel: − Type: Diesel − Capacity: 310 gal ▪ Hitch: Pintel Page 244 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Trailers 26’ Refrigerated Trailer .............................................................................. 246 48’ Refrigerated Trailer .............................................................................. 247 Aviation Trailer ........................................................................................... 248 CBRNE Trailer ........................................................................................... 249 DPMU Trailer ............................................................................................. 250 Flatbed Trailer............................................................................................ 251 Landoll Trailer 930C .................................................................................. 252 Landoll Trailer 317 ..................................................................................... 253 Landoll Trailer 440 ..................................................................................... 254 Logistics Trailer.......................................................................................... 255 Major Incident Response Trailer (MIRT) .................................................... 256 Mobile Office Trailer ................................................................................... 257 Scene Investigations Unit (SIU) Trailer ...................................................... 258 Training Trailer........................................................................................... 259 UVIS-CMS Mobile Communications Unit ................................................... 260 Light Open Trailer ...................................................................................... 261 Heavy Open Trailer.................................................................................... 262 Page 245 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Trailers 26’ Refrigerated Trailer Purpose: The trailer can be delivered to a mass fatality incident and used as a refrigerated remains storage unit. The trailer can also be used to deliver critical equipment to a scene or field morgue. Capabilities: Can store approximately 35 bodies without shelving at a temperature range from 20° to 80° F. Specifications: ▪ Make: Utility ▪ Quantity: 1 ▪ Year: 2013 ▪ Color: White/Marked ▪ Fuel: Diesel ▪ Tank size: 100 gal ▪ Dimensions: − Length: 26’ − Width: 8’6” − Clearance: 12’6” ▪ Generator: − Electric Standby − 50 amp 3-phase CS plug Equipment: ▪ Straps and Braces Driver Requirements: ▪ A Class A commercial driver’s license (CDL) is required for any vehicle over a gross vehicle weight rating (GVWR) of 26,001 lbs. Page 246 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths 48’ Refrigerated Trailer Purpose: The trailer can be delivered to a mass fatality incident and used as a refrigerated remains storage unit. The trailer can also be used to deliver critical equipment to a scene or field morgue. Capabilities: Can store approximately 63 bodies without shelving at a temperature range from 20° to 80° F. Specifications: ▪ Make: Utility ▪ Quantity: 1 ▪ Year: 2013 ▪ Color: White ▪ Fuel: Diesel ▪ Tank size: 100 gal ▪ Dimensions: − Length: 48’ − Width: 8’6” − Clearance: 12’6” ▪ Generator: − Electric Standby − 50 amp 3-phase CS plug ▪ Lift gate Equipment: ▪ Straps ▪ Braces Driver Requirements: ▪ A Class A commercial driver’s license (CDL) is required for any vehicle over a gross vehicle weight rating (GVWR) of 26,001 lbs. Page 247 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Aviation Trailer Purpose: The Aviation Trailer is equipped to deliver enough human remains pouches to a handle large-scale mass fatality incident. Capabilities: The Aviation trailer is equipped with a pull-down ramp back door, standard side door and small hatch. Specifications: ▪ Make: Haulmark ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White/Marked ▪ Dimensions: − Length: 24’ − Width: 8’ − Clearance: 12’ − Interior Dimensions: 16’x7’x6’ ▪ Weight: 1,200 lbs ▪ Maximum Payload: 7,000 lbs ▪ Dual Axel ▪ Hitch: 25/16” ball hitch ▪ Lights run off HVAC external L5-30 Amp plug ▪ AC/Heat Equipment: ▪ 500 human remains pouches (HRP) Driver Requirements: ▪ None Page 248 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths CBRNE Trailer Purpose: The CBRNE trailer is equipped with HAZMAT gear and personal protective equipment to facilitate eight personnel to respond to a mass fatality incident that may involve a chemical, biological, radiological, nuclear, or explosive component. Capabilities: The CBRNE Trailer is equipped with a pull-down ramp back door, standard side door and small hatch. Specifications: ▪ Make: Haulmark ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White/Marked ▪ Dimensions: − Length: 24’ − Width: 8’ − Clearance: 12’ − Interior Dimensions: 16’x7’x6’ ▪ Weight: 1,200 lbs ▪ Maximum Payload: 7,000 lbs ▪ Dual Axel ▪ Hitch: 25/16” ball hitch ▪ Lights run off HVAC external L5-30 Amp plug ▪ AC/Heat Equipment: ▪ SCBA racks, tanks and harnesses ▪ White board/markers ▪ Bench Driver Requirements: ▪ None Page 249 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths DPMU Trailer Purpose: The trailer is equipped to respond to a mass fatality incident and deliver mobile morgue equipment and possibly serve as a temporary body collection point. Capabilities: The DPMU Trailer is equipped with a pull-down ramp back door, standard side door and small hatch. Specifications: ▪ Make: Haulmark ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White/Marked ▪ Dimensions: − Length: 24’ − Width: 8’ − Clearance: 12’ − Interior Dimensions: 16’x7’x6’ ▪ Weight: 1,200 lbs ▪ Maximum Payload: 7,000 lbs ▪ Dual Axel ▪ Hitch: 25/16” ball hitch ▪ Lights run off HVAC external L5-30 Amp plug ▪ AC/Heat Equipment: ▪ Plastic tubs ▪ Tables ▪ Gurneys Driver Requirements: ▪ None Page 250 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Flatbed Trailer Purpose: Deliver critical assets to a large mass fatality incident or field morgue. Specifications ▪ Make: Eager Beaver ▪ Quantity: 1 ▪ Year: 2006 ▪ Color: Black ▪ Dimensions: − Length: 31‘ − Width: 8.5‘ − Height: 3’ ▪ Load Weight Capacity: 48K lbs ▪ Dual Axel ▪ Electric, 12 volt powered winch ▪ Hitch: Large Pintle ▪ Lights ▪ Storage compartments ▪ Wooden surface ▪ Hydraulic ramp Equipment: ▪ Chains and Straps Driver Requirements: ▪ A Class A commercial driver’s license (CDL) is required for any vehicle over a gross vehicle weight rating (GVWR) of 26,001 lbs. Page 251 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Landoll Trailer 930C Purpose: This trailer is designed to transport crucial equipment and vehicles to a mass fatality incident response or field morgue. Specifications ▪ Make: Landoll 930C ▪ Quantity: 1 ▪ Year: 2013 ▪ Color: N/A ▪ Dimensions: − Length: 51’ − Width: 8.5’ − Height: 3’ ▪ Capacity: 70,000 lbs ▪ Dual Axel ▪ Hitch: Kingpin tractor with air break ▪ Wooden surface ▪ Hydraulic ramp ▪ Winch Equipment: ▪ Chains and straps Driver Requirements: ▪ A Class A commercial driver’s license (CDL) is required for any vehicle over a gross vehicle weight rating (GVWR) of 26,001 lbs. *Tractor must have a wet-line kit that is set up for a Landoll trailer GPM flow. Page 252 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Landoll Trailer 317 Purpose: This trailer is designed to transport crucial equipment and vehicles to a mass fatality incident response or field morgue. Specifications ▪ Make: Landoll 317 ▪ Quantity: 3 ▪ Year: 1990, 2016 ▪ Color: N/A ▪ Dimensions: − Length: 48’ − Width: 8.5’ − Height: ▪ Capacity: 70,000 lbs ▪ Dual Axel ▪ Hitch: Kingpin tractor with air break ▪ 2 Steel; 1Wooden surface w/ container rails ▪ Winch Equipment: ▪ Chains and straps Driver Requirements: ▪ A Class A commercial driver’s license (CDL) is required for any vehicle over a gross vehicle weight rating (GVWR) of 26,001 lbs. *Tractor must have a wet-line kit that is set up for a Landoll trailer GPM flow. Page 253 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Landoll Trailer 440 Purpose: This trailer is designed to transport crucial equipment and vehicles to a mass fatality incident response or field morgue. Specifications ▪ Make: Landoll 440 ▪ Quantity: 1 ▪ Year: 2016 ▪ Color: N/A ▪ Dimensions: − Length: 53’ − Width: 8.5’ − Height: ▪ Capacity: 80,000 lbs ▪ Dual Axel ▪ Hitch: Kingpin tractor with air break ▪ Wooden surface ▪ Hydraulic ramp ▪ Winch Equipment: ▪ Chains and straps Driver Requirements: ▪ A Class A commercial driver’s license (CDL) is required for any vehicle over a gross vehicle weight rating (GVWR) of 26,001 lbs. *Tractor must have a wet-line kit that is set up for a Landoll trailer GPM flow. Page 254 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Logistics Trailer Purpose: The trailer contains tools and equipment to support and maintain prolonged mass fatality field operations. Capabilities: The Logistics Trailer is equipped with shelves, a pull-down ramp back door, standard side door and small hatch. Specifications: ▪ Make: Haulmark ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White/Marked ▪ Dimensions: − Length: 24’ − Width: 8’ − Clearance: 12’ − Interior Dimensions: 16’x7’x6’ ▪ Weight: 1,200 lbs ▪ Maximum Payload: 7,000 lbs ▪ Dual Axel ▪ Hitch: 25/16” ball hitch ▪ Lights run off HVAC external L5-30 Amp plug ▪ AC/Heat Equipment: ▪ Maintenance tools ▪ Equipment Page 255 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Major Incident Response Trailer (MIRT) Purpose: Deliver critical recovery and investigative equipment to a large mass fatality incident. Capabilities: MIRT is a fully loaded trailer containing enough equipment and PPE to work independently on-scene for the first 48 hours of an incident. The vehicle is stocked with enough HRP’s, equipment and PPE to process more than 30 victims. Specifications: ▪ Make: Maxey Trailer ▪ Quantity: 1 ▪ Year: 1996 ▪ Color: White ▪ Dimensions: − Length: 30’ − Width: 8’ − Clearance: 10’ ▪ Single Axle ▪ 5th wheel with air breaks ▪ Hitch: tractor trailer Equipment: ▪ PPE ▪ Hard hats ▪ Rubber boots ▪ Outer and inner gloves ▪ Masks ▪ Safety glasses ▪ Bunker gear ▪ Lights ▪ Investigators kits ▪ HRPs Driver Requirements: ▪ Class A license – must be towed using tractor Page 256 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Mobile Office Trailer Purpose: The Mobile Office trailer is fully equipped to serve as a mobile field command center, private meeting room or work space. Capabilities: The trailer contains a rehab area, bathrooms, locker and storage areas and office. Specifications: ▪ Make: Great Dane ▪ Quantity: 1 ▪ Year: 1997 ▪ Color: White ▪ Dimensions: o Length: 48’ o Width: 8’ o Clearance: 12’6” ▪ Hitch: tractor trailer Equipment: ▪ 3 Computers with internet and Microsoft Office ▪ 1 Printer/Scanner/Fax machine ▪ 1 Copy machine ▪ Portable radios and chargers ▪ Office supplies ▪ 1 Fargo printer with cards and cartridges ▪ 1 Barcode Scanner ▪ 1 Computer camera Driver Requirements: ▪ Class A license – must be towed using tractor Page 257 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Investigations Unit (SIU) Trailer Purpose: The trailer can be used to deliver investigative equipment to be used in trainings or a mass fatality incident. Capabilities: The SIU Trailer is equipped with a pull-down ramp back door, standard side door and small hatch. Specifications: ▪ Make: Haulmark ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White/Marked ▪ Dimensions: o Length: 16’ o Width: 8.5’ o Clearance: 12’ o Interior Dimensions: 16’x7’x6’ ▪ Weight: 1,200 lbs ▪ Maximum Payload: 10,000 lbs ▪ Dual Axel ▪ Hitch: 25/16” ball hitch ▪ Lights run off HVAC external L5-30 Amp plug ▪ AC/Heat Equipment: ▪ Mapping and investigation equipment Driver Requirements: ▪ None Page 258 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Training Trailer Purpose: The trailer can be used to deliver field response and morgue equipment to be used in trainings or mass fatality incident. Capabilities: The Training Trailer is equipped with a pull-down ramp back door, standard side door and small hatch. Specifications: ▪ Make: Haulmark ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White/Marked ▪ Dimensions: o Length: 16’ o Width: 8.5’ o Clearance: 12’ o Interior Dimensions: 16’x7’x6’ ▪ Weight: 1,200 lbs ▪ Maximum Payload: 10,000 lbs ▪ Dual Axel ▪ Hitch: 25/16” ball hitch ▪ Lights run off HVAC external L5-30 Amp plug ▪ AC/Heat Equipment: ▪ Variable used in mass fatality incident training exercises. Driver Requirements: ▪ None Page 259 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths UVIS-CMS Mobile Communications Unit Purpose: The UVIS-CMS Mobile Communications Unit is fully equipped to serve as a mobile field command center, private meeting room or work space. Capabilities: The trailer can be run on single-phase generator or direct power and includes a 50’ 50-amp shore cord. It is equipped with air conditioning and heating. Specifications: ▪ Make: Haulmark ▪ Quantity: 1 ▪ Year: 2007 ▪ Color: White/Marked ▪ Dimensions: o Length: 23.5’ o Width: 8.5’ o Height: 11’ ▪ Total Weight: 12,000 ▪ Dual Axel ▪ Trailer Hitch 25/16” ball Equipment: ▪ 3 computer work stations ▪ Network printer ▪ Telephones and conference bridge ▪ Television ▪ Motorola XTL 2500 radio base ▪ White board ▪ Conference table ▪ Seating for 10 people Driver Requirements: ▪ None Page 260 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Light Open Trailer Purpose: The trailer can deliver critical assets to mass fatality incidents and training exercises. Specifications: ▪ Make: Big Tex ▪ Quantity: 1 ▪ Year: 2006 ▪ Color: Black ▪ Dimensions: o Length: 12’ o Width: 5’ o Height: 24” ▪ Weight: 2,500 lbs ▪ Maximum Payload: 2,500 lbs ▪ Hitch: 25/16” ball hitch Driver Requirements: ▪ None Page 261 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Heavy Open Trailer Purpose: The trailer can deliver critical assets to mass fatality incidents and training exercises. Specifications: ▪ Make: Big Tex ▪ Quantity: 1 ▪ Year: 2006 ▪ Color: Black ▪ Dimensions: o Length: 16’ o Width: 5’ o Height: 24” ▪ Weight: 5,000 lbs ▪ Maximum Payload: 5,000 lbs ▪ Dual Axel ▪ Hitch: 25/16” ball hitch Driver Requirements: ▪ None Page 262 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths F. Job Action Sheets Page 263 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 264 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Agency Command Functions Disaster Response Coordinator Disaster Response Coordinator Purpose / Mission To direct, oversee, and coordinate the OCME agency’s response, for all five boroughs during a biological incident. ▪ ▪ ▪ Objectives ▪ ▪ Coordinate, supervise, and manage incident operations and personnel Ensure all Fatality Management Operations are conducted in a safe manner Conduct Fatality Management tasks in accordance with established forensic standards Conduct Fatality Management tasks in a dignified and respectful manner Support judicial, public health, and investigative objectives and requirements Suggested Qualifications ▪ ▪ ▪ ▪ ▪ Assigned Area Agency Command Post Supervisor OCME Chief Medical Examiner Supporting Positions / Functions ▪ ▪ ▪ ▪ ▪ ▪ Executive or Senior Leadership position at OCME ICS Knowledge Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Agency Logistics Chief Operations Center Coordinator Fatality Management Branch Director Public Information Officer Safety Officer Agency Liaison Activation Checklist □ □ □ □ □ Initiate the Incident Briefing Form and Incident Characterization. Contact Chief Medical Examiner & Executive Team to initiate OCME’s Biological Incident Surge Plan to Manage In- and Out-of-Hospital Deaths. Determine need for and appropriately appoint Agency Command Staff and Fatality Management Branch Director. Identify Agency Command Post locations. ▪ Due to the distributive nature of a biological incident response, it may be useful to utilize borough offices as Command Posts. ▪ Must be in a safe location, preferably reducing the need to move frequently ▪ Must be accessible to FM personnel and equipment arriving to the post. Identify possible locations for the following: □ Remains Storage Facilities □ Body Collection Points □ Family Assistance Centers Page 265 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths □ □ □ □ □ □ □ □ □ □ □ □ □ □ Victim Information Centers (if not co-located within the Family Assistance Center) □ Logistics Staging Areas Distribute corresponding Job Action sheets. Assign or complete the Organizational Chart, as appropriate. Direct Agency Operations Center to surge operations to respond to incident. Make contact with NYC Emergency Management Emergency Operations Center. Brief all appointed staff of the nature of the event, immediate critical issues, and initial plan of action. For critical issues please refer to the Incident Characterization Form. At next briefing, receive initial status reports from Agency senior staff. Determine operational periods. Develop the first OCME Situation Report. Document all key activities, actions, and decisions. Provide to Documentation Unit Leader. Document all communications (internal and external to the OCME agency) and provide to the Documentation Unit Leader. Provide all documentation to the Documentation Group Supervisor under the Agency Operations Center Coordinator. Participate in discussions with the NYPD and Mayor’s Office regarding the activation of UVIS-CMS. Participate in FAC Lead Team Call with NYC Emergency Management regarding the decision to open one or more Family Assistance Centers (FAC) and OCME’s activation of a Victim Identification Center (VIC). Operational Responsibilities The Disaster Response Coordinator is responsible for the following items throughout operations. Several of these items will be ongoing or repeated through the course of the response. The Disaster Response Coordinator should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Authorize resources as needed or requested by Command Staff. • Designate regular briefings with Command Staff. • Establish incident specific agency policies or practices for the purpose of providing clarity of response. • Determine best means of communicating such policies and practices to all OCME locations in additional to briefing personnel at meetings. • Establish OCME Situation Report for each operational period to coordinate the response between all facilities and Command Staff. • Oversee and approve revision of the Situation Report developed by the Operations Center Coordinator. • Ensure approved Situation Report is communicated to all Command Staff. • Communicate agency and incident status and the Situation Report to key agency executives on a need-to-know basis. • Ensure command staff and operational staff briefings are being conducted regularly. • Confirm the OCME is providing the public correct information regarding management of decedents during the biological incident. • Review and revise OCME biological incident characterization based on new information obtained through DOHMH and revise OCME response strategy to Page 266 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • • • • • • mitigate the effects of the event as appropriate. Evaluate/re-evaluate the need to deploy an OCME EOC Representative to the NYCEM Emergency Operations Center (EOC). Ensure Situation Report for each operational period and reporting of the Situation Report at each shift change or briefing. Evaluate overall agency status and ensure critical issues are addressed. Maintain all essential daily operations throughout the course of the incident. Ensure Command Staff physical readiness through proper nutrition, water intake, rest periods, stress management, and established work hour rules, e.g., 12 hours onduty/12 hour off-duty. Monitor staff for symptoms related to the biological incident. With natural biological incidents, prepare for a percentage of staff to become ill and not be available for response efforts or daily operations. Ensure continued coordination with external agencies through designated Liaison Officers. Observe all staff and volunteers for signs of stress. Report concerns to appropriate leadership staff, including the OCME Support Branch Director. Assess the plan developed by the Demobilization Unit Leader, which would be approved by the Agency Operations Center Coordinator for the gradual demobilization of assets for all operations. Demobilize assets and return personnel and resources to their normal jobs as appropriate. Ensure demobilization of the operations regarding restocking supplies, equipment, etc. Ensure after-action activities are coordinated and completed. Ensure OCME is prepared to manage post incident medical briefings and public education and information. Ensure staff has access to stress management & healthcare services. General: • Attend all briefings/meetings as coordinated or requested by the OCME Command Staff and external agencies. • Maintain communication with the Command Staff regarding requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with Command Staff on issues related to changes to or deviations from established procedures. • Develop and maintain the Command Staff operational and staff schedule. • Ensure all Command Staff personnel check-in and out at the beginning and end of each shift. • Ensure all Command Staff personnel are using applicable portions of their position checklists. • Be aware of Command Staff well-being and provide necessary resources. • At the end of each operational period, receive situation reports from Command Staff related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • OCME Incident Characterization Form Page 267 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • OCME Situation Report Incident Objectives Organizational Assignment List Assignment List Radio Communications Plan Medical Plan Organizational Chart Incident Check-In List Activity Log Vehicle Log Equipment • • • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Radios Cell Phone Note Pad Pens White board Clip board Best Practices and Considerations • • • • Based on incident characteristics, identify alterations to FM protocols that may be necessary to investigate, recover, and process remains in a safe and efficient manner. Consider external aspects of the recovery operations (such as public view, inclement weather, etc.) that may alter the time available to process decedents. Consider specialized skills needed to process the scene. Coordinate with the FM Branch director to request specialized personnel capable of assisting in the investigation and recovery process. Coordinate with the Agency Command Post to determine any necessary alterations to FM Operations specific to the biological contaminant. − The Contamination Control Group Supervisor should be notified to determine alteration to FM Protocols. Page 268 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Agency Public Information Officer Area Public Information Officer Purpose / Mission Relay information between the OCME and the news media, via coordination with the New York City Joint Information Center (JIC) and visitors, including families, as approved by the Disaster Response Coordinator. ▪ Communicate correct information to the families of victims, general public, media, and politicians as necessary and related to the pandemic event Suggested Qualifications ▪ ▪ ▪ ▪ Executive or Senior Leadership position in the OCME agency Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Assigned Area Agency Command Post Supervisor OCME Executive Team Supporting Positions / Functions Disaster Response Coordinator Objectives Activation Checklist □ □ □ □ □ □ □ □ □ □ □ □ Obtain information from the Disaster Response Coordinator regarding OCME’s implementation of their strategy. Coordinate efforts with the NYC Emergency Management Emergency Operations Center (EOC) Joint Information Center (JIC) to ensure uniform, consistent public statements. Establish designated media staging locations near relevant locations (i.e. command posts, Family Assistance Centers, etc.). ▪ Media staging locations must be completely separate from families and operations. Inform on-site media of the physical areas to which they have access and those which are restricted. Coordinate media area designation with the Safety Officer. Consider need to deploy PIO staff to NYC EOC JIC. Develop public information and media message to be reviewed and approved by the Disaster Response Coordinator and OCME Executive Team before release to the news media and public. Identify appropriate spokesperson to deliver the press briefings, family briefings and public information announcements. Attend all command briefings and meetings to gather and share incident and OCME information. Send message to all OCME personnel outlining agency rules on statements to the press. Conduct or assign personnel to monitor or report to you information from sources such as the internet, radio, television, and newspapers. Work with the OCME Communication Unit as appropriate to develop OCME agency Page 269 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths □ □ □ responses to general information requests. Work with the Agency Liaison, as appropriate, to develop OMCE agency responses to general and specific information requests when working with faith based organizations and private sector entities (i.e., funeral directors and crematorium and cemetery owners). Document all key activities, actions and decisions. Document all communications (internal and external). Provide a copy of communications to the Documentation Unit, via the Agency Operations Center Coordinator. Operational Responsibilities The Agency Public Information Officer is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Agency Public Information Officer should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Continue to attend all Command briefings and meetings to gather and share incident and hospital information. Contribute to briefing by updating media and public information activities and goals to the Situation Report. • Continue contact and dialogue with external Public Information Officers at the NYC JIC. Ascertain public information and media messages being developed by those entities to ensure consistent and collaborative message. • Continue to develop and revise public information and media messages for release to news media and OCME visitors. Be sure to obtain Disaster Response Coordinator and Executive Team approval to make such announcements. • Develop means to provide regular information and status update messages to keep OCME staff informed of the biological incident and the NYC’s response to the event. • Determine means whereby OCME staff can share information with the Agency PIO. • Review the need to provide updates of critical information through signage for staff, visitors, and media. • Continue to document all actions and observations. • Continue to provide public announcement messages to the JIC with the approval of the Disaster Response Coordinator and Executive Team. • Ensure ongoing information coordination with other agencies through the JIC. Such agencies include but are not limited to: − HCFs via the EOC Health and Medical Desk. − Private sector entities such as funeral directors, faith-based organizations, cemetery owners, and crematorium owners. • Prepare and maintain records and reports as indicated or requested. • Ensure physical readiness through proper nutrition, water intake, rest, and stress management techniques. • Observe all staff for signs of stress and inappropriate behavior. Report concerns to the Safety Officer or Support Branch Chief. • Determine to what extent the OCME must be prepared to continue to make media announcements regarding the management of decedents following a biological incident, since death care is likely to extend past the “crisis” associated with managing patients. • Ensure return/retrieval of equipment and supplies and return of all assigned equipment. Page 270 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • Upon deactivation of the PIO positions, brief the Disaster Response Coordinator on the current issues and items requiring follow up. Participate in after-action briefings and document observations, including recommendations for improvement. The PIO should query his/her own staff prior to participating in the OCME after-action briefing. Topics include but are not limited to: − Accomplishments and issues. − Position descriptions and operational checklists. − Procedural changes/modifications. Participate in stress management and encourage PIO staff to do the same. General: • Attend all briefings/meetings as coordinated or requested by the Disaster Response Coordinator. • Maintain communication with the Disaster Response Coordinator regarding interagency public information requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with PIO representatives on issues related to changes to or deviations from established procedures. • Develop and maintain the PIO operational and staff schedule. • Ensure all PIO personnel check-in and out at the beginning and end of each shift. • Ensure all PIO personnel are using applicable portions of their position checklists. • Prepare and maintain PIO records and reports, as appropriate. Provide reports regularly to the Disaster Response Coordinator, or as requested. • Monitor use of supplies and notify Support Group Supervisor of anticipated replenishment needs. • Be aware of PIO personnel well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the Disaster Response Coordinator related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • • • • • Activity Log OCME communication guidance OCME organization chart OCME telephone directory Community and governmental Public Information Officer and Joint Information Center (JIC) contact information Local media contact information Equipment • • • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Radios Cell Phone Note Pad Pens White board Clip board Best Practices and Considerations Page 271 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • Be mindful of wording used in all messages to families, politicians, and media personnel. Ensure family members are the first to receive new information. Provide an appropriate amount of detail in public messages. Keep lines of communication between facilities to ensure consistent information is being released and requested. Remind personnel on scene or otherwise in public view to be mindful of their behavior. Page 272 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Agency Safety Officer Agency Safety Officer Purpose / Mission Minimize the potential risk of injury to FM personnel during the biological incident response ▪ Ensure all Fatality Management scene operations are conducted in a safe manner Ensure compliance with established health and safety protocols Objectives ▪ Suggested Qualifications ▪ ▪ Assigned Area Agency Command Post Supervisor Disaster Response Coordinator Knowledge of health and safety regulations Member of the OCME Health and Safety Team * Safety Officer(s) Supporting Positions / Functions *Note: The Agency Safety Officer should maintain frequent contact with the Borough Safety Officer(s). The Safety Officer(s) will officially report to the FM Branch Director. Activation Checklist  Upon notification arrive at the Agency Command Post as directed by the Disaster Response Coordinator.  Receive incident characterization, with specific attention to the hazardous conditions present.  Determine and develop relevant Health and Safety Plans and Protocols. □ Coordinate with FM Branch Director(s) to ensure appointment of operational Safety Officers, as necessary.  Identify resources required to ensure the safety of personnel (i.e. PPE, etc.).  Determine health and safety staffing needs based on operational locations, make notifications, and provide instructions.  Ensure operational Safety Officers coordinate with Support Group Supervisors to determine the availability of sufficient amounts of PPE supplies.  Establish PPE donning and doffing areas.  Prior to commencing operations, provide health and safety briefing to all personnel. Health and Safety briefing should include:  Identify Safety measures and point out potential risks/hazards.  Identify required PPE for personnel in all functions, identify locations for donning and doffing of PPE and demonstrate proper use, if needed.  Identify Health and Safety Incident reporting protocol.  Document all communications, key decisions, and actions. Operational Responsibilities The Agency Safety Officer is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the Page 273 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths response. The Agency Safety Officer should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Prior to the commencement of operations and at the beginning of each operational period, update health and safety requirements as necessary. – Identify Safety measures and point out potential risks/hazards. – Identify required PPE for all personnel, identify locations for donning and doffing of PPE and demonstrate proper use, if needed. – Identify Health and Safety Incident reporting protocol. • Monitor all operations for health and safety protocol compliance. – Ensure that all personnel are wearing appropriate personal protective equipment (PPE) and adhering to the HASP at all times. – Take any necessary corrective actions as quickly as possible. • Continue to communicate with Safety Personnel and ensure FM specifics are included in the Health and Safety Plan. • Review any incident reports for any breach in Health and Safety Protocols. The appropriate supervisory staff must be alerted in the event of such an incident and corrective recommendations must be made. • Any unsafe conditions and actions taken should be documented appropriately for record management. • Monitor PPE and other supply stockpile available for FM personnel. – When needed, make resource request to appropriate Support Group for additional PPE cache. General: • Attend all briefings/meetings as coordinated or requested by the Disaster Response Coordinator. • Maintain communication with the Safety Officers regarding Health and Safety requirements and observations. – Report any issues that arise or process alterations needed to meet Health and Safety needs. • Maintain communications with Health and Safety personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Health and Safety operational and staff schedule. • Ensure all Health and Safety personnel check-in and out at the beginning and end of each shift. • Ensure all Health and Safety personnel are using applicable portions of their position checklists. • Prepare and maintain Health and Safety records and reports, as appropriate. Provide reports regularly to the Disaster Response Coordinator, or as requested. • Ensure Borough Safety Officers monitor use of supplies and notify Support Group Supervisors of anticipated replenishment needs. • Be aware of Health and Safety personnel well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the Disaster Response Coordinator related to the accomplishments/issues encountered during the operational period. Page 274 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Forms/Job Aids • • Activity Log Health and Safety Plan (HASP) Equipment • • • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Radios Cell Phone Note Pad Pens White board Clip board Best Practices and Considerations • • The Agency Safety Officer is responsible for ensuring safe work practices by the FM Scene Personnel. These should include: – Proper PPE worn at all times. – Proper handling of hazardous materials by adequately trained personnel. – Personnel must be taking appropriate food and rest breaks to ensure health and prevent exhaustion. – Personnel must utilize safe lifting and moving techniques to prevent injury. Depending on the hazardous materials present on the scene and the required level of PPE, the Agency Safety Officer, in coordination with the Contamination Control Group Supervisor, must determine requirements to determine medical clearance for scene personnel. The Agency Safety Officer should document the pre- and postoperation medical statistics for Scene and Morgue Personnel. Personnel unable to meet the requirements must be documented and deterred from operating in the identified PPE level. Page 275 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 276 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Agency Planning Operations Center Coordinator Operations Center Coordinator Purpose / Mission Maintain full situational awareness and detailed documentation regarding agency operations for the purpose of developing and recommending agency Situation Reports. ▪ ▪ Objectives ▪ ▪ To provide the overall collection, evaluation and dissemination of all operational information concerning the incident in order to understand the current situation Predict incident course, and to assist in the preparation of response objectives and strategies. Make decisions on resource needs. Prepare an approved Situation Report for each operational period Suggested Qualifications ▪ ▪ ▪ ▪ Assigned Area Agency Operations Center Supervisor Disaster Response Coordinator Supporting Positions / Functions Situation Unit Leader Resource Management Unit Leader Documentation Unit Leader Technical Expertise Unit Leader Demobilization Unit Leader Senior Leadership position at OCME Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Activation Checklist □ □ Obtain information from the Disaster Response Coordinator regarding OCME’s implementation of their strategy. Identify Operations Center staff. Review their JAS with them to ensure familiarity with their role and responsibilities in relation to the planning. The following positions are likely to be part of the agency Operations Center: − Situation Unit Leader − Resource Management Unit Leader ▪ Site Planning Team Leader ▪ Mapping Team Leader − Documentation Unit Leader − Technical Expertise Unit Leader ▪ Scene Planning Team Leader • Joint Agency Investigation • Decedent Recovery ▪ Postmortem Planning Team Leader • Morgue Operations • Decedent Disposition Page 277 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Transport/Storage Antemortem Planning Team Leader • Victim Information Center • Long-Term Family Management • Decedent Manifest ▪ Support Planning Team Leader • Fatality Management Branch • Health and Safety • Epidemiological Data • Agency Recovery • DVI Reconciliation − Demobilization Unit Leader Brief Operations Center staff on critical issues pertaining to the incident. Attend all briefings and cross-level information between the Operations Center and the Command Staff. Begin formulating recommended OCME Situation Reports. Direct FM Branch Directors to consider and identify facility needs. Direct specific Operations Center staff to obtain further logistics details from the Logistics staff, as needed. Direct specific Operations Center staff to obtain further logistics details from the Finance/Administration staff, as needed. Document all key activities, actions, and communications. ▪ □ □ □ □ □ □ □ Operational Responsibilities The Operations Center Coordinator is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Operations Center Coordinator should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Continue briefing Operations Center staff on critical issues pertaining to the incident. • Attend all briefings and cross-level information between the Operations Center staff and the Command Staff. • Complete the recommended OCME agency Situation Reports. • Direct FM Branch Directors to consider and identify needs, as the operations progress. • Direct specific Operations Center staff to obtain further logistics details from the Logistics staff, as the operations progress. • Direct specific Operations Center staff to obtain further logistics details from the Finance/Administration staff, as the operations progress. • Document all key activities, actions, and communications. General: • Attend all briefings/meetings as coordinated or requested by the Disaster Response Coordinator. • Maintain communication with the Disaster Response Coordinator regarding planning requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with Command Staff on issues related to changes to or Page 278 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • deviations from established procedures. Develop and maintain the Operations Center operational and staff schedule. Ensure Operations Center staff check-in and out at the beginning and end of each shift. Ensure Operations Center staff members are using applicable portions of position checklists. Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Disaster Response Coordinator and Command Staff, or as requested. Monitor use of supplies and notify Support Group Supervisor of anticipated replenishment needs. Be aware of Operations Center staff well-being and provide necessary resources. At the end of each operational period, provide a situation report to the Disaster Response Coordinator related to the accomplishments encountered during the operational period. Forms/Job Aids • • • • • • • • • • • OCME Incident Characterization Form OCME Situation Report Incident Objectives Organizational Assignment List Assignment List Radio Communications Plan Medical Plan Organizational Chart Incident Check-In List Activity Log Vehicle Log Equipment • • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Radio Note Pad Pens Clip board Best Practices and Considerations • • Ensure staff members are documenting all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Page 279 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 280 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths NYCEM Operations Center Representative NYCEM Operations Center Representative Purpose / Mission Represent the OCME at the NYCEM Emergency Operations Center during a biological incident to coordinate decedent management needs between appropriate NYC agencies. ▪ Objectives ▪ Coordinate agency needs/requests with relevant agencies at the NYCEM EOC Facilitate the flow of information between OCME and external agencies and entities as necessary and related to the biological incident Suggested Qualifications ▪ ▪ ▪ Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Assigned Area NYCEM Emergency Operations Center Supervisor Agency Liaison Officer Activation Checklist □ □ □ □ □ Receive appointment and briefing from the Agency Liaison Officer. Notify your usual supervisor of your disaster collateral assignment. Report to NYCEM Emergency Operations Center. Coordinate with non-governmental entities at the EOC to obtain resources that cannot be obtained locally, regionally or within the private sector. – Note: Obtaining these resources, just like when obtaining local assets, requires official coordination within the EOC. – Metropolitan Funeral Directors Association and all other funeral directors – Private Sector Cemetery Owners – Private Sector Crematorium Owners – State Funeral Director Association – American Red Cross – The Salvation Army – New York Disaster Interfaith Services (NYDIS) – Other Private and Commercial Entities Coordinate with State and Federal entities represented at the EOC to obtain resources that cannot be obtained locally, regionally, or within the private sector. – Note: Obtaining these resources, just like when obtaining local assets, requires official coordination within the EOC. – New York State Department of Health (DOH) – New York State Department of Homeland Security and Emergency Services (DHSES) – Division of Cemeteries in the New York Department of State – New York State Army National Guard – US Department of Homeland Security and Federal Emergency Management Agency (DHS/FEMA) – US Department of Health and Human Services (HHS) – US Department of Transportation (DOT) – US Department of Defense (DOD) Page 281 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths □ □ – US Department of State Document all key activities, actions, and communications. Participate in EOC briefings and report information between the Disaster Response Coordinator and entities within the EOC. Operational Responsibilities The NYCEM Operations Center Representative is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The NYCEM Operations Center Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Attend all EOC briefings and Citywide Incident Action Planning meetings to gather and share incident and OCME agency information. Contribute to the briefing by identifying OCME goals for incorporation into the Citywide Incident Action Plan (IAP). • Request assistance and information as needed through the DOHMH Operation Center Representative. • Respond to requests and issues from other EOC entities. • Report pertinent information to appropriate OCME positions. • Prepare and maintain records and reports as appropriate. General: • Attend all briefings/meetings as coordinated or requested by the Agency Liaison Officer. • Maintain communication with the Disaster Response Coordinator regarding interagency liaison requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with Liaison representatives on issues related to changes to or deviations from established procedures. • Develop and maintain the Liaison operational and staff schedule. • Check-in and out at the beginning and end of each shift. • Use applicable portions of position checklists. • Prepare and maintain Liaison records and reports, as appropriate. Provide reports regularly to the Agency Liaison Officer, or as requested. • Monitor use of supplies and notify Support Group Supervisor of anticipated replenishment needs. • Be aware of Liaison personnel well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the Agency Liaison Officer related to the accomplishments encountered during the operational period. Forms/Job Aids • Activity Log Equipment • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Note Pad Page 282 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • Pens Clip board Best Practices and Considerations • • • Ensure information is being released through appropriate channels. – For instance, the total number of fatalities is released by OCME to the Mayor’s Office, who will distribute the information to other city agencies or the media. All information coming from any OCME representative should be consistent and approved by the Disaster Response Coordinator or OCME Executive Team. Press and media inquiries should be directed to the Public Information Officer. Page 283 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 284 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths DOHMH Operations Center Representative DOHMH Operations Center Representative Purpose / Mission Represent the OCME at the NYC DOHMH Emergency Operations Center during a biological incident to coordinate decedent management needs between appropriate NYC agencies. ▪ Objectives ▪ Coordinate agency needs/requests with relevant agencies at the DOHMH EOC Facilitate the flow of information between OCME and external agencies and entities as necessary and related to the pandemic event Suggested Qualifications ▪ ▪ ▪ Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Assigned Area NYC DOHMH Emergency Operations Center Supervisor Agency Liaison Officer Activation Checklist □ □ □ □ □ Receive appointment and briefing from the Agency Liaison Officer. Notify your usual supervisor of your disaster collateral assignment. Report to NYC DOHMH Emergency Operations Center. Coordinate with non-governmental entities at the EOC to obtain resources that cannot be obtained locally, regionally or within the private sector. – Note: Obtaining these resources, just like when obtaining local assets, requires official coordination within the EOC. – Metropolitan Funeral Directors Association and all other funeral directors – Private Sector Cemetery Owners – Private Sector Crematorium Owners – State Funeral Director Association – American Red Cross – The Salvation Army – New York Disaster Interfaith Services (NYDIS) – Other Private and Commercial Entities Coordinate with State and Federal entities represented at the EOC to obtain resources that cannot be obtained locally, regionally, or within the private sector. – Note: Obtaining these resources, just like when obtaining local assets, requires official coordination within the EOC. – New York State Department of Health (DOH) – New York State Department of Homeland Security and Emergency Services (DHSES) – Division of Cemeteries in the New York Department of State – New York State Army National Guard – US Department of Homeland Security and Federal Emergency Management Agency (DHS/FEMA) – US Department of Health and Human Services (HHS) – US Department of Transportation (DOT) – US Department of Defense (DOD) Page 285 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths □ □ – US Department of State Document all key activities, actions, and communications. Participate in EOC briefings and report information between the OCME Disaster Response Coordinator and entities within the EOC. Operational Responsibilities The DOHMH Operations Center Representative is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The DOHMH Operations Center Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Attend all EOC briefings and Citywide Incident Action Planning meetings to gather and share incident and OCME agency information. Contribute to the briefing by identifying OCME goals for incorporation into the Citywide Incident Action Plan (IAP). • Request assistance and information as needed through the DOHMH Operation Center Representative. • Respond to requests and issues from other EOC entities. • Report pertinent information to appropriate OCME positions. • Prepare and maintain records and reports as appropriate. General: • Attend all briefings/meetings as coordinated or requested by the Agency Liaison Officer. • Maintain communication with the Disaster Response Coordinator regarding interagency liaison requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with Liaison representatives on issues related to changes to or deviations from established procedures. • Develop and maintain the Liaison operational and staff schedule. • Check-in and out at the beginning and end of each shift. • Use applicable portions of position checklists. • Prepare and maintain Liaison records and reports, as appropriate. Provide reports regularly to the Agency Liaison Officer, or as requested. • Monitor use of supplies and notify Support Group Supervisor of anticipated replenishment needs. • Be aware of Liaison personnel well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the Liaison Officer related to the accomplishments encountered during the operational period. Forms/Job Aids • Activity Log Equipment • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Note Pad Pens Page 286 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Clip board Best Practices and Considerations • • • Ensure information is being released through appropriate channels. – For instance, the total number of fatalities is released by OCME to the Mayor’s Office, who will distribute the information to other city agencies or the media. All information coming from any OCME representative should be consistent and approved by the Disaster Response Coordinator or OCME Executive Team. Press and media inquiries should be directed to the Public Information Officer. Page 287 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 288 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Planning Representative Planning Representative Purpose / Mission Provide support in the Operations Center to coordinate and document response activities Functions ▪ ▪ ▪ ▪ ▪ ▪ Suggested Qualifications Employee within OCME Emergency Management Division Assigned Area Agency Operations Center Documentation Situation Report Food Planning Task Forces Resource Tracking Just-in-Time Training Activation Checklist  Receive assignment and report to the Operations Center.  Attend briefings and report on critical issues pertaining to the incident.  Attend all briefings and cross-level information between operational and administrative staff and the Operations Center.  Coordinate with response personnel to record operational updates and details, as needed.  Coordinate with OCME personnel regarding incident-related items and requests, as needed.  Document all key activities, actions, and communications.  Request additional support for Operations Center activities, as needed. Operational Responsibilities The Planning Representative is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Planning Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: ▪ Coordinate between the Operations Center and all personnel involved with the incident response during the course of operations. ▪ Ensure all necessary documentation related to the incident response is documented and collected. ▪ Produce a Situation Report for each operational period, or as determined, and distribute to the appropriate personnel. ▪ Coordinate with Finance/Administration and Logistics to order and delivery food to personnel supporting operations. General: ▪ Attend all briefings/meetings as coordinated or requested by the Operations Center Coordinator and/or Disaster Response Coordinator. ▪ Maintain communication with the Operations Center Coordinator. ▪ Report any issues that arise or process alterations needed. Page 289 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ▪ ▪ ▪ ▪ ▪ ▪ Maintain communications with operational staff on issues related to changes to or deviations from established procedures. Check-in and out at the beginning and end of each shift. Use applicable portions of position checklists. Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Operations Center Coordinator and Command Staff, or as requested. Be aware of staff well-being and provide necessary resources. At the end of each operational period, provide a situation report to the Operations Center Coordinator related to the accomplishments encountered during the operational period. Forms/Job Aids • • • • • • • • • • • OCME Incident Characterization Form OCME Situation Report Incident Objectives Organizational Assignment List Assignment List Radio Communications Plan Medical Plan Organizational Chart Incident Check-In List Activity Log Vehicle/Equipment Log Equipment • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Page 290 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Logistics Representative Logistics Representative Purpose / Mission Provide support in the Operations Center to coordinate logisticst response activities Functions ▪ ▪ Suggested Qualifications OCME Employee familiar with Logistics Assigned Area Agency Operations Center Resource Requests Vendor Management Activation Checklist □ □ □ □ □ □ □ Receive assignment and report to the Operations Center. Attend briefings and report on critical issues pertaining to the incident. Attend all briefings and cross-level information between operational and administrative staff and the Operations Center. Coordinate with response personnel to record operational updates and details, as needed. Coordinate with OCME personnel regarding incident-related items and requests, as needed. Document all key activities, actions, and communications. Request additional support for Operations Center activities, as needed. Operational Responsibilities The Logistics Representative is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Logistics Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: ▪ Coordinate with Logistics personnel involved with the incident response during the course of operations. ▪ Ensure all necessary documentation related to the incident response is documented and collected. ▪ Properly route all resource requests made by response personnel to the Logistics Chief and the OCME Finance/Administration Representative. ▪ Assist the Logistics Chief in maintaining requested vendor information, including delivery/pick up schedules, etc. General: • Attend all briefings/meetings as coordinated or requested by the Operations Center Coordinator and/or Disaster Response Coordinator. • Maintain communication with the Operations Center Coordinator. • Report any issues that arise or process alterations needed. • Maintain communications with operational staff on issues related to changes to or deviations from established procedures. • Check-in and out at the beginning and end of each shift. • Use applicable portions of position checklists. Page 291 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Operations Center Coordinator and Command Staff, or as requested. Be aware of staff well-being and provide necessary resources. At the end of each operational period, provide a situation report to the Operations Center Coordinator related to the accomplishments encountered during the operational period. Forms/Job Aids • • • • • • • • • • • OCME Incident Characterization Form OCME Situation Report Incident Objectives Organizational Assignment List Assignment List Radio Communications Plan Medical Plan Organizational Chart Incident Check-In List Activity Log Vehicle/Equipment Log Equipment • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Page 292 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operations Representative Operations Representative Purpose / Mission Provide support in the Operations Center to coordinate and document response activities Functions ▪ ▪ ▪ Suggested Qualifications OCME Employee familiar with agency operations Assigned Area Agency Operations Center Scene Postmortem Processing Antemortem Processing Activation Checklist □ □ □ □ □ □ □ Receive assignment and report to the Operations Center. Attend briefings and report on critical issues pertaining to the incident. Attend all briefings and cross-level information between operational and administrative staff and the Operations Center. Coordinate with response personnel to record operational updates and details, as needed. Coordinate with OCME personnel regarding incident-related items and requests, as needed. Document all key activities, actions, and communications. Request additional support for Operations Center activities, as needed. Operational Responsibilities The Operations Representative is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Operations Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: ▪ Coordinate between the Operations Center and all personnel involved with the incident response during the course of operations. ▪ Ensure all necessary documentation related to the incident response is documented and collected. General: • Attend all briefings/meetings as coordinated or requested by the Operations Center Coordinator and/or Disaster Response Coordinator. • Maintain communication with the Operations Center Coordinator. • Report any issues that arise or process alterations needed. • Maintain communications with operational staff on issues related to changes to or deviations from established procedures. • Check-in and out at the beginning and end of each shift. • Use applicable portions of position checklists. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Operations Center Coordinator and Command Staff, or as requested. • Be aware of staff well-being and provide necessary resources. Page 293 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • At the end of each operational period, provide a situation report to the Operations Center Coordinator related to the accomplishments encountered during the operational period. Forms/Job Aids • • • • • • • • • • • OCME Incident Characterization Form OCME Situation Report Incident Objectives Organizational Assignment List Assignment List Radio Communications Plan Medical Plan Organizational Chart Incident Check-In List Activity Log Vehicle/Equipment Log Equipment • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Page 294 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Information Technology Representative Information Technology Representative Purpose / Mission Provide information technology support in the Operations Center Functions ▪ ▪ Suggested Qualifications Member of OCME Information Technology department Assigned Area Agency Operations Center IT Support UVIS-CMS Support Activation Checklist □ □ □ □ □ □ □ Receive assignment and report to the Operations Center. Attend briefings and report on critical issues pertaining to the incident. Attend all briefings and cross-level information between operational and administrative staff and the Operations Center. Coordinate with response personnel to record operational updates and details, as needed. Coordinate with OCME personnel regarding incident-related items and requests, as needed. Document all key activities, actions, and communications. Request additional support for Operations Center activities, as needed. Operational Responsibilities The Information Technology Representative is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Information Technology Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: ▪ Provide IT support (including UVIS-CMS) as necessary to the Operations Center, including computers, printers, televisions, audio/visual capabilities, etc. ▪ Coordinate with IT personnel supporting operations (including scene, morgue, VIC, and Microwave Communications System). General: • Attend all briefings/meetings as coordinated or requested by the Operations Center Coordinator and/or Disaster Response Coordinator. • Maintain communication with the OCME Chief Information Officer. • Report any issues that arise or process alterations needed. • Maintain communications with operational staff on issues related to changes to or deviations from established procedures. • Check-in and out at the beginning and end of each shift. • Use applicable portions of position checklists. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Operations Center Coordinator and Command Staff, or as requested. • Be aware of staff well-being and provide necessary resources. Page 295 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • At the end of each operational period, provide a report to the Operations Center Coordinator related to the accomplishments encountered during the operational period. Forms/Job Aids • • • • • • • • • • • OCME Incident Characterization Form OCME Situation Report Incident Objectives Organizational Assignment List Assignment List Radio Communications Plan Medical Plan Organizational Chart Incident Check-In List Activity Log Vehicle/Equipment Log Equipment • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Page 296 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Facilities Representative Facilities Representative Purpose / Mission Provide support in the Operations Center to coordinate facility needs Functions ▪ Suggested Qualifications Member of OCME Facilities department Assigned Area Agency Operations Center Building Maintenance Requests Activation Checklist □ □ □ □ □ □ □ Receive assignment and report to the Operations Center. Attend briefings and report on critical issues pertaining to the incident. Attend all briefings and cross-level information between operational and administrative staff and the Operations Center. Coordinate with response personnel to record operational updates and details, as needed. Coordinate with OCME personnel regarding incident-related items and requests, as needed. Document all key activities, actions, and communications. Request additional support for Operations Center activities, as needed. Operational Responsibilities The Facilities Representative is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Facilities Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: ▪ Coordinate any facilities’ requests that arise during the course of operations, including cleaning requests, repair requests, and maintenance requests General: • Attend all briefings/meetings as coordinated or requested by the Operations Center Coordinator and/or Disaster Response Coordinator. • Maintain communication with the Executive Director of Facilities. • Report any issues that arise or process alterations needed. • Maintain communications with operational staff on issues related to changes to or deviations from established procedures. • Check-in and out at the beginning and end of each shift. • Use applicable portions of position checklists. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Operations Center Coordinator and Command Staff, or as requested. • Be aware of staff well-being and provide necessary resources. • At the end of each operational period, provide a report to the Operations Center Coordinator related to the accomplishments encountered during the operational period. Page 297 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Forms/Job Aids • • • • • • • • • • • OCME Incident Characterization Form OCME Situation Report Incident Objectives Organizational Assignment List Assignment List Radio Communications Plan Medical Plan Organizational Chart Incident Check-In List Activity Log Vehicle/Equipment Log Equipment • • • • Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Page 298 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Finance/Administration Representative Finance/Administration Representative Purpose / Mission Provide coordination between the Operations Center and OCME Finance/Administration Departments during an incident response Functions Represented ▪ ▪ ▪ ▪ ▪ ▪ ▪ Suggested Qualifications Employee within OCME Finance/Administrative Departments Assigned Area Agency Operations Center Human Resources Contracts Procurement Budget Audits & Accounts Receiving Materials Management Activation Checklist □ □ □ □ □ □ □ Receive assignment and report to the Operations Center. Attend briefings and report on critical issues pertaining to the incident. Attend all briefings and cross-level information between Finance/Administration staff and the Operations Center. Coordinate with Finance/Administration staff to provide operational updates and details to the Operations Center staff, as needed. Coordinate with response personnel regarding incident-related items and requests, as needed. Document all key activities, actions, and communications. Request additional support for Finance/Administration activities, as needed. Operational Responsibilities The Finance/Administration Representative is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Finance/Administration Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: ▪ Coordinate between the Operations Center and OCME Finance/Administration Departments during the course of incident operations. ▪ Assist OCME Finance/Administration Departments in completing requests related to the incident response. General: • Attend all briefings/meetings as coordinated or requested by the Operations Center Coordinator and/or Disaster Response Coordinator. • Maintain communication with the Operations Center Coordinator. • Report any issues that arise or process alterations needed. • Maintain communications with Finance/Administration staff on issues related to changes to or deviations from established procedures. Page 299 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • Check-in and out at the beginning and end of each shift. Use applicable portions of position checklists. Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Operations Center Coordinator and Command Staff, or as requested. Be aware of staff well-being and provide necessary resources. At the end of each operational period, provide a situation report to the Operations Center Coordinator related to the accomplishments encountered during the operational period. Forms/Job Aids • • • • • • • • • • • OCME Incident Characterization Form OCME Situation Report Incident Objectives Organizational Assignment List Assignment List Radio Communications Plan Medical Plan Organizational Chart Incident Check-In List Activity Log Vehicle/Equipment Log Equipment • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Page 300 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Agency Logistics Agency Logistics Chief Agency Logistics Chief Purpose / Mission To oversee the provision of resources to support OCME’s disaster response activities ▪ ▪ Coordinate and provide all necessary support to scene, postmortem, antemortem, and command/control operations Source necessary equipment, supplies, and/or staff from external vendors/agencies Troubleshoot logistical/operational issues as they arise Suggested Qualifications ▪ ▪ ▪ ▪ Senior Leadership position at OCME Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Assigned Area Agency Command Post Supervisor Disaster Response Coordinator Supporting Positions / Functions Support Branch Director Services Branch Director Logistics personnel ▪ Objectives Activation Checklist □ □ □ □ □ □ □ Obtain information from the Disaster Response Coordinator regarding OCME’s implementation of their strategy. Identify Logistics staff. Review their JAS with them to ensure familiarity with their role and responsibilities. The following positions are likely to be necessary: − Support Branch Director ▪ Food Unit Leader ▪ Transport/Lodging Unit Leader ▪ Communications Unit Leader ▪ Information Technology Unit Leader ▪ Health/Medical Unit Leader − Services Branch Director ▪ Supply Unit Leader ▪ Just-In-Time Training Unit Leader ▪ Contract/Resource Management Unit Leader ▪ Facilities Unit Leader Contact and become familiar with Logistics personnel and ensure familiarity with their role and responsibilities. Brief Logistics staff on critical issues pertaining to the incident. Attend all briefings and cross-level information between the Logistics and Command Staff. Direct Logistics personnel to consider and identify needs. Direct specific Logistics staff to provide operational updates and details to the Agency Operations Center, as needed. Page 301 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths □ □ Direct specific Logistics staff to provide operational updates and details to the Finance/Administration staff, as needed. Document all key activities, actions, and communications. Operational Responsibilities The Logistics Chief is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Logistics Chief should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Continue briefing Logistics staff on critical issues pertaining to the incident. • Attend all briefings and cross-level information between the Logistics and Command Staff. • Direct Logistics personnel to consider and identify needs, as the operations progress. • Direct specific Logistics staff to provide operational updates and details to the Agency Operations Center, as the operations progress. • Direct specific Logistics staff to provide operational updates and details to the Finance/Administration staff, as the operations progress. • Document all key activities, actions, and communications. General: • Attend all briefings/meetings as coordinated or requested by the Disaster Response Coordinator. • Maintain communication with the Disaster Response Coordinator regarding planning requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with Logistics Staff on issues related to changes to or deviations from established procedures. • Develop and maintain the Logistics operational and staff schedule. • Ensure Logistics staff check-in and out at the beginning and end of each shift. • Ensure Logistics Staff are using applicable portions of position checklists. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Disaster Response Coordinator and Command Staff, or as requested. • Monitor use of supplies and notify Support Group Supervisor of anticipated replenishment needs. • Be aware of Logistics Staff well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the Disaster Response Coordinator related to the accomplishments encountered during the operational period. Forms/Job Aids • • • • • • Activity Log Logistics Plan Demobilization Plans Resource Request Forms Pre-Scripted Mission Requests Memoranda of Understanding Page 302 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Equipment • • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Radio Note Pad Pens Clip board Best Practices and Considerations • • • • • Consider additional or specialized equipment/supply needs based on external aspects of operations (such as inclement weather, etc.). Consider specialized skills needed to conduct operations (such as specialized or heavy equipment operators). Extrapolate supply/equipment usage and work with Finance/Administration personnel to restock to the appropriate level. Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Page 303 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 304 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Logistics Operations Support Team Logistics Operations Support Team Purpose / Mission To support the provision of resources to support OCME’s disaster response activities ▪ ▪ Assist in coordinating and providing all necessary support to scene, postmortem, antemortem, and command/control operations Source necessary equipment, supplies, and/or staff from external vendors/agencies Troubleshoot logistical/operational issues as they arise Suggested Qualifications ▪ ▪ ▪ Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Assigned Area Variable Supervisor Agency Logistics Chief Objectives ▪ Activation Checklist □ □ □ □ □ □ □ Obtain information from the Logistics Chief regarding OCME’s implementation of their strategy. Review JAS to ensure familiarity with role and responsibilities. Contact and become familiar with any additional Logistics and operational personnel and ensure familiarity with their role and responsibilities. Attend all briefings and cross-level information between the Logistics and Command Staff. Provide operational updates and details to the Agency Operations Center, as needed. Provide operational updates and details to the Finance/Administration staff, as needed. Document all key activities, actions, and communications. Operational Responsibilities The Logistics Operations Support Team is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Logistics Operations Support Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Attend all briefings and cross-level information between the Logistics and Command Staff. • Consider and identify needs, as the operations progress. • Provide operational updates and details to the Agency Operations Center, as the operations progress. • Provide operational updates and details to the Finance/Administration staff, as the operations progress. • Document all key activities, actions, and communications. Page 305 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths General: • Attend all briefings/meetings as coordinated or requested by the Logistics Chief. • Maintain communication with the Logistics Chief regarding planning requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with Logistics Chief on issues related to changes to or deviations from established procedures. • Check-in and out at the beginning and end of each shift. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Disaster Response Coordinator and Command Staff, or as requested. • Monitor use of supplies and notify Administrative Logistics Support Team of anticipated replenishment needs. • At the end of each operational period, provide a situation report to the Logistics Chief related to the accomplishments encountered during the operational period. Forms/Job Aids • • • • • Activity Log Logistics Plan Resource Request Forms Pre-Scripted Mission Requests Memoranda of Understanding Equipment • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • • • • • Consider additional or specialized equipment/supply needs based on external aspects of operations (such as inclement weather, media attention, etc.). Consider specialized skills needed to conduct operations (such as specialized or heavy equipment operators). Extrapolate supply/equipment usage and work with Finance/Administration personnel to restock to the appropriate level. Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Coordinate with the Operations Center as necessary to ensure staff members are capable of operating any specialized equipment. Page 306 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Logistics Administration Support Team Logistics Administration Support Team Purpose / Mission To support the provision of resources to support OCME’s disaster response activities ▪ ▪ Assist in coordinating and providing all necessary support to scene, postmortem, antemortem, and command/control operations Source necessary equipment, supplies, and/or staff from external vendors/agencies Troubleshoot logistical/operational issues as they arise Suggested Qualifications ▪ ▪ ▪ Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Assigned Area Variable Supervisor Agency Logistics Chief Objectives ▪ Activation Checklist □ □ □ □ □ □ □ Obtain information from the Logistics Chief regarding OCME’s implementation of their strategy. Review JAS to ensure familiarity with role and responsibilities. Contact and become familiar with any additional Logistics and operational personnel and ensure familiarity with their role and responsibilities. Attend all briefings and cross-level information between the Logistics and Command Staff. Provide operational updates and details to the Agency Operations Center, as needed. Provide operational updates and details to the Finance/Administration staff, as needed. Document all key activities, actions, and communications. Operational Responsibilities The Logistics Administration Support Team is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Logistics Operations Support Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Attend all briefings and cross-level information between the Logistics and Command Staff. • Consider and identify needs, as the operations progress. • Provide operational updates and details to the Agency Operations Center, as the operations progress. • Provide operational updates and details to the Finance/Administration staff, as the operations progress. • Document all key activities, actions, and communications. Page 307 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths General: • Attend all briefings/meetings as coordinated or requested by the Logistics Chief. • Maintain communication with the Logistics Chief regarding planning requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with Logistics Chief on issues related to changes to or deviations from established procedures. • Check-in and out at the beginning and end of each shift. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Disaster Response Coordinator and Command Staff, or as requested. • Monitor use of supplies and notify Administrative Logistics Support Team of anticipated replenishment needs. • At the end of each operational period, provide a situation report to the Logistics Chief related to the accomplishments encountered during the operational period. Forms/Job Aids • • • • • Activity Log Logistics Plan Resource Request Forms Pre-Scripted Mission Requests Memoranda of Understanding Equipment • • • • • Relevant maps (recovery locations, BCPs, command posts, morgues, FACs, etc.) Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • • • • • Consider additional or specialized equipment/supply needs based on external aspects of operations (such as inclement weather, media attention, etc.). Consider specialized skills needed to conduct operations (such as specialized or heavy equipment operators). Extrapolate supply/equipment usage and work with Finance/Administration personnel to restock to the appropriate level. Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Coordinate with the Operations Center as necessary to ensure staff members are capable of operating any specialized equipment. Page 308 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operations Fatality Management Branch Director Fatality Management Branch Director Purpose / Mission To establish and manage Fatality Management Operations in accordance with medicolegal best practices ▪ ▪ Objectives ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Suggested Qualifications Coordinate, supervise, and manage operations and personnel ▪ Scene (operations in a biological incident will be decentralized) ▪ Postmortem Processing ▪ Antemortem Processing Ensure all Fatality Management Operations are conducted in a safe manner Conduct Fatality Management tasks in accordance with established forensic standards Ensure the documentation, investigation, and recovery of decedents in a dignified and respectful manner Support judicial, public health and investigative objectives and requirements Executive or Senior Leadership position in the OCME agency ICS Knowledge Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with search and recovery methods and strategies Assigned Area Agency Command Post Incident Scene / Command Post Supervisor Disaster Response Coordinator Supporting Positions / Functions Deputy FM Branch Director – Scene Deputy FM Branch Director – Postmortem Processing Deputy FM Branch Director – Antemortem Processing Activation Checklist □ Appoint Deputy Fatality Management Branch Directors for Scene Operations, Postmortem Processing, and Antemortem Processing. □ Coordinate with Deputy Fatality Management Branch Directors to identify initial personnel and resource deployment requirements. □ Make contact with the Agency Operations Center to communication the establishment of Operations. □ Request a Safety Officer for all phases of operations. □ Coordinate FM Health and Safety requirements with Agency Safety Officer. □ Identify PPE requirements set by the Agency Safety Officer and ensure compliance at all times. □ Due to the potential biological threat of incident cases, activate the Contamination Page 309 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Control Group Supervisor to coordinate with HAZMAT personnel and Health and Safety Personnel to develop incident-specific operational protocols. □ Ensure FM Branch participation in all command meetings and briefings (typically held at the beginning and end of operational periods, or at the discretion of the Agency Command). □ Identify operational security measures and brief Deputies on established perimeters and required credentials. Operational Responsibilities The FM Branch Director is responsible for the following items throughout the scene operations. Several of these items will be ongoing or repeated through the course of the response. The FM Branch Director should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • • • • Continue to update incident characterization form, as needed, to identify decision making needs and operational changes. Ensure that FM priorities and protocols are well communicated to the participating agencies across shift changes. Attend all briefings/meetings as coordinated or requested by the Disaster Response Coordinator. Maintain communication with the Disaster Response Coordinator regarding all operations. – Report any issues that arise or process alteration needed. Monitor all fatality management operations. Identify staffing schedules based on the operational periods, operational requirements and staffing availability. – Be aware of changes in staffing for partner agencies and maintain up-to-date contact information. – Ensure all scene personnel report to the Command Post, as directed and check-in and check-out at the beginning and end of their shift, respectively. Ensure proper resources are available to complete fatality management operations. Manage issues that arise during operations, including interagency coordination. Ensure all FM operations are conducted in a safe, efficient, and effective manner. Establish regular operational briefings. Each meeting should serve to: – Provide situational awareness and updates on incident response/recovery. – Identify issues and correct any problems before they become major. – Convey operational protocols/procedures to FM personnel. – Establish work schedule for current operational period, including required breaks. – Identify lines of communication. Provide information regularly to the Agency Operations Center for inclusion in the Situation Report and as requested for incident-specific planning. Forms/Job Aids • • Incident Characterization Form Activity Log Equipment • Site maps Page 310 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • Radios Cell Phone Note Pad Pens White board Clip board Best Practices and Considerations • • • • • Based on incident characteristics, identify alterations to FM protocols that may be necessary to investigate and recovery remains in a safe and efficient manner. Because of the decentralized nature of a biological incident, staff should be dispatched as necessary from the Command Post in order to investigate and recover cases. Consider external aspects of the scene (such as public view, inclement weather, etc.) that may alter operational strategies. Consider specialized skills needed to conduct operations. Coordinate with the Disaster Response Coordinator to request specialized personnel capable of assisting in the investigation and recovery process. Coordinate with the Agency Command Post to determine any changes to FM operations due to the potential spread of the pathogen in question. – The Contamination Control Group Supervisor should be notified to determine alteration to FM Protocols based on the biological hazard. – It may be necessary to bring in an Infectious Disease Subject Matter Expert and/or other specially trained HAZMAT Teams to assist in the processing of the scene and to ensure the maintenance of the forensic integrity of the remains. Page 311 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 312 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Operations Deputy Fatality Management Branch Director – Scene The Deputy FM Branch – Scene, appointed by the FM Branch Director, is responsible for the establishment and management of all FM Scene Operations. Depending on the available staffing and nature and complexity of the incident, the Deputy FM Branch Director-Scene may expand or contract the Scene personnel structure as needed. Deputy Fatality Management (FM) Branch Director – Scene Purpose / Mission To establish and manage FM Scene Operations in accordance with medicolegal best practices. ▪ ▪ Objectives ▪ ▪ ▪ Coordinate, supervise and manage scene operations and personnel ▪ Scene operations in a biological incident will be decentralized Ensure all Fatality Management Scene Operations are conducted in a safe manner Conduct Fatality Management tasks in accordance with established forensic standards Ensure the documentation, investigation, and recovery of decedents in a dignified and respectful manner Support judicial, public health and investigative objectives and requirements Suggested Qualifications ▪ ▪ ▪ ▪ ▪ Assigned Area Command Post Supervisor FM Branch Director Supporting Positions / Functions ▪ ▪ ▪ ▪ ▪ Senior Leadership position in the OCME agency ICS Knowledge Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with search and recovery methods and strategies FM Safety Officer – Scene Investigation / Recovery Group Supervisor Remains Storage / Transport Group Supervisor Scene Support Group Supervisor Contamination Control Group Supervisor Activation Checklist □ Coordinate with FM Branch Director to identify initial scene personnel and resource deployment. □ Make contact with the Agency Operations Center to communication the establishment of Scene Operations. □ Request a Safety Officer for scene operations. □ Coordinate FM Health and Safety requirements with Agency Safety Officer. □ Identify PPE requirements set by the Agency Safety Officer and ensure compliance at all times. Page 313 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths □ Activate Group Supervisors and provide with incident characterization and required □ □ □ □ □ □ mobilization. □ Notify the Scene Support Group Supervisor of initial resource deployment, staging area location and other relevant information. □ Identify initial personnel requirements, location of muster point and specific security and/or health and safety requirements. □ Coordinate with the Scene Support Group Supervisor and the Remains Storage/Transport Group Supervisor to identify staging location for Body Collection Point (BCP) and anticipate storage needs. Due to the potential biological threat of incident cases, activate the Contamination Control Group Supervisor to coordinate with HAZMAT personnel and Health and Safety Personnel to develop incident-specific operational protocols. Coordinate with Scene Support Group Supervisor to identify communications needs. □ Confirm radio channels used for various scene operations. □ Establish communications with other investigative agencies active on-scene. Ensure FM Branch participation in all command meetings and briefings (typically held at the beginning and end of operational periods, or at the discretion of the Disaster Response Coordinator). Participate in the JAFET in coordination with other investigative agencies, or identify a designee to participate. □ Update Incident Characterization Form, as possible and any other scene documentation necessary (sketch maps, etc.). □ Provide updated scene details to the FM Branch Director for decision making purposes. □ Begin to coordinate a strategy to process the scene(s). □ Identify additional assets required to process the scene(s). □ Provide the OCME Executive Leadership updates on any changes related to Scene Operations. □ Develop updated protocol to process the scene and delegate responsibilities to Group Supervisors as appropriate. □ Continue to update incident characterization and provide to necessary parties. □ Identify staffing requirements and operational periods for FM operations. □ Provide schedule of operational briefings. □ Request a report back from Group Supervisors with confirmation on mobilization efforts to stand up the FM Scene Operations. □ Request Scene Group Supervisors to identify resource needs/gaps based on Scene processing protocol. ▪ Push resource requests to the Scene Support Group to fulfill gaps from the cache. ▪ If the Scene Support Group is unable to fulfill the request push it to the Logistics staff and/or Agency Operations Center for sourcing. Identify Scene security measures and brief Group Supervisors on established perimeters and required credentials. Notify FM Branch Director when scene operations are ready to commence. Operational Responsibilities The Deputy FM Branch Director - Scene is responsible for the following items throughout the scene operations. Several of these items will be ongoing or repeated through the Page 314 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths course of the response. The Deputy FM Branch Director - Scene should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • • • • • Continue to update incident characterization form, as needed, to identify decision making needs and operational changes. Ensure that FM priorities and protocols are well communicated to the participating agencies across shift changes. Attend all briefings/meetings as coordinated or requested by the FM Branch Director, or as required by Scene Operations. Maintain communication with the FM Branch Director regarding all scene operations. – Report any issues that arise or process alteration needed to properly process the scene. Monitor FM Operations on scene. – Instruct the Investigations/Recovery Group Supervisor to assemble and manage Teams comprised of the necessary specialties. Teams will be assigned to cases to investigate, document, and collect remains according to determine protocol. – Instruct the Remains Storage/Transport Group Supervisor to assemble and manage Teams to operate the BCPs located at the scene. Teams will store, track, and transport remains to the morgue facility when directed to do so. Identify staffing schedules based on the operational periods, scene requirements and staffing availability. – Be aware of changes in staffing for partner agencies and maintain up-to-date contact information. – Ensure all scene personnel report to the Command Post, as directed and check-in and check-out at the beginning and end of their shift, respectively. Ensure proper resources are available to complete FM scene operations; delegate the Scene Support Group Supervisor to coordinate with Logistics personnel. If procurement of assets is needed, submit requests to Agency Operations Center for sourcing. Manage issues that arise during the processing of the scene, including interagency coordination. Ensure all FM operations are conducted in a safe, efficient and effective manner. Establish a regular meeting schedule for individuals on scene. Each meeting should serve to: – Provide situational awareness and updates on incident response/recovery – Identify issues and correct any problems before they become major – Convey operational protocols/procedures to FM scene personnel – Establish work schedule for current operational period, including required breaks – Identify lines of communication Coordinate with Deputy FM Branch Director – Morgue to identify times and locations for remains being transported from the scene to the morgue facility. Provide information regularly to the Agency Operations Center for inclusion in the Situation Report and as requested for incident-specific planning. Forms/Job Aids • • Incident Characterization Form Activity Log Page 315 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Equipment • • • • • • • Site map Radios Cell Phone Note Pad Pens White board Clip board Best Practices and Considerations • • • • • Based on incident characteristics, identify alterations to FM protocols that may be necessary to investigate and recovery remains in a safe and efficient manner. Because of the decentralized nature of a biological incident, staff should be dispatched as necessary from the Command Post in order to investigate and recover cases. Consider external aspects of the scene (such as public view, inclement weather, etc.) that may alter the time available to process the scene. Consider specialized skills needed to process the scene. Coordinate with the FM Branch director to request specialized personnel capable of assisting in the investigation and recovery process. Coordinate with the Disaster Response Coordinator to determine any changes to FM operations due to the potential spread of the pathogen involved in the incident. – The Contamination Control Group Supervisor should be notified to determine alteration to FM Protocols based on the biological hazard. – It may be necessary to bring in an Infectious Disease Subject Matter Expert and/or other specially trained HAZMAT Teams to assist in the processing of the scene and to ensure the maintenance of the forensic integrity of the remains. Page 316 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Security Officer Scene Security Officer Purpose / Mission To provide for facility security and the security of all human remains, equipment, and personnel in the scene operations ▪ Objectives Ensure scene facilities are secure for the entirety of the operation Assigned Area Various areas / patrol Check-in and check-out Supervisor Deputy Fatality Management Branch Director – Scene Activation Checklist  Upon notification, arrive at the scene location as directed by the Deputy FM Branch Director – Scene.  Meet with the Deputy FM Branch Director – Scene and receive: – Incident Characterization and Situational Awareness – Scene Operations and Security Expectations  Perform site security assessment based on the location, facility characteristics, and incident characteristics. Brief the Deputy FM Branch Director – Scene on the results of the assessment. – Identify immediate needs to secure the scene facility: ▪ Establishment of perimeters surrounding the Command Post. ▪ Access points for scene personnel (check-in / check-out station). ▪ Potential interagency representatives to be present in the scene. ▪ Accepted credentials/identification for scene personnel and/or credentialing system to create identification for all scene personnel.  Based on the incident characteristics and the scale of the Scene Security operations, determine Security staffing requirements.  Notify security staff and provide them with instructions to report immediately to the Scene.  Upon arrival at the scene, meet with the Security personnel and brief them on the following instruction/information: – Incident Characterization and situational awareness – Results of the Security site assessment – Security operations, staffing, and schedules – Equipment / Supply request procedure – Security incident reporting procedure  Establish Security measures in anticipation of Scene activation. Optimally, security measures should be in place prior to the arrival of Scene personnel. – Establish and staff Check-in and Check-out stations for Scene personnel. – Establish and staff necessary roadblocks to curtail vehicle access to the area. – Ensure all facility access points are secure and staff surveillance patrols as needed. – Ensure that all non-entry and other advisory signs are placed at all appropriate locations.  Participate in Scene walk-through with the Deputy FM Branch Director – Scene and Group Supervisors/Team Leaders. Page 317 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Provide Security Briefing to Scene personnel, if requested to do so by the Deputy FM Branch Director – Scene. – Identify credentials required to enter the Scene. – Identify the available access points and location of check-in and check-out locations. Emphasize the requirement of personnel accountability. – Identify mechanism for reporting potential breaches in scene security.  Determine security communication needs (i.e., radios, phones, video surveillance) and make request to Scene Support Group.  Identify equipment/supplies required by Security Staff and make request to Scene Support Group.  Advise the Deputy FM Branch Director – Scene of any security issues, foreseeable or actual, and make corrective recommendations.  Notify the Deputy FM Branch Director – Scene when scene is secure and ready for the commencement of operations. Operational Responsibilities The Scene Security Officer is responsible for the following items throughout the scene operations. Several of these items will be ongoing or repeated through the course of the response. The Scene Security Officer should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Obtain a list of authorized scene personnel that will be allowed access to the facility. • Monitor personnel accountability and that all scene personnel are utilizing check-in and check-out points. – Ensure Scene Security staff is posted at check-in and check-out points at all times. – Ensure only authorized personnel have access to the scene and proximal facilities as needed. – If utilizing a credentialing system to create identification for scene personnel, monitor functionality. – Monitor current scene personnel roster at all times at all checkpoints. • Ensure security personnel monitor the perimeter at all times. • Keep thorough written documentation of all patrols taken by the Scene Security Team. • For any incident or breach in scene security: – Notify the Deputy FM Branch Director – Scene of the incident. – Take corrective actions to address the issue. – Complete an incident report. • Remove any unauthorized persons entering the scene facility. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – Scene. • Maintain communication with the Deputy FM Branch Director – Scene regarding Security Team operations. – Report any issues that arise or process alterations needed to meet Security Team needs. • Maintain communications with Security Team personnel on issues related to changes to or deviations from established procedures. Page 318 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • Develop and maintain the Security Team operational and staff schedule. Ensure all Security Team personnel check-in and out at the beginning and end of each shift. Schedule and provide operational briefings with the Security Team at the beginning and end of each operational period. − Operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; anticipated arrival or release of remains ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with remains ▪ Review of security procedures; perimeter and road blocks; credential requirements, etc. ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Ensure all Security Team personnel are using applicable portions of their position checklists. Prepare and maintain Security Team records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – Scene, or as requested. Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols – Instruct Security Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Security Team personnel adhere to PPE requirements Be aware of Security Team personnel well-being and maintain communication with the Scene Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Scene Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – Scene related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • • • Activity Log Security log book Incident report form Personnel check-in and check-out form Equipment and Supplies • • • • • Checkpoint tables Office supplies Chairs Credentialing System and ancillary supplies (if needed) Communication needs (i.e., radios, phones, video surveillance) Considerations • Scene security may want to issue identification badges unique to the incident. Page 319 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • Confusion may arise if personnel are instructed to use their day-to-day work identification, as members of numerous different agencies may be present in the scene and as the identification badges will not list each staff member’s correct position. Following a Mass Fatality Incident, it is likely that media/press will attempt to access the scene site and/or interview OCME personnel. It is critical that security is aware of the presence of media personnel and is able to prevent their access from sensitive locations. Consider coordinating with the OCME Executive Team to require the Disaster Response Coordinator identify a specific location for scheduled incident media briefings. Information is only released by the OCME as dictated by the Public Information Officer. In the case that the OCME does not have adequate security personnel to staff all required areas, the Security Officer may utilize law enforcement, auxiliary, or private contractor personnel to supplement the security staff. The Scene Security Team should always be aware of scene staff members’ wellbeing and maintain communication with the Scene Health and Safety Team to ensure that assistance, medical or otherwise, is available to scene personnel. Page 320 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Safety Officer Scene Safety Officer Purpose / Mission To minimize the potential risk of injury to FM personnel during Scene Operations ▪ ▪ Ensure all Fatality Management scene operations are conducted in a safe manner Ensure compliance with established health and safety protocols Monitor staff for illness and fatigue Suggested Qualifications ▪ ▪ Knowledge of health and safety regulations Member of the OCME Health and Safety Team Assigned Area Incident/Agency Command Post Supervisor Deputy FM Branch Director – Scene ▪ Objectives Activation Checklist  Upon notification arrive at the Incident Command Post as directed by the Deputy FM Branch Director – Scene.  Receive incident characterization, with specific attention to the hazardous conditions present.  Communicate with Agency Safety Officer to determine relevant Health and Safety Plans and Protocols already in development or in place.  Perform site risk assessment to identify Health and Safety procedures specific to FM Scene Personnel.  Identify, or receive report of, potential unsafe conditions, foreseeable or actual and make corrective actions/recommendations. Report all issues to the Deputy FM Branch Director – Scene.  Provide FM Health and Safety requirements and any supporting documentation to the Deputy FM Branch Director – Scene.  Provide risk assessment materials and reports to the Agency Safety Officer for inclusion in any Health and Safety Plans being developed.  Identify resources required to ensure the safety of FM Scene Personnel (i.e. PPE, hardhats, etc.).  Determine health and safety staffing needs based on scene location, make notifications and provide instructions.  Coordinate with Scene Support Group Supervisor to determine the availability of sufficient amounts of PPE supplies.  Establish PPE donning and doffing areas.  Determine health and safety communications needs (i.e. radios, phones) and make request to the Scene Support Group.  Prior to commencing operations, provide health and safety briefing to all scene personnel. Health and Safety briefing should include:  Identify Safety measures and point out potential risks/hazards.  Identify required PPE for all scene personnel, identify locations for donning and doffing of PPE and demonstrate proper use, if needed.  Identify Health and Safety Incident reporting protocol. Page 321 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Responsibilities The Scene Safety Officer is responsible for the following items throughout the scene operations. Several of these items will be ongoing or repeated through the course of the response. The Scene Safety Officer should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Prior to the commencement of operations and at the beginning of each operational period, provide health and safety briefings to scene personnel. – Identify Safety measures and point out potential risks/hazards. – Identify required PPE for all scene personnel, identify locations for donning and doffing of PPE and demonstrate proper use, if needed. – Identify Health and Safety Incident reporting protocol. • Monitor Scene operations for health and safety protocol compliance. – Ensure that all personnel are wearing appropriate personal protective equipment (PPE) and adhering to the HASP at all times. – Take any necessary corrective actions as quickly as possible. • Continue to communicate with Agency Safety Officer and ensure FM specifics are included in the Health and Safety Plan. • Complete an incident report for any breach in Health and Safety Protocols. The appropriate supervisory staff must be alerted in the event of such an incident and report any unsafe conditions and corrective recommendations to the Deputy FM Branch Director – Scene. • Any unsafe conditions and actions taken should be documented appropriately for record management. • Monitor PPE and other supply stockpile available for FM scene personnel. – When needed, make resource request to Scene Support Group for additional PPE cache. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – Scene. • Maintain communication with the Deputy FM Branch Director – Scene regarding Health and Safety requirements and observations. – Report any issues that arise or process alterations needed to meet Health and Safety needs. • Maintain communications with Health and Safety personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Health and Safety operational and staff schedule. • Ensure all Health and Safety personnel check-in and out at the beginning and end of each shift. • Prepare and maintain Health and Safety records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director - Scene, or as requested. • Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. • Be aware of Health and Safety personnel well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the Deputy FM Page 322 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Branch Director – Scene related to the accomplishments/issues encountered during the operational period. Forms / Job Aids • • Health and Safety Plan Activity Log Best Practices and Considerations • • The Scene Safety Officer is responsible for ensuring safe work practices by the FM Scene Personnel. These should include: – Proper PPE worn at all times. – Proper handling of hazardous materials by adequately trained personnel – Personnel must be taking appropriate food and rest breaks to ensure health and prevent exhaustion. – Personnel must utilize safe lifting and moving techniques to prevent injury. Based on the required PPE level for the biological contamination, the Scene Safety Officer, in coordination with the Contamination Control Group Supervisor, must determine requirements to determine medical clearance for scene personnel. The Scene Safety Officer should document the pre- and post-operation medical statistics for each FM Scene Personnel. Personnel unable to meet the requirements must be documented and deterred from operating in the identified PPE level. Page 323 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 324 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Investigations/Recovery Group Supervisor Investigation/Recovery Group Supervisor Purpose / Mission To oversee investigation and recovery of all remains present at the scene ▪ ▪ Determine the Investigations/Recovery Team needs based on the scope and scale of the incident as defined by the incident characterization and resources available Facilitate the scene investigation and recovery process in coordination with other investigative agencies Maintain communication with the Deputy FM Branch Director – Scene; provide regular briefings regarding the investigation and recovery process Conduct MFM Tasks in accordance with established forensic standards Document, record, investigate and recover decedents locations in a dignified and respectful manner Ensure all MFM operations are conducted in a safe manner Suggested Qualifications ▪ ▪ Experienced in Medicolegal Investigation Knowledge of Incident Command System (ICS) Assigned Area Incident/Agency Command Post; Incident Scene(s) Supervisor Deputy FM Branch Director-Scene Supporting Positions / Functions Investigation and Recovery Team(s) ▪ ▪ Objectives ▪ ▪ Activation Checklist  Upon notification and deployment, receive incident characterization.  Report to the Incident Command Post to receive instructions from the Deputy FM Branch Director – Scene.  Coordinate medicolegal investigations and recovery priorities and protocols with other scene investigative agencies.  Identify the potential to conduct joint agency investigations.  Determine the process for documenting and collecting evidence and personal effects located at the scene.  Identify the field specimen numbering system to be utilized for remains recovered.  Determine the scene Investigations/Recovery requirements and report to Deputy FM Branch Director.  Identify the need for Investigations/Recovery Teams to complete effective and efficient processing of located remains to ensure timely removal from the scenes.  Determine the need to include field specialists in Investigation/Recovery Teams to complete operations (i.e. Photography, etc).  Determine type and level of support provided by other agencies, if appropriate.  Coordinate with the Remains Storage/Transport Group Supervisor to determine the Page 325 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths location of the Body Collection Points (BCPs) and the process for transferring remains from the scene to storage.  Assemble Investigation/Recovery Teams as appropriate for the operation.  Assign each Investigation/Recovery Team to cases in an organized fashion.  Brief Investigation/Recovery Team Leader(s) on protocols/methods to systematically process and collect human remains.  Brief Investigation/Recovery Team Leader(s) regarding the documentation and collection of associated evidence and personal effects with the remains.  Determine what equipment and supplies are required to complete operations.  Ensure investigations/recovery personnel are equipped with appropriate PPE to comply with health and safety requirements.  Ensure that all necessary equipment is staged in easily accessed location and security is aware of its presence.  Distribute radios to appropriate personnel to ensure communication among the Investigation/Recovery Group.  Notify the Deputy FM Branch Director - Scene when the Investigation/ Recovery Group is ready to commence operations. Operational Responsibilities The Investigations and Recovery Group Supervisor is responsible for the following items throughout the processing of the scene. Several of these items will be ongoing or repeated through the course of the operation. The Investigations and Recovery Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • Monitor the systematic investigation and recovery of human remains and associated evidence at scenes. – Assign each Investigations/Recovery Team a specific zone to perform operations. – Brief Teams on Investigations and Recovery protocols/methods and Health and Safety requirements for operations. – Ensure that investigation and recovery operations are conducted in accordance with medicolegal death investigation best practices to ensure accuracy of information. – Track the Investigations/Recovery Teams’ documentation of each scene; plot progress of Teams on map, and update Incident Characterization Form, as needed. – Ensure Investigations/Recovery Teams are equipped with required equipment and supplies; coordinate with Scene Support Group to obtain additional resources as needed. – Ensure all documentation; case files, sketches, photographs, etc. are collected to a centralized location to be provided to the personnel in the morgue. – Ensure all remains are removed from the scene in a timely, organized fashion. Coordinate with the Remains Storage/Transport Group Supervisor to ensure the systematic collection of human remains pouches from the scene to the designated Body Collection Point. Continue to communicate with the Deputy FM Branch Director to determine the optimal methods for systematically processing the scene. Page 326 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – Scene. • Maintain communication with the Deputy FM Branch Director – Scene regarding Investigation and Recovery operations. – Report any issues that arise or process alterations needed to meet Investigation and Recovery needs. • Maintain communications with Investigation/Recovery Teams on issues related to changes to or deviations from established procedures. • Develop and maintain the Investigation/Recovery Groups operational and staff schedule. • Ensure all Investigation/Recovery personnel check-in and out at the beginning and end of each shift. • Ensure all Investigation/Recovery personnel are using applicable portions of their position checklists. • Prepare and maintain Investigation/Recovery Group records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director - Scene, or as requested. • Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. • Be aware of Investigation/Recovery Group personnel well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • At the end of each operational period, provide a situation report to the Deputy FM Branch Director – Scene related to the accomplishments/issues encountered during the operational period. Forms and Job Aids • • Incident Characterization Form Medicolegal Investigations Form Equipment and Supplies • • • • • • • • • • Scene Maps Camera Remains Recovery Tags Note Pad Writing utensils Human Remains pouches of various size (as determined by the incident characterization and scene search) Tape Measures Crow Bar Rope Flashlight Best Practices and Considerations • Medicolegal investigations should be performed in accordance with Death Investigator protocols to describe and document remains and associated evidence. • Evidence should be photographed and mapped prior to disturbance. Page 327 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • All anatomically-connected human biological tissue should receive the same tracking or field specimen number. Specialists such as Anthropologists or Archaeologists or special equipment may be necessary and should be requested through the proper process as soon as the need is identified. The Investigation/Recovery Group Supervisor oversees a number of Investigation/Recovery Teams. • Each team will be managed by a Team Leader, an experienced medicolegal death investigator. • Teams will be deployed to reported scenes in an orderly fashion to complete investigations and recovery operations. • In a biological incident, it is likely that the Team Leader (medicolegal death investigator) will be able to process all scenes individually. If the need arises, additional support specialists (i.e. photographers, scribes, etc) may be deployed with the MLI. Page 328 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Investigation/Recovery Team Leader Investigation/Recovery Team Leader Purpose / Mission To oversee an Investigation/Recovery Team for a designated scene ▪ ▪ Communicate with Investigation/Recovery Group Supervisor regarding team status and remains removal coordination Coordinate with the Investigations/Recovery Group Supervisor to obtain information regarding protocols and priorities associated with the processing of the respective scene Facilitate the scene Investigation and recovery process in coordination with other investigative agencies Oversee the documentation of the condition, context, position and relationships between remains and personal effects to each other and their surroundings Conduct MFM Tasks in accordance with established forensic standards Document, record, investigate and recover decedents locations in a dignified and respectful manner Ensure all MFM operations are conducted in a safe manner Suggested Qualifications ▪ ▪ Experienced in Medicolegal Investigator/Anthropologist Knowledge of Incident Command System (ICS) Assigned Area Scene – Assigned Investigative Scene Supervisor Investigation/Recovery Group Supervisor Supporting Positions / Functions Recovery Unit Photography Unit Scribe(s) ▪ ▪ ▪ Objectives ▪ ▪ Activation Checklist  Upon notification and deployment, receive incident characterization and position assignment.  Report to the Command Post to receive instructions from the Investigations/Recovery Group Supervisor.  Receive Investigations/Recovery scene assignment and instruction from the Investigations/Recovery Group Supervisor.  Identify the need for additional specialists based on scene characteristics and report to supervisor.  Make appropriate notifications to specialist personnel and provide reporting instructions. ▪ Photography Unit ▪ Excavation Unit ▪ Recovery Unit ▪ Scribe(s)  Identify the field specimen numbering system to be utilized for remains recovered from the scene.  Assemble Investigation/Recovery Team as appropriate for the processing of the Page 329 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths specific scene.  Brief Investigation/Recovery Team Leader(s) on protocols/methods to systematically process and collect human remains identified in their respective scene. ▪ Ensure Investigative/Recovery team members are aware of any known hazards present that may hinder the investigation and/or recovery process. ▪ Ensure Investigative/Recovery Team is aware of health and safety requirements.  Brief Investigation/Recovery Team Leader(s) regarding the documentation and collection of associated evidence and personal effects with the remains.  Ensure Investigations/Recovery Team is equipped with all necessary equipment and supplies. ▪ Ensure investigations/recovery personnel are equipped with appropriate PPE to comply with health and safety requirements. ▪ Ensure that all necessary equipment is staged in easily accessed location and security is aware of its presence. ▪ Distribute radios to appropriate personnel to ensure communication among the Investigation/Recovery Team members.  Notify the Investigative/Recovery Group Supervisor when the Investigation/Recovery Team is ready for the commencement of operations. Operational Responsibilities The Investigation/Recovery Team Leader is responsible for the following items throughout the processing of the scene. Several of these items will be ongoing or repeated through the course of the Investigation/Recovery. The Investigation/Recovery Team Leader should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • Conduct the investigation and documentation of all potential human remains in a systematic manner. – Ensure that a unique tracking number is assigned to each set of remains and is documented on the remains recovery tag attached to the remains. – Provide direction to Specialists on the Investigative/Recovery Team regarding operations in the specified investigative zone. – Ensure all investigation activities are completed according to standard operating protocols and protocol decisions determined by the operational leadership. ▪ Instruct the scribe(s) to complete a medicolegal investigations form for each set of remains. ▪ Instruct photography unit to properly document the remains in situ. – Upon completion of examination and documentation of remains, instruct the Recovery Unit to transfer remains to a human remains pouch. – Ensure Recovery Team attaches the appropriate Remains Recovery Tag number to the human remains pouch prior to removing it from the scene. – Relay scene start and completion times to the Investigation/Recovery Group Supervisor. Coordinate with the Remains Storage/Transport Group Supervisor to ensure Recovery Unit is able to transfer remains to the designated Remains Storage Facility (RSF). Page 330 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • Collect documentation (or provide collection mechanism) following the completion of each scene and removal of remains to the Remains Storage Facility. Update the Incident Characterization Form as needed. Request the update of any maps as needed by the Agency Operations Center. General: • Attend all briefings/meetings as coordinated or requested by the Investigations/ Recovery Group Supervisor. • Maintain communication with the Investigations/Recovery Group Supervisor regarding Investigation and Recovery operations. – Report any issues that arise or process alterations needed to meet Investigation and Recovery needs. • Maintain communications with Investigation and Recovery Team on issues related to changes to or deviations from established procedures. • Develop and maintain the Investigation and Recovery Team operational and staff schedule. • Ensure all Investigation and Recovery personnel check-in and out at the beginning and end of each shift. • Ensure all Investigation and Recovery personnel are using applicable portions of their position checklists. • Prepare and maintain Investigation and Recovery Team records and reports, as appropriate. Provide reports regularly to the Investigations/Recovery Group Supervisor, or as requested. • Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. • Be aware of Investigation and Recovery Team personnel well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • At the end of each operational period, provide a situation report to the Deputy FM Branch Director – Scene related to the accomplishments/issues encountered during the operational period. Forms and Job Aids • • • Incident Characterization Form Medicolegal Investigations Form Activity Log Equipment and Supplies • • • • • Scene Maps Camera Remains Recovery Tags Note Pad, Writing utensils Human Remains pouches of various size (as determined by the incident characterization and scene search) Best Practices and Considerations • The Investigation/Recovery Group Supervisor oversees a number of Investigation/ Recovery Teams. • Each team will be managed by a Team Leader, an experienced medicolegal Page 331 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths death investigator. Teams will be deployed to reported scenes in an orderly fashion to complete investigations and recovery operations. • In a pandemic event, it is likely that the Team Leader (medicolegal death investigator) will be able to process all scenes individually. If the need arises, additional support specialists (i.e. photographers, scribes, etc) may be deployed with the MLI. The Investigation/Recovery Team Leader serves as the investigator to examine and document each set of remains at a scene. The Scribe assigned to the Investigation/Recovery Team must have knowledge of the medicolegal investigation process. If possible, the Scribe position may be filled by additional medicolegal investigators to assist in the examination and documentation of the remains. Medicolegal investigations should be performed in accordance with Death Investigator protocols to describe and document remains and associated evidence. • Evidence should be photographed and mapped prior to disturbance (see Photography and Mapping Procedures). • All anatomically-connected human biological tissue should receive the same tracking or field specimen number. • Individual and isolated personal effects items should be tagged separately. Any potential association to remains should be noted. • Transportation of processed evidence/ remains should be coordinated through the communication chain to the FM Branch. Specialists such as Anthropologists/Archaeologists or special equipment may be necessary and should be requested through the proper process as soon as the need is identified. Mapping personnel may not be available to be assigned to each team. Mapping may be done separately by a specialized team tasked with documenting the entire scene or by the investigation team. In a prolonged recovery operation it would be prudent to assign a team to manage and secure the field recovery data i.e. download and archive photos, maps and notes. This may reduce errors made by exhausted field crews. • • • • • • • Page 332 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Recovery Unit Recovery Unit Purpose / Mission To place remains in the human remains pouch, ensuring proper tagging and documentation and deliver remains to the designated storage location ▪ ▪ Coordinate with Investigation/Recovery Team to properly place remains and any associated evidence in a human remains pouch (HRP) Ensure remains and HRP are properly marked and documented Remove HRP from scene in a timely and efficient manner Suggested Qualifications ▪ Experienced Mortuary Technician Assigned Area Scene – Assigned Investigative Scene Supervisor Investigation/Recovery Team Leader Objectives ▪ Activation Checklist  Upon notification and deployment, receive incident characterization and position assignment.  Report to the Command Post to receive instructions from assigned Investigations/Recovery Team Leader.  Receive instruction from the Investigations/Recovery Team Leader to determine goals and objectives for processing the scene.  Coordinate with Investigations/Recovery Team Leader to identify the need for additional recovery specialists to complete the objectives.  Make appropriate notifications to additional recovery specialists, if needed, and provide reporting instructions.  Ensure remains recovery equipment is complete; all necessary equipment and supplies are staged in an easily accessed location. Test all equipment to ensure functionality prior to the commencement of operations.  Receive briefing from Investigations/Recovery Team Leader regarding remains recovery protocols and priorities.  Coordinate with the Investigations/Recovery Team Leader and the Remains Storage/Transport Group Supervisor to identify protocols for transition of remains to the Remains Storage Facility (RSF).  Identify the location(s) of RSF(s) staged at the scene.  Identify point-of-contact for remains transfer to storage.  Notify the Investigative/Recovery Group Team Leader when the recovery specialist(s) is ready for the commencement of operations and ensure the Remains Storage / Transport Group is prepared to receive remains. Operational Responsibilities The Recovery Unit is responsible for the following items throughout the processing of the scene. Several of these items will be ongoing or repeated through the course of the Investigations/Recovery. The Recovery Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Page 333 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • Coordinate with other Investigations/Recovery Team Leader to confirm remains are ready for removal from the scene. Ensure that unique tracking or field specimen numbers are assigned to each set of remains and is documented on the remains recovery tag. Recover remains from the scene and place in a HRP. – Ensure remains are handled in a way that minimizes further damage or alteration. – Ensure all associated evidence stays with the remains and is also in the HRP. – Properly document the tracking number on the exterior of the HRP. Communicate with Remains Storage/Transport Group regarding the removal of HRP from scene and transfer of HRP to the appropriate BCP. Ensure proper documentation of the transfer of remains from the scene to the BCP, including the Remains Recovery Tag number. General: • Attend all briefings/meetings as coordinated or requested by the Investigations/ Recovery Team Leader. • Maintain communication with the Investigations/Recovery Team Leader regarding recovery of remains from the designated zone. – Report any issues that arise or process alterations needed to meet needs. • Maintain communications with Investigations/Recovery Team Leader on issues related to changes to or deviations from established procedures. • Ensure all Recovery Unit personnel check-in and out at the beginning and end of each shift. • Ensure all Recovery Unit personnel are using applicable portions of their position checklists. • Prepare and maintain Recovery Unit records and reports, as appropriate. Provide reports regularly to the Investigations/Recovery Team Leader, or as requested. • Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. • Be aware of Recovery Unit personnel and colleagues’ well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • At the end of each operational period, provide a situation report to the Investigations/Recovery Team Leader related to the accomplishments/issues encountered during the operational period. Forms and Job Aids • Activity Log Equipment and Supplies • • • • • • Scene Maps Human Remains Pouches (various sizes depending on the incident characterization) PPE Tracking number tags Zip ties Sharpies Page 334 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Best Practices and Considerations • • • Proper labeling should be maintained by affixing a duplicate tracking / field specimen number on the outside of the HRP (or write the number on the exterior of the HRP). Consider which remains should be placed in the same HRP: – All anatomically-connected human biological tissue should receive the same tracking or field specimen number. – Isolated fragments not anatomically-connected should receive a separate tracking or field specimen number. One Recovery Unit may work with multiple Investigative/Recovery Teams depending on the proximity of scenes. Consider coordinating recoveries in order to increase the efficiency with which remains are removed from scenes and transported to BCPs. Page 335 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 336 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Photography Unit Scene Photography Unit Purpose / Mission To contribute to the documentation of the scene, remains and evidence • • To document the location, condition, context, position and relationships between remains and personal effects to each other and their surroundings Conduct MFM Tasks in accordance with established forensic standards Document and record decedents in a dignified and respectful manner Ensure all MFM Operations are conducted in a safe manner Suggested Qualifications • • • Knowledge of photography and equipment Familiarity with forensic documentation protocols Experience with medicolegal investigation preferred Assigned Area Scene – Assigned Investigative Scene Supervisor Investigation/Recovery Team Leader • Objectives • Activation Checklist  Upon notification and deployment, receive incident characterization and position assignment.  Report to the Command Post to receive instructions from assigned Investigation/Recovery Team Leader.  Coordinate with Investigation/Recovery Team Leader to identify the need for additional photographers.  Make appropriate notifications to additional photography specialists, if needed, and provide reporting instructions.  Ensure photography equipment is complete all necessary equipment and supplies and they are staged in an easily accessed location.  Receive briefing from Investigation/Recovery Team Leader regarding scene processing protocols and priorities.  Notify the Investigation/Recovery Group Team Leader when the photography specialist(s) is ready for the commencement of operations. Operational Responsibilities The Scene Photography Unit is responsible for the following items throughout the processing of the scene. Several of these items will be ongoing or repeated through the course of the Investigations/Recovery. The Scene Photography Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. ▪ Coordinate with Investigation/Recovery Team members to ensure proper documentation of the scene and the remains in situ in accordance with standard protocols for crime scene documentation – Document the condition of the remains and the remains in context of the scene as instructed by the Investigation/Recovery Team Leader. – Photograph all evidence or personal effects (PE) as instructed by the Page 337 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ▪ ▪ Investigation/Recovery Team Leader. Photographers should maintain a photo log with the photo number, the Remains Recovery Tag number and the description of the item. – Note: All shots in the photo log. Include the photo number, the recovery tag number, the time the photo was taken, and a brief description of the shot. Ensure all photos are uploaded to enable access by other medicolegal personnel and stored in the proper file utilizing a consistent labeling scheme. General: • Attend all briefings/meetings as coordinated or requested by the Investigation/ Recovery Team Leader. • Maintain communication with the Investigation/Recovery Team Leader regarding photography of designated zone. – Report any issues that arise or process alterations needed to meet photography needs. • Maintain communications with Investigation/Recovery Team Leader on issues related to changes to or deviations from established procedures. • Ensure all photography personnel check-in and out at the beginning and end of each shift. • Ensure all photography personnel are using applicable portions of their position checklists. • Prepare and maintain photography records and reports, as appropriate. Provide reports regularly to the Investigation/Recovery Team Leader, or as requested. • Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. • Be aware of photography personnel and colleagues’ well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. ▪ At the end of each operational period, provide a situation report to the Investigation/ Recovery Team Leader related to the accomplishments/issues encountered during the operational period. Forms and Job Aids • • Photo Log Form Activity Log Equipment and Supplies ▪ ▪ ▪ ▪ Photo equipment, preferably digital Scale of various sizes North Arrow Photo Log materials Best Practices and Considerations • • • Photography specialists should adhere to Standard Protocols for crime scene photography and documentation. Evidence should be photographed with appropriate scale, north arrow, and tracking / field specimen number. In addition to providing a record of the recovery actions taken and material recovered, documentation of the scene should include photographs of the cleared Page 338 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • areas and a justification of why the search of a particular area was determined to be complete. In a prolonged recovery operation it would be prudent to assign a team to manage and secure the field recovery data i.e. download and archive photos, maps and notes. Page 339 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 340 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Remains Storage/Transport Group Supervisor Remains Storage/Transport Group Supervisor Purpose / Mission To oversee the storage, tracking, and transportation of remains removed from the scene prior to transfer to the disaster morgue ▪ ▪ Objectives ▪ ▪ ▪ Suggested Qualifications Identify appropriate Remains Storage Facility and/or Body Collection Point type and numbers based on incident characteristics Coordinate with the Investigations/Recovery Group Supervisor and the Deputy FM Branch Director – Scene to determine optimal staging locations for storage Coordinate remains storage and transportation between scene, storage, and morgue Experienced Mortuary Supervisor Knowledge of Scene Operations and remains storage requirements Assigned Area Command Post Remains Storage Facility(ies) Body Collection Point(s) Supervisor Deputy FM Branch Director – Scene Supporting Positions / Functions Remains Storage and Transport Team Activation Checklist  Upon notification and deployment, receive incident characterization and initial information concerning the type and scope of remains storage needs.  Report to the Command Post to receive instructions from the Deputy FM Branch Director – Scene.  Receive instruction from the Deputy FM Branch Director – Scene to determine goals and objectives for processing the scene.  Coordinate with the Deputy FM Branch Director – Scene to determine initial storage deployment.  Identify initial staging location for storage.  Coordinate with Scene Support Group Supervisor to determine optimal route to the staging location.  Coordinate with Investigation/Recovery Team Leader to identify the need for additional storage to complete the objectives.  Coordinate with other agencies on scene and Investigation/Recovery Group Supervisor to identify optimal location(s) for storage.  Coordinate with Deputy FM Branch Director – Scene to report the location(s) of case storage to scene personnel.  Ensure storage facilities are properly staffed and all staff is adequately trained on storage and transport protocols.  Assemble Remains Storage/Transport Team(s) as appropriate for the operation. Page 341 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Ensure Team Leaders are identified within each Remains Storage/Transport Team.  Assign each Remains Storage/Transport Team to a storage facility. Identify the recovery areas associated with the specific storage facility and the capacity of the respective storage facility.  Brief Remains Storage/Transport Team Leader(s) on protocols/methods to systematically accession remains into the storage facility, track the Remains Recovery Tag Numbers, and store remains.  Brief Remains Storage/Transport Team Leader(s) on protocols/methods to systematically transfer BCP from the scene location to the disaster morgue.  Ensure remains storage and transport equipment and supplies are complete.  Ensure Remains Storage and Transport Teams are equipped with appropriate PPE to comply with health and safety requirements.  Test all equipment to ensure functionality prior to the commencement of operations.  Ensure that all necessary equipment is staged in easily accessed location and security is aware of its presence.  Distribute radios to appropriate personnel to ensure communication among the Remains Storage/Transport Group as well as with the Investigation/Recovery Teams on scene.  Notify the Deputy FM Branch Director – Scene when the storage facility is ready for the commencement of operations and ensure the Remains Storage/Transport Group is prepared to receive remains. Operational Responsibilities The Remains Storage/Transport Group Supervisor is responsible for the following items throughout the processing of the scene. Several of these items will be ongoing or repeated through the course of the Investigations/Recovery. The Remains Storage/Transport Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • Monitor the systematic removal of remains from the scene and accessioning into the storage facility. − Coordinate with the Investigation/Recovery Group Supervisor to maintain current appraisal of potential remains and the rate of recovery. − Maintain awareness of the inventory of the remains in the storage facility and determine the need to augment remains storage resources on scene. ▪ Ensure that all remains recovered to the storage facility are documented and tracked. ▪ Ensure that all remains are tracked and stored in a manner that minimizes further damage or alteration. At the appropriate time, instruct the Remains Storage/Transport Team to coordinate delivery of their assigned BCP to the Disaster Morgue and transfer remains to the designated Remains Storage Facility. – Coordinate with the Remains Storage Group Supervisor in the Morgue to determine readiness of the Remains Storage Facility to receive disasterrelated remains. – Maintain communication with the Remains Storage/Transport Team during the transport process. Document the departure from the scene and arrival at the morgue site. Page 342 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – Consider the need for the Remains Storage/Transport Team to return to the scene to establish another storage facility and continue the receipt of remains from the scene. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – Scene. • Maintain communication with the Deputy FM Branch Director – Scene regarding Remains Storage/Transport operations. – Report any issues that arise or process alterations needed to meet Remains Storage and Transport needs. • Maintain communications with Remains Storage/Transport Group personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Remains Storage/Transport Group operational and staff schedule • Ensure all Remains Storage/Transport personnel check-in and out at the beginning and end of each shift • Ensure all Remains Storage/Transport personnel are using applicable portions of their position checklists. • Prepare and maintain Remains Storage/Transport Group records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – Scene, or as requested. • Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. • Be aware of Investigation/Recovery Group personnel well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • At the end of each operational period, provide a situation report to the Deputy FM Branch Director – Scene related to the accomplishments/issues encountered during the operational period. Forms • Activity Log Equipment and Supplies • • • • • Scene Maps Human Remains Pouches (various sizes depending on the incident characterization) PPE Equipment to augment storage capacity (i.e. shelving) Lifting Equipment Best Practices and Considerations • • • • It is optimal to store remains at a maximum temperature of 37 degrees Fahrenheit; ensure all equipment is functioning properly prior to operations. Consider which storage facility option is the most appropriate depending on the scene, number of remains, and the response capacity. Consider additional equipment needed to support the proper functioning of the storage facility (generators, lights, etc.). Consider the use of augmentation equipment (i.e. shelving) to increase the capacity Page 343 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • of the storage facility. Be aware of the fueling requirements for the storage facility and ensure that a regular refueling regiment is scheduled by the Scene Support Group and/or Agency Logistics personnel. Following the incident, clean all vehicles and equipment with the appropriate disinfecting agents as recommended by Health and Safety personnel. Page 344 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Remains Storage/Transport Team Remains Storage/Transport Team Purpose / Mission To manage the storage and tracking of remains removed from the scene to a specific storage facility and the transfer of remains to the disaster morgue for accessioning to the Morgue Remains Storage Facility ▪ ▪ Objectives ▪ ▪ ▪ ▪ Suggested Qualifications Facilitate the proper storage and tracking of remains recovered from the scene Conduct MFM Tasks in accordance with established forensic standards Handle, store and transport decedents in a dignified and respectful manner Ensure all MFM operations are conducted in a safe manner Experienced Mortuary Supervisor Knowledge of Scene Operations and remains storage requirements Assigned Area Body Collection Point Remains Storage Facility Supervisor Remains Storage/Transport Group Supervisor Activation Checklist  Upon notification and deployment, receive incident characterization and initial storage requirements.  Receive instruction from the Remains Storage/Transport Group Supervisor to determine goals and objectives for storing and tracking remains.  Receive instruction from the Remains Storage/Transport Group Supervisor regarding assignment to a storage facility and deployment.  Identify staging location for assigned storage facility.  Coordinate with Scene Support Group Supervisor to determine optimal route to the staging location.  Stage storage facility at the identified location and set up ancillary equipment (generators, shelving, etc.) required.  Report to the Remains Storage/Transport Group Supervisor upon arrival and establishment of the storage facility.  Ensure storage facility is properly staffed and all staff is adequately trained on storage and transport protocols.  Assemble Remains Storage/Transport Team as appropriate for the operation.  Identify the recovery zones associated with the assigned storage facility and determine the rate of recovery.  Brief Remains Storage/Transport Team members on protocols/methods to systematically accession remains into the storage facility, track the Remains Recovery Tag Numbers and store remains.  Brief Remains Storage/Transport Team members on protocols/methods to systematically transfer storage facility from the scene location to the disaster morgue.  Ensure remains storage and transport equipment and supplies are complete. Page 345 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Ensure Remains Storage/Transport Team is equipped with appropriate PPE to comply with health and safety requirements.  Test all equipment to ensure functionality prior to the commencement of operations.  Ensure that all necessary equipment is staged in easily accessed location and security is aware of its presence.  Distribute radios to appropriate personnel to ensure communication among the Remains Storage/Transport Group as well as with the Investigation/Recovery Teams on scene.  Notify the Remains Storage/Transport Group Supervisor when the storage facility is ready for the commencement of operations and is prepared to receive remains. Operational Responsibilities The Remains Storage/Transport Team is responsible for the following items throughout the processing of the scene. Several of these items will be ongoing or repeated through the course of the operation. The Remains Storage/Transport Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • Receive remains from the scene and accession them into the storage facility according to established protocol. − Coordinate with the Investigation/Recovery Team in the relative recovery area to maintain current appraisal of potential remains and the rate of recovery. − Maintain awareness of the inventory of the remains in the storage facility and determine the need to augment remains storage resources on scene. ▪ Ensure that all remains recovered to the storage facility are documented and tracked. ▪ Ensure that all remains are tracked and stored in a manner that minimizes further damage or alteration. – Monitor the functioning of the storage facility. Regularly check the temperature, fuel levels and other specifications of the storage facilityBCP. Make augmentation and/or request service as needed. For Body Collection Points, Receive instruction from the Remains Storage/Transport Group Supervisor to coordinate delivery of their assigned BCP to the Disaster Morgue and transfer remains to the designated Remains Storage Facility. – Maintain communication with the Remains Storage/Transport Group Supervisor during the transport process. Document the departure from the scene and arrival at the morgue site. – Document the transfer of remains to the Remains Intake Team at the disaster morgue. Include the Remains Recovery Tag number, the date/time of transfer and the name of the person receiving the remains. Establish another storage facility and continue the receipt of remains from the scene as instructed by the Remains Storage/Transport Group Supervisor. General: • Attend all briefings/meetings as coordinated or requested by the Remains Storage/Transport Group Supervisor. • Maintain communication with the Remains Storage/Transport Group Supervisor regarding Remains Storage/Transport operations – Report any issues that arise or process alterations needed to meet Remains Page 346 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • Storage/Transport needs. Maintain communications with Remains Storage/Transport Team personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Remains Storage/Transport Team operational and staff schedule. Ensure all Remains Storage/Transport personnel check-in and out at the beginning and end of each shift. Ensure all Remains Storage/Transport personnel are using applicable portions of their position checklists. Prepare and maintain Remains Storage/Transport Team records and reports, as appropriate. Provide reports regularly to the Remains Storage/Transport Group Supervisor, or as requested. Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. Be aware of Remains Storage/Transport Group Supervisor personnel well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Remains Storage/Transport Group Supervisor related to the accomplishments/issues encountered during the operational period. Equipment and Supplies • • • • • Scene Maps Human Remains Pouches (various sizes depending on the incident characterization) PPE Equipment to augment storage capacity (i.e. shelving) Lifting Equipment Best Practices and Considerations • • • • • • It is optimal to store remains at a maximum temperature of 37 degrees Fahrenheit; ensure all equipment is functioning properly prior to operations. Consider which storage facility option is the most appropriate depending on the scene, number of remains, and the response capacity. Consider additional equipment needed to support the proper functioning of the storage facility (generators, lights, etc.) Consider the use of augmentation equipment (i.e. shelving) to increase the capacity of the storage facility Be aware of the fueling requirements for the storage facility and ensure that a regular refueling regiment is scheduled by the Scene Support Group and/or Agency Logistics personnel. Following the incident, clean all vehicles and equipment with the appropriate disinfecting agents as recommended by Health and Safety personnel. Page 347 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 348 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Support Group Supervisor Scene Support Group Supervisor Purpose / Mission To support all scene operations by managing the mobilization, maintenance and demobilization of equipment, supplies, and information technology and communications capabilities ▪ Objectives ▪ Coordinate with Deputy FM Branch Director – Scene to ensure the appropriate equipment, vehicles, and supplies are available at the scene to support search, investigations and recovery operations Ensure that all operations are conducted in a safe and efficient manner Suggested Qualifications ▪ ▪ Assigned Area Command Post Staging Area Logistics Specialist Experience with Disaster Operations Deputy FM Branch Director – Scene Supervisor *Note: The Scene Support Group Supervisor should maintain frequent contact with the Agency Logistics Chief. Activation Checklist  Upon notification, coordinate with the FM Branch Director and Deputy FM Branch Director – Scene to identify initial logistics package to support the establishment of the scene and initial operations.  Coordinate with the agency Logistics personnel to identify logistics structures in place. – Identify the location of the scene staging area. – Identify the best route to the scene staging area; develop maps and identify scene access points.  Meet with the Deputy FM Branch Director – Scene to determine extent of FM scene operations and logistics support needs.  Establish contact with the Agency Operations Center through the Deputy FM Branch Director – Scene to confirm process for requesting resources not available on-scene.  Identify Scene Support Group personnel needs and make necessary notifications.  Instruct Scene Support Group to perform initial set up operations:  Coordinate with the Safety Officer to support requirements and protocols: – Determine Personal Protective Equipment (PPE) requirements for staff. – Ensure adequate supplies of PPE are available for scene personnel at the donning station and proper receptacles are present for doffing of PPE. – Support the reconciliation of any identified unsafe conditions.  Coordinate with the Remains Storage/Transport Group Supervisor to support remains storage needs. – Assist in the determination of the optimal facility to support remains storage onscene. – Coordinate with scene personnel to determine storage facility staging locations. – Receive request for additional equipment and/or supplies to augment storage Page 349 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths facility storage capacity. If additional storage facilities are required, ensure infrastructure is present and identify staging locations for the units. Determine any information technology needs for scene operations. Coordinate with the Deputy FM Branch Director – Scene to determine communications needs to support scene operations. Coordinate with Investigation/Recovery Group Supervisor and the Remains Storage/Transport Group Supervisor to determine resource needs. – Upon deployment of equipment and supplies to the various areas, instruct scene support personnel to assist in the set up of each station. – Ensure that all necessary resources are staged in easily accessible locations and security is aware of its presence. – Work with Scene personnel to set up equipment and test for proper functionality prior to commencing operations. Coordinate with Scene Group Supervisors to identify resource gaps and determine ability to fulfill requests – Brief all group supervisors regarding the process to request additional resources – If unable to fulfill requests, submit a request to the Agency Operations Center for sourcing. Identify process for tracking FM resource cache and maintaining inventory of supplies. Advise the Deputy FM Branch Director – Scene of any Support Group issues, foreseeable or actual, and make corrective recommendations Notify the Deputy FM Branch Director – Scene of all Support Group deployments and arrival on scene of requested resources. –        Operational Tasks and Responsibilities The Scene Support Group Supervisor is responsible for the following items throughout the processing of the scene. Several of these items will be ongoing or repeated through the course of the Scene Operations. The Scene Support Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • Maintain awareness of the scene scale, scope, and required FM scene operations. Determine the type and quantity of equipment sufficient to set up and continue the recovery operation for each operational period. – Monitor use of supplies and anticipate needs for ongoing operations. – Maintain awareness of any special accommodations that may be needed for certain equipment such as power supply and water supply. – Create a regular fueling schedule and maintain access to equipment. Monitor the information technology and communications infrastructure of the scene operation. – Brief the Deputy FM Branch Director – Scene of any issues that may affect scene operations. Determine the type and quantity of equipment sufficient to set up and continue the Scene operation for each operational period. When possible, fulfill resource requests from Scene Group Supervisors. If the Scene Support Group cannot fulfill a request: – Coordinate with other on-scene logistics personnel/groups to fulfill request if possible. Page 350 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – • • • • • • • • • • • Coordinate with the Agency Operations Center to procure the requested resources through contract or resource request submitted to the Emergency Operations Center (EOC). Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – Scene. Brief Deputy FM Branch Director – Scene on any logistics issues or changes in procedure. Prepare and maintain facility, supply, equipment records and reports as appropriate. Develop and maintain the Scene Support Group operational and staff schedule. Assemble, brief, and assign work locations and preliminary work tasks to Scene Support Group Teams/personnel. Ensure all personnel observe established level of operational safety and adhere to all health and safety protocols. Maintain communications with Scene Support Group personnel on issues related to changes to or deviations from established disaster specific processing procedures. Be aware of Scene Support Group personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Ensure all Scene Support Group personnel are using applicable portions of their position checklists. At the end of each operational period, provide a situation report to the Deputy FM Branch Director - Scene related to the accomplishments/issues encountered during the operational period Ensure communication and coordination among the Scene Support Group and with other agency logistics personnel/groups. Best Practices and Considerations • • • • • • Determine the best route to deliver equipment and supplies. Consider the following: – Some routes may be obstructed due to the incident. – The weight/size of the vehicle may prohibit the use of particular roadways. – Access may be limited due to overhead wires, overpasses, sharp turns, etc. Coordinate with Agency Logistics Chief to determine optimal access for delivery and removal of equipment and vehicles. When determining the optimal locations for staging and/or any scene operations be aware of the following considerations: – Visibility to the public and/or press. – Accessibility of equipment to Scene personnel. The Scene Support Group Supervisor must coordinate with the Remains Storage/Transport Group Supervisor to identify the optimal location(s) for the storage facilities required on scene and to ensure that the appropriate ancillary resources and support is available for the remains storage and transport operation. The Scene Support Group Supervisor must coordinate with the Contamination Control Group Supervisor in the event that contamination is present on-scene to ensure that personnel are equipped with the appropriate PPE and other equipment needed to operate in a contaminated operation. The Scene Support Group will be responsible for the demobilization of all the FM Scene Resources following the completion of scene operations. The Scene Support Group Supervisor must maintain communication with the Deputy FM Branch Director – Scene to identify the scaling down of scene operations. Page 351 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – – – – Ensure that all equipment and un-used supplies are returned to the Scene Support Group and inventoried appropriately. Coordinate with other agencies on-scene to ensure that all equipment and supplies are removed from the scene and the scene is returned to its original status (as much as possible). Document all damaged or lost equipment/resources. Brief the Deputy FM Branch Director – Scene on any issues that require follow up. Page 352 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Facilities Team Scene Facilities Team Purpose/Mission To maintain any scene facilities to support investigation/recovery operations ▪ Objectives Evaluate, prepare, and maintain scene facilities to support investigation/recovery operations Assigned Area Command Post Supervisor Scene Support Group Supervisor Activation Checklist  Upon notification, arrive at the Command Post as directed by the Scene Support Group Supervisor.  Check in with the Scene Support Group Supervisor, and receive situation briefing and Scene Facilities Team operational requirements and set up instructions.  Participate in walk-through with the Scene Support Group Supervisor and receive operational briefing. – Obtain information on the current scene facilities and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ Scene security protocols and credential/access requirements ▪ Staffing and scheduling information  Determine team staffing requirements and make necessary notifications.  Assemble Scene Facilities Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Scene security protocols and procedures; including credential requirements − Scene Facilities Team operations − Staffing and scheduling information  Based on the Incident Characterization, the Scene type and workflow, and the instruction of the Scene Support Group Supervisor, evaluate the potential scene facility to: – Ensure the proper infrastructure is present to support scene operations. – Determine the ability to augment the facility to meet the needs of the scene operation.  Per instruction from the Scene Support Group Supervisor, clean and prepare the facility for the deployment of scene equipment and supplies.  Coordinate with the Health and Safety Officer to determine infrastructure requirements to support health and safety protocols. – Determine optimal temperature for operations. – Ensure proper lighting for operations. – Ensure all trip hazards are moved.  Develop schedule for cleaning the scene facility each operational period, including restrooms and ancillary areas.  Receive all resource requests from the Scene Support Group Supervisor and fulfill as possible. Page 353 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Identify any facilities issues to the Scene Support Group Supervisor for resolution.  Notify Scene Support Group Supervisor when Scene Facilities Team is ready for the commencement of operations. Operational Responsibilities The Scene Facilities Team is responsible for the following items throughout the scene operations. Several of these items will be ongoing or repeated through the course of the response. The Scene Facilities Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • • Monitor and maintain facility at all scene operations. – Monitor infrastructure, identify damages and notify Scene Support Group Supervisor of anticipated repair needs. – Respond to requests from the Scene Support Group Supervisor. – Maintain cleaning schedule. – Monitor temperature and airflow. – Provide regular reports to the Scene Support Group Supervisor regarding the condition of the scene facilities and the need for augmentation and/or repairs. Attend all briefings/meetings as coordinated or requested by the Scene Support Group Supervisor. Ensure all team personnel are using applicable portions of their position checklists. Develop and maintain the Scene Supply Team operational and staff schedule. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Ensure all team personnel are using applicable portions of their position checklists. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with the Scene Safety Officer to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Scene Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Page 354 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Supplies Team Scene Supplies Team Purpose/Mission To order, receive, distribute, and store supplies to support scene operations ▪ Objectives ▪ Receive and respond to supply orders from authorized scene staff Maintain inventory of supplies and equipment Assigned Area Command Post Supervisor Scene Support Group Supervisor Activation Checklist  Upon notification, arrive at the Command Post as directed by the Scene Support Group Supervisor.  Check in with the Scene Support Group Supervisor, and receive situation briefing and Scene Supply Team operational requirements and set up instructions.  Participate in walk-through with the Scene Support Group Supervisor and receive operational briefing. – Obtain information on the current scene facilities and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ Scene security protocols and credential/access requirements ▪ Staffing and scheduling information  Determine team staffing requirements and make necessary notifications.  Assemble Scene Supply Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Scene security protocols and procedures; including credential requirements − Scene Supply Team operations − Staffing and scheduling information  Evaluate the space assigned to Scene Supplies staging and determine if adequate for team work flow and needs. − If additional facility space is needed, discuss needs with Scene Support Group Supervisor.  Conduct an initial inventory of the supply stockpile and develop schedule for updating supply inventory.  Per the instruction of the Scene Support Group Supervisor, deploy required supplies to the necessary locations.  Receive all resource requests from the Scene Support Group Supervisor and fulfill as possible.  Identify supply gaps or depletion to the Scene Support Group Supervisor for replenishment.  Notify Scene Storage Group Supervisor when Scene Supplies Team is ready for the commencement of operations. Page 355 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Responsibilities The Scene Supplies Team is responsible for the following items throughout the scene operations. Several of these items will be ongoing or repeated through the course of the response. The Scene Supplies Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • Monitor and maintain supplies levels at all scene operations. − Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. − Respond to requests from the Scene Support Group Supervisor. − Maintain an inventory of the scene supply cache. − Provide regular reports to the Scene Support Group Supervisor regarding the inventory levels of supplies and the need to receive/order additional supplies. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Attend all briefings/meetings as coordinated or requested by the Scene Support Group Supervisor. Ensure all team personnel are using applicable portions of their position checklists. Develop and maintain the Scene Supply Team operational and staff schedule. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with the Scene Safety Officer to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Scene Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Page 356 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Equipment Team Scene Equipment Team Purpose / Mission To order, receive, distribute, and store equipment to support scene operations ▪ Objectives ▪ Receive and respond to equipment orders from authorized scene staff Maintain inventory of equipment Assigned Area Command Post Supervisor Scene Support Group Supervisor Activation Checklist  Upon notification, arrive at the Command Post as directed by the Scene Support Group Supervisor.  Check in with the Scene Support Group Supervisor, and receive situation briefing and Scene Equipment Team operational requirements and set up instructions.  Participate in walk-through with the Scene Support Group Supervisor and receive operational briefing. – Obtain information on the current scene facilities and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ Scene security protocols and credential/access requirements ▪ Staffing and scheduling information  Determine team staffing requirements and make necessary notifications.  Assemble Scene Equipment Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Scene security protocols and procedures; including credential requirements − Scene Equipment Team operations − Staffing and scheduling information  Evaluate the space assigned to Scene Equipment staging and determine if adequate for team work flow and needs. − If additional facility space is needed, discuss needs with Scene Support Group Supervisor.  Conduct an initial inventory of the equipment cache prior to deployment to stations. – Determine type and amount of equipment available in scene cache. – Develop schedule for updating equipment inventory.  Per the instruction of the Scene Support Group Supervisor, deploy required equipment to the necessary locations. – Coordinate with scene personnel to set up stations at designated locations. – Coordinate with the scene personnel to test all equipment to be sure all is in working order.  Provide “Just-in-Time” Training on equipment for scene personnel, if needed.  Receive all resource requests from the Scene Support Group Supervisor and fulfill as possible.  Identify equipment gaps or depletion to the Scene Support Group Supervisor for Page 357 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths replenishment.  Notify Scene Support Group Supervisor when Scene Equipment Team is ready for the commencement of operations. Operational Responsibilities The Scene Equipment Team is responsible for the following items throughout the scene operations. Several of these items will be ongoing or repeated through the course of the response. The Scene Equipment Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • Monitor and maintain equipment at all scene operations. – Monitor use of equipment, identify damaged/inoperable equipment and notify Scene Support Group Supervisor of anticipated repair and/or replenishment needs. – Respond to requests from the Scene Support Group Supervisor. – Maintain an inventory of the scene equipment cache. – Provide regular reports to the Scene Support Group Supervisor regarding the inventory levels of equipment and the need to receive/order additional equipment. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Attend all briefings/meetings as coordinated or requested by the Scene Support Group Supervisor. Ensure all team personnel are using applicable portions of their position checklists. Develop and maintain the Scene Equipment Team operational and staff schedule. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with the Scene Safety Officer to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Scene Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Page 358 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Information Technology Team Scene Information Technology Team Purpose / Mission To provide Information Technology and Telecommunications support to the scene operation ▪ Establish and maintain Information Technology and Telecommunications support of scene operations Provide Just-in-Time training to scene personnel regarding the proper use of UVIS-CMS and other technologies Objectives ▪ Assigned Area Command Post Supervisor Scene Support Group Supervisor Activation Checklist  Upon notification, arrive at the Command Post as directed by the Scene Support Group Supervisor.  Check in with the Scene Support Group Supervisor, and receive situation briefing and Scene Information Technology Team operational requirements and set up instructions.  Obtain briefing regarding UVIS-CMS and other IT requirements for scene operations.  Participate in walk-through with the Scene Support Group Supervisor and receive operational briefing. – Obtain information on the current scene facilities and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ Scene security protocols and credential/access requirements ▪ Staffing and scheduling information  Perform assessment of scene facility infrastructure to determine the ability to support UVIS-CMS. – Identify necessary augmentation of the facility infrastructure to support UVISCMS.  Determine team staffing requirements and make necessary notifications. Consider creating units responsible for the following areas: – Desktop: Responsible for managing all desktop equipment needs – Server: Responsible for managing all server and telephony needs – Network: Responsible for managing all network needs – Applications: Responsible for managing all application needs  Assemble Scene IT Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Scene security protocols and procedures; including credential requirements − Scene IT Team operations to establish and maintain UVIS-CMS and/or communications capabilities − Staffing and scheduling information  Provide instruction to the Scene IT Team to set up equipment necessary to establish the IT infrastructure. – Coordinate with the Scene Support Group to deploy all equipment and Page 359 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths supplies necessary to establish the necessary IT infrastructure. Instruct Scene IT Team to assist forensic personnel to set up respective Case UVIS-CMS equipment. – Instruct Scene IT Team to test UVIS-CMS and ancillary equipment to ensure all is functional. – Ensure all scene personnel receive “Just-in-Time” Training on UVIS-CMS to ensure that they are able to properly enter all scene data. Instruct Scene IT Team to establish necessary communications methods. – Coordinate with Scene Group Supervisors to determine communications needs. – Coordinate with the Scene Support Group to deploy all equipment and supplies necessary to establish the necessary communications infrastructure. – Instruct Scene IT Team to test all radios and/or other communications tools to ensure all are functional. – Instruct Scene IT Team to distribute radios and/or other communications tools. – Ensure all scene personnel receive “Just-in-Time” Training on radio-use to ensure that they are able to properly communicate with other scene personnel. Receive all resource requests from the Scene Support Group Supervisor and fulfill as possible. Report any Scene IT issues to the Scene Support Group Supervisor for resolution. Notify Scene Support Group Supervisor when Scene IT Team is ready for the commencement of operations. –     Operational Responsibilities The Scene IT Team is responsible for the following items throughout the scene operations. Several of these items will be ongoing or repeated through the course of the response. The Scene IT Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • Monitor and maintain Information Technology and Telecommunications to support scene operations. – Monitor infrastructure, identify damages and notify Scene Support Group Supervisor of anticipated repair needs. – Order and receive IT equipment and supplies as needed; coordinate with the Scene Equipment and Supplies Teams as needed. – Respond to requests from the Scene Support Group Supervisor. – Maintain personnel to assist scene personnel with data entry and/or record keeping issues. – Provide regular reports to the Scene Support Group Supervisor regarding Information Technology and Telecommunications; identify the need for augmentation and/or repairs. Consider staffing an IT Help Desk to serve as a central point-of-contact for any ITrelated issues. Attend all briefings/meetings as coordinated or requested by the Scene Support Group Supervisor. Ensure all team personnel are using applicable portions of their position checklists. Develop and maintain the Scene IT Team operational and staff schedule. Maintain communications with team personnel on issues related to changes to or Page 360 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • deviations from established disaster specific processing procedures. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with the Scene Safety Officer to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Scene Support Group Supervisor related to the accomplishments/issues encountered during the operational period. 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Page 362 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Scene Contamination Control Group Supervisor Scene Contamination Control Group Supervisor Purpose / Mission To ensure safe Medicolegal operations in a biologically contaminated environments or when handling remains that are biologically contaminated ▪ Objectives ▪ Determine the necessary alterations to scene processing operations Facilitate the execution of contaminated scene protocols to ensure personnel are operating safely to investigate and recover remains Suggested Qualifications ▪ ▪ Experienced Medicolegal investigator HAZMAT Certified Assigned Area Command Post; Scene Supervisor Deputy FM Branch Director – Scene Activation Checklist  Upon notification and deployment, receive incident characterization and initial information concerning the type and scope of contamination.  Report to the Command Post to receive instructions from the Deputy FM Branch Director – Scene.  Receive briefing from Deputy FM Branch Director – Scene regarding scene processing protocols and priorities.  Coordinate with Safety Officer to gain awareness of all relevant Health and Safety Protocols already in place.  Participate in coordinated decision-making process with Health and Safety personnel to determine the handling of contaminated remains.  Identify required PPE for all personnel operating in contaminated zones.  Identify stay time allowances for personnel operating in contaminated zones based on PPE requirements.  Identify training requirements for Scene personnel.  Coordinate with Deputy FM Branch Director – Scene to identify the need for additional Contaminated Control Group personnel to complete the objectives.  Make recommended altered protocols to the Deputy FM Branch Director – Scene.  Identify additional partner agencies and/or resources necessary to complete scene operations.  Coordinate with the Scene Support Group Supervisor to determine the equipment and supplies needed to support contamination control operations.  Ensure equipment is complete; all necessary equipment and supplies are staged in an easily accessed location.  Test all equipment to ensure functionality prior to the commencement of operations.  Ensure Scene personnel receive Just-in-Time Training on the proper use of equipment.  Brief Investigation/Recovery Group Supervisor regarding the alterations to scene procedures and requirements for the safe handling of contaminated remains  Brief Remains Storage/Transport Group Supervisor regarding the storage Page 363 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths requirements for contaminated remains; including the considerations for potential temporary storage prior to delivery to the morgue facility.  Notify the Deputy FM Branch Director – Scene when the Contamination Control Group is ready for the commencement of operations and ensure the Investigation/Recovery Group is prepared to execute HAZMAT operations. Operational Responsibilities The Contamination Control Group Supervisor is responsible for the following items throughout the processing of the scene. Several of these items will be ongoing or repeated through the course of the Investigations/Recovery. The Contamination Control Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Monitor Scene operations and compliance with contamination control requirements. – Assign Contaminated Control Group personnel to Investigation/Recovery teams, as needed to monitor operations within each zone. – Brief scene personnel on contamination control protocols, methods, and health and safety requirements for operations in their respective areas. – Ensure all personnel have access to the proper PPE and are trained to operate in the PPE. – Ensure proper monitoring of personnel utilizing PPE and the maintenance of proper stay times. – Ensure documentation of the start times for personnel in contaminated zones and they leave zone in the time defined. • Coordinate with the Investigation/Recovery Group Supervisor to ensure operations are conducted in accordance with medicolegal standards to the best extent possible. • Coordinate with Remains Storage/Transport Group to ensure all remains are properly tracked and remains storage functionality is monitored. • Maintain communication with the Deputy FM Branch Director – Scene to determine any alterations to scene protocols. • Maintain communication with the Contamination Control Group Supervisor in the Morgue to indicate the contaminated remains recovered from the scene and morgue operations considerations. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – Scene. • Maintain communication with the Deputy FM Branch Director – Scene regarding medicolegal operations in the contaminated scene. – Report any issues that arise or process alterations needed to meet contamination control needs. • Maintain communications with scene personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Contamination Control Group operational and staff schedule • Ensure all Contamination Control Group personnel check-in and out at the beginning and end of each shift • Ensure all Contamination Control Group personnel are using applicable portions of their position checklists. Page 364 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • Prepare and maintain Contamination Control Group records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – Scene, or as requested. Monitor use of supplies and notify Scene Support Group Supervisor of anticipated replenishment needs. Be aware of scene personnel well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – Scene related to the accomplishments/issues encountered during the operational period. Best Practices and Considerations • • • The Contamination Control Group Supervisor will make alterations to standard scene procedures in order to ensure operator safety in a pandemic incident. All deviations from standard medicolegal operations must be reported to the Deputy FM Branch Director – Scene, FM Branch Director, and approved by the Chief Medical Examiner. The FM Branch leadership must prioritize the safety of OCME personnel during all scene operations. Page 365 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 366 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Postmortem Processing Operations Deputy Fatality Management Branch Director – Postmortem Processing Deputy FM Branch Director – Postmortem Processing Purpose / Mission To manage all aspects of operations pertaining to postmortem processing of disaster-related cases ▪ ▪ Objectives ▪ Ensure all MFM operations are conducted in a safe manner Conduct MFM tasks in accordance with established forensic standards – Document, record, investigate, recover, and process decedents in a dignified and respectful manner – Accurately determine the cause and manner of death – Perform the accurate and efficient identification of victims – Support judicial, public health, and investigative objectives and requirements Conduct the rapid return of decedents to their legal next of kin (NOK) Assigned Area Morgue Supervisor FM Branch Director Supporting Positions / Functions Morgue Security Officer Morgue Safety Officer Remains Storage Group Supervisor Forensic Group Supervisor Morgue Support Group Supervisor Postmortem Quality Assurance/Quality Control Group Supervisor Contamination Control Group Supervisor Activation Checklist  Upon receipt of notification request briefing on incident characteristics and executive decisions.  Review the relevant information in the Incident Characterization Form.  Verify with the OCME the decisions made regarding the following policies: o Identification Modalities to be utilized o Autopsy Policy o OCME Case Numbering System  Participate in the operational meeting with the FM Branch Director, Disaster Response Coordinator, and other necessary agency executive staff to determine the following:  Type of Morgue  Number of Morgues  Location of Morgues  Morgue Workflow  Time the morgue must be operational Page 367 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Based on these decisions, determine the following:  Initial disaster morgue personnel and resource deployment  Morgue set up requirements and timeline  Operational periods / staffing patterns  Notify the Morgue Security Officer and request that security personnel report to secure the facility site, establish a perimeter to prevent public/media access, and establish credentialing check points.  Notify the Morgue Safety Office and request they conduct a risk analysis and develop health and safety requirements for the morgue operation.  Identify Personal Protective Equipment (PPE) requirements for disaster morgue personnel. Ensure PPE compliance at all times.  Notify the Remains Storage Group Supervisor and request him/her to assess the current morgue storage capacity and determine the need for augmentation.  Notify the Morgue Support Group Supervisor and request the deployment or all equipment and supplies to support disaster morgue operations  Request the preparation of the disaster morgue facility / site  Request the modification of the disaster morgue infrastructure as needed to support the disaster morgue type and workflow  Request the setup of the case management system and ancillary information technology equipment to support the collection of postmortem data.  Request an assessment of disaster morgue communication needs and develop a communications plan for Morgue Operations, including radio distribution plan and accountability  Activate additional Group Supervisors and provide them with the incident characterization and required disaster morgue mobilization.  Request Group Supervisors to activate necessary disaster morgue personnel and provide required reporting time.  Due to the presence of biological contamination as indicated in the Incident Characterization, activate the Contamination Control Group Supervisor to coordinate with hazardous materials (HAZMAT) personnel and health and safety personnel to develop incident-specific operational protocols.  Based on the incident characterization, identify partner agencies/organizations that will participate in disaster morgue operations.  Make necessary notifications and provide agency/organization liaisons with information regarding disaster morgue mobilization and operations.  Report to Morgue site to oversee the mobilization of operations  Establish location to support disaster morgue administrative and management functions.  Make contact with the Agency Operations Center to communication the establishment of disaster morgue operations.  Perform walk-through of Morgue and identify layout of Morgue functional areas with Morgue Security Officer, Morgue Safety Officer, Remains Storage Group Supervisor, Forensic Group Supervisor, Morgue Support Group Supervisor, and DVI Group Supervisor.  Request an update on previous morgue mobilization requests from Security, Health and Safety, Morgue Support and Remains Storage Groups.  Identify set up requirements for forensic stations based on the disaster morgue type and workflow.  Define expectations and establish a timeline for disaster morgue setup. Page 368 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Request Morgue Group Supervisors coordinate with staff to identify gaps in resources and make resource requests.  Push resource requests to the Morgue Support Group (Facilities and Supply) to fulfill gaps from the cache.  If the Morgue Support Group is unable to fulfill the request push it to the Operations Center for sourcing.  Meet with the Postmortem Quality Assurance / Quality Control (QA/QC) Group Supervisor to make certain the proper mechanisms are in place to reduce errors and maintain accountability.  Establish communications with the Deputy FM Branch Director – Scene and Deputy FM Branch Director – Antemortem Operations (AM).  Monitor the deployment of forensic examination and remains storage areas.  Conduct a walk-through to ensure that each unit and station has sufficient staff, resources and equipment to conduct postmortem operations.  Notify the FM Branch Director and the Agency Operations Center when disaster morgue is ready to commence operations. Operational Responsibilities The Deputy FM Branch Director – PM is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Deputy FM Branch Director – PM should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • Conduct beginning of shift and end of shift briefings with Disaster Morgue Group Supervisors and Security and Safety Officers. Monitor Morgue Operations and evaluate on-going work flow performance to include: – Instruct Remains Storage Group Supervisor to assemble and manage Teams to systematically accession remains into the morgue and properly store and track remains throughout the morgue process. – Instruct the Forensic Group Supervisor to establish and staff functions to complete postmortem examinations for all disaster-related cases. Instruct morgue personnel to maintain complete records in the case management system. – Ensure DVI Reconciliation Group has access to all information required to make presumptive identifications. – Instruct disaster morgue personnel to obtain additional data and/or documentation as requested by the DVI Reconciliation Group to support identification. Coordinate with the PM QA/QC Group Supervisor to monitor the postmortem examination and data entry process. – Upon identification, ensure proper protocols are followed and personnel approval is obtained prior to the release of remains. Identify staffing schedules based on Operational Periods, morgue requirements, and staffing availability. – Be aware of changes in staffing for partner agencies and maintain up-todate contact information. – Ensure all morgue personnel report to the morgue, as directed and check-in and check-out at the beginning and end of their shift, respectively. Ensure proper resources are available to complete morgue operations; delegate the Page 369 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • Morgue Support Group Supervisor to manage resource requests from morgue personnel. If procurement of assets is needed, submit requests to Agency Operations Center for sourcing. Manage issues that arise during morgue operations, including interagency coordination. Establish a regular meeting schedule for individuals in the morgue. Each meeting should serve to: – Provide situational awareness and updates regarding the incident. – Identify issues and correct any problems before they become major. – Convey operational protocols/procedures to morgue personnel. – Establish work schedule for current operational period, including required breaks. – Identify lines of communication. Ensure disaster morgue is thoroughly cleaned and resupplied at end of every operational period. Ensure all postmortem operations are conducted in a safe, efficient and effective manner. Maintain communication with the Deputy FM Branch Directors of Scene and AM to ensure up-to-date information pertaining to the incident and the ability to make identifications. Provide information regularly to the Agency Operations Center for inclusion in the Situation Report and as requested for incident-specific planning. Forms/Job Aids • • Incident Characterization Form Activity Log Considerations • • The OCME Executive Leadership will depend on the Deputy FM Branch Director – PM for recommendations regarding Morgue Type and workflow. These recommendations will depend on the Incident Characterization. The presence of biological contaminants will present significant operational challenges and the need to alter morgue operations to ensure the safety of personnel. The Contamination Control Group Supervisor will be activated to serve as the subject matter expert in HAZMAT operations and ensure that all operations are conducted according to protocol. Page 370 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Morgue Security Officer Morgue Security Officer Purpose / Mission To provide for facility security and the security of all human remains, equipment, and personnel in the disaster morgue ▪ Objectives Ensure morgue facility is secure for the entirety of the morgue operations Assigned Area Various areas / patrol Check-in and check-out Supervisor Deputy Fatality Management Branch Director – PM Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Deputy FM Branch Director – PM.  Meet with the Deputy FM Branch Director – PM and receive: – Incident Characterization and Situational Awareness – Morgue Operations and Security Expectations  Perform site security assessment based on the location, facility characteristics, and incident characteristics. Brief the Deputy FM Branch Director – PM on the results of the assessment. – Identify immediate needs to secure the morgue facility: ▪ Establishment of perimeters surrounding the disaster morgue ▪ Access points for disaster morgue personnel (check-in / check-out station) ▪ Potential interagency representatives to be present in the morgue ▪ Accepted credentials/identification for morgue personnel and/or credentialing system to create identification for all morgue personnel  Based on the incident characteristics and the scale of the Morgue Security operations, determine Security staffing requirements.  Notify security staff and provide them with instructions to report immediately to the Disaster Morgue.  Upon arrival at the morgue, meet with the Security personnel and brief them on the following instruction/information: – Incident Characterization and situational awareness – Results of the Security site assessment – Security operations, staffing, and schedules – Equipment / Supply request procedure – Security incident reporting procedure  Establish Security measures in anticipation of Morgue activation. Optimally, security measures should be in place prior to the arrival of Morgue personnel. – Establish and staff Check-in and Check-out stations for Morgue personnel. – Establish and staff necessary roadblocks to curtail vehicle access to the area. – Ensure all facility access points are secure and staff surveillance patrols as needed. – Ensure that all non-entry and other advisory signs are placed at all appropriate locations.  Participate in Morgue walk-through with the Deputy FM Branch Director –PM and Page 371 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Group Supervisors/Team Leaders.  Provide Security Briefing to Morgue personnel, if requested to do so by the Deputy FM Branch Director – PM. – Identify credentials required to enter the Disaster Morgue. – Identify the available access points and location of check-in and check-out locations. Emphasize the requirement of personnel accountability. – Identify mechanism for reporting potential breaches in morgue security.  Determine security communication needs (i.e., radios, phones, video surveillance) and make request to Morgue Support Group.  Identify equipment/supplies required by Security Staff and make request to Morgue Support Group.  Advise the Deputy FM Branch Director – PM of any security issues, foreseeable or actual, and make corrective recommendations.  Notify the Deputy FM Branch Director – PM when morgue is secure and ready for the commencement of operations. Operational Responsibilities The Morgue Security Officer is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Morgue Security Officer should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Obtain a list of authorized morgue personnel that will be allowed access to the facility. • Monitor personnel accountability and that all morgue personnel are utilizing check-in and check-out points. – Ensure Morgue Security staff is posted at check-in and check-out points at all times. – Ensure only authorized personnel have access to the morgue and proximal facilities as needed. – If utilizing a credentialing system to create identification for morgue personnel, monitor functionality. – Monitor current morgue personnel roster at all times at all checkpoints. • Ensure security personnel monitor the perimeter at all times. • Keep thorough written documentation of all patrols taken by the Morgue Security Team. • For any incident or breach in morgue security: – Notify the Deputy FM Branch Director – PM of the incident. – Take corrective actions to address the issue. – Complete an incident report. • Remove any unauthorized persons entering the morgue facility. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – PM. • Maintain communication with the Deputy FM Branch Director – PM regarding Security Team operations. – Report any issues that arise or process alterations needed to meet Security Team needs. Page 372 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • • Maintain communications with Security Team personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Security Team operational and staff schedule. Ensure all Security Team personnel check-in and out at the beginning and end of each shift. Schedule and provide operational briefings with the Security Team at the beginning and end of each operational period. − Operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; anticipated arrival or release of remains ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with remains ▪ Review of security procedures; perimeter and road blocks; credential requirements, etc. ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Ensure all Security Team personnel are using applicable portions of their position checklists. Prepare and maintain Security Team records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – PM, or as requested. Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols – Instruct Security Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Security Team personnel adhere to PPE requirements Be aware of Security Team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Morgue Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – PM related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • • • Activity Log Security log book Incident report form Personnel check-in and check-out form Equipment and Supplies • • • • • Checkpoint tables Office supplies Chairs Credentialing System and ancillary supplies (if needed) Communication needs (i.e., radios, phones, video surveillance) Considerations Page 373 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • Morgue security may want to issue identification badges unique to the incident. Confusion may arise if personnel are instructed to use their day-to-day work identification, as members of numerous different agencies may be present in the morgue and as the identification badges will not list each staff member’s correct position. Following a Mass Fatality Incident, it is likely that media/press will attempt to access the morgue site and/or interview OCME personnel. It is critical that security is aware of the presence of media personnel and is able to prevent their access from sensitive locations. Consider coordinating with the OCME Executive Leadership to require the Disaster Response Coordinator identify a specific location for scheduled incident media briefings. Information is only released by the OCME as dictated by your Public Information Officer. In the case that the OCME does not have adequate security personnel to staff all required areas, the Security Officer may utilize law enforcement, auxiliary, or private contractor personnel to supplement the security staff. The Morgue Security Team should always be aware of morgue staff members’ wellbeing and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to morgue personnel. Page 374 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Morgue Safety Officer Morgue Safety Officer Purpose / Mission To provide for the safety and well-being of all disaster morgue personnel. Objectives ▪ ▪ Assigned Area Morgue Supervisor Deputy FM Branch Director – PM Ensure all morgue operations are conducted in a safe manner Ensure compliance with established health and safety protocols Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Deputy FM Branch Director – PM.  Meet with the Deputy FM Branch Director – PM and receive: – Incident Characterization and situational awareness – Morgue Operations and Health and Safety Expectations  Perform site risk assessment based on the location, facility characteristics and incident characteristics. Brief the Deputy FM Branch Director – PM on the results of the assessment. – Identify immediate needs to ensure morgue facility is safe for operations: ▪ Identify potential unsafe conditions, foreseeable or actual. ▪ Identify the necessary PPE requirements to maintain personnel safety. ▪ Identify locations for the donning and doffing of PPE. – Make recommendations for corrective actions.  Based on the incident characteristics and the scale of the Morgue Health and Safety operations, determine staffing requirements.  Notify Health and Safety staff and provide them with instructions to report immediately to the Disaster Morgue.  Upon arrival at the morgue, meet with the Health and Safety personnel and brief them on the following instruction/information: – Incident Characterization and situational awareness – Results of the Health and Safety site assessment – Health and Safety Operations, Staffing and schedules – Equipment / Supply request procedure – Health and Safety incident reporting procedure  Coordinate to determine the need for a Health and Safety Plan for the Morgue Operation. – If needed, coordinate with appropriate personnel to complete the Health and Safety Plan. – Supply finalized Health and Safety Plan to the Deputy FM Branch Director – PM.  Participate in Morgue walk-through with the Deputy FM Branch Director – PM and Group Supervisors/Team Leaders.  Identify equipment/supplies required by health and safety staff and make request to Morgue Support Group. Page 375 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – Direct Morgue Health and Safety Team to set up any necessary equipment in the morgue facility. – Request adequate supplies of PPE staged at the donning station by the Morgue Supply Team. – Set up stations at the entrance and exit of the morgue facility for personnel to don and doff PPE.  Provide Health and Safety Briefing to morgue personnel, if requested to do so by the Deputy FM Branch Director – PM. – Identify Safety measures and point out potential risks/hazards. – Identify required PPE for all morgue personnel, identify locations for donning and doffing of PPE and demonstrate proper use, if needed. – Identify Health and Safety Incident reporting protocol.  Determine health and safety communication needs (i.e., radios, phones) and make request to Morgue Support Group.  Advise the Deputy Branch Director – PM of any health and safety issues, foreseeable or actual, and make corrective recommendations. Operational Responsibilities The Morgue Safety Officer is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Morgue Safety Officer should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Conduct a health and safety briefing for all disaster morgue personnel at the beginning of each new operational period. – Identify Safety measures and point out potential risks/hazards. – Identify required PPE for all morgue personnel, identify locations for donning and doffing of PPE and demonstrate proper use, if needed. – Identify Health and Safety Incident reporting protocol. • Monitor morgue operations for health and safety protocol compliance. – Ensure that all personnel are wearing appropriate personal protective equipment (PPE) and adhering to the HASP at all times in the disaster morgue. – Take any necessary corrective actions as quickly as possible. • Complete an incident report for any breach in morgue Health and Safety Protocols. The appropriate supervisory staff must be alerted in the event of such an incident and report any unsafe conditions and corrective recommendations to the Deputy FM Branch Director – PM. • Any unsafe conditions and actions taken should be documented appropriately for record management. • Monitor PPE and other supply stockpile available for disaster morgue personnel. – When needed, make resource request to Morgue Supply Team for additional PPE cache. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – PM. • Maintain communication with the Deputy FM Branch Director – PM regarding Health and Safety requirements and observations. Page 376 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – • • • • • • • • • Report any issues that arise or process alterations needed to meet Health and Safety needs. Maintain communications with Health and Safety personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Health and Safety operational and staff schedule. Ensure all Health and Safety personnel check-in and out at the beginning and end of each shift. Ensure all Health and Safety personnel are using applicable portions of their position checklists. Prepare and maintain Health and Safety records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – PM, or as requested. Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Be aware of Health and Safety personnel well-being and provide necessary resources. Coordinate with Morgue Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – PM related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • Health and Safety Log Activity Log Equipment and Supplies • Adequate supply of all necessary PPE items for all morgue personnel Considerations • • • • The Deputy FM Branch Director – PM directs the Agency Safety Officer to appoint a Morgue Safety Officer who will report to the Deputy FM Branch Director – PM. It is required that a HASP be developed prior to the commencement of operations. Consult local requirements for the development of the HASP. All individuals present in the disaster morgue will require protection from blood-borne and aerosol transmissible pathogens. The Health and Safety Officer will instruct personnel to wear designated protective equipment. – PPE must be worn at all times. Minimum protection includes: ▪ Long-sleeved Tyvek suit with impervious apron or impervious gown ▪ Disposable surgical cap ▪ Disposable surgical mask ▪ Eye protection (goggles or face shield) ▪ Disposable shoe covers ▪ Disposable surgical gloves The Morgue Safety Officer, in coordination with the Contamination Control Group Supervisor, must determine requirements to determine medical clearance for morgue personnel operating in a biologically contaminated area. The Morgue Safety Officer should document the pre- and post-operation medical statistics for each Morgue Personnel. Personnel unable to meet the requirements must be documented and deterred from operating in the identified PPE level. Page 377 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 378 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Remains Storage Group Supervisor Remains Storage Group Supervisor Purpose / Mission To manage and track the storage of remains from accessioning into the disaster morgue through release. ▪ Assess the current available decedent storage capacity and augment to accommodate storage of disaster-related remains throughout the morgue operation. Ensure all remains are properly tracked through storage, during the postmortem processing, and when remains are released for final disposition. Objectives ▪ Assigned Area Remains Storage Facility Supervisor Deputy FM Branch Director – Postmortem Supporting Positions / Functions Remains Intake Team Remains Storage Team Remains Escorts Team Remains Release Team Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Deputy FM Branch Director – PM.  Check in with the Deputy FM Branch Director – PM and participate in operational briefing to receive: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Disaster Morgue Operational Overview − Staffing and scheduling information  Participate in Morgue walk-through with the Deputy FM Branch Director –PM and Group Supervisors/Team Leaders.  Meet with the Deputy FM Branch Director – PM to determine remains storage needs based on information from the Scene and the anticipated arrival of remains to the morgue.  Notify the Remains Storage Team Leaders and provide them with instructions to report to the Disaster Morgue: − Remains Intake Team − Remains Storage Team − Remains Release Team − Remains Escort Team  Assemble Remains Storage Group Team Leaders and staff and provide them: − All necessary information regarding the mass fatality incident (MFI) − Remains Storage Group operations, staffing, and schedules − Morgue type and Workflow − PPE requirements and use − Health and Safety Plan information − Equipment / supply request procedure − Direct personnel to use their position checklists Page 379 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Instruct Remains Storage Team to perform an assessment of current morgue storage capacity for incoming disaster-related remains.  Based on assessment determine the needs for augmentation for the morgue storage team. − Determine ability to meet the requirement to segregate disaster-related cases and daily cases. − Determine additional infrastructure needed in current storage units (i.e. shelving). − Determine need for external remains storage facilities to expand the morgue storage capacity (i.e. refrigerated trailers, etc.).  Coordinate with Morgue Support Group to deploy and set up Remains Storage equipment/supplies.  Ensure that Team Leaders set up Remains Storage Group equipment in the morgue facility.  Ensure that Team Leaders test all Remains Storage Group equipment to be sure all is in working order.  Identify tracking mechanism to maintain inventory of remains location within the storage units. − Provide instruction to Remains Storage Group personnel regarding the use of inventory.  Coordinate with Morgue Security Officer to ensure that all Remains Storage Facilities are secure and only specified personnel are permitted access.  Identify any additional equipment/supplies required by remains storage staff and make request to Morgue Support Group.  Ensure storage space is ready to receive disaster-related remains.  Determine communication needs (i.e., radios, phones) and make request to Morgue Support Group.  Advise the Deputy Branch Director – PM of any remains storage issues, foreseeable or actual, and make corrective recommendations.  Notify the Deputy FM Branch Director – PM that the Remains Storage Group is ready for the commencement of operations. Operational Responsibilities The Remains Storage Group Supervisor is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Remains Storage Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • Coordinate with Scene Remains Storage and Transport Group Supervisor to identify the estimated arrival time and number of remains to be accessioned into the disaster morgue. • Monitor the remains storage operations to ensure they are continuing to operate efficiently and that any issues are identified and addressed. − Ensure Remains Intake Team is properly accessioning remains from the arriving body collection point (BCP) into the morgue. ▪ Remains’ Recovery Tag will be recorded with UVIS-CMS to maintain chain-of-custody and indicate that the remains are now located in the morgue. ▪ Unopened human remains pouch will be transferred to the Remains Page 380 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths − − − Storage Facility and the inventory will be updated. Ensure the Remains Storage Team is maintaining the Remains Storage Facilities properly and are maintaining an awareness of the capacity levels. ▪ Keep a current record of the cases present in the Remains Storage Facility. ▪ Coordinate to ensure remains are stored while awaiting the next examination station to prevent bottlenecks. ▪ Ensure Remains Storage Facilities are secure at all times. ▪ Augment Remains Storage Facility as needed to accommodate the storage needs. Ensure Remains Escort Team assigns a Remains Escort to guide an OCME through the postmortem examination process. ▪ Upon request, the assigned Remains Escort will bring an unopened human remains pouch to the Triage Station. ▪ The Triage Team personnel will complete the initial examination of the remains contained in the human remains pouch and determine the individual cases present. • If the remains are separated into more than one case, additional Remains Escorts will be requested to be assigned to the additional cases. ▪ Cases will be escorted through the postmortem examination process • Maintain documents and/or files that must accompany remains between stations. ▪ Upon completion of postmortem examination, the case is stored in the appropriate Remains Storage Facility until release. Ensure Remains Release Team properly releases remains to final disposition upon confirmed identification. ▪ Coordinate with PM QA/QC Group Supervisor to determine the remains that have been identified and NOK has been notified. ▪ Bring the identified remains to the release area from the Remains Storage Facility. ▪ Ensure that all paperwork is complete and signed by the appropriate personnel prior to release. ▪ Compare all paperwork to OCME Case number to ensure all matches prior to release. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – PM. • Maintain communication with the Deputy FM Branch Director – PM regarding the remains intake, storage and release process. − Report any issues that arise or process alterations needed to meet remains storage needs. • Develop and maintain the Remains Storage Group operational and staff schedule. • Ensure all Remains Storage Group personnel check-in and out at the beginning and end of shift. • Schedule and provide operational briefings with the Remains Storage Group at the beginning and end of each operational period. − Operational briefings should include, but are not limited to: Page 381 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ▪ ▪ ▪ ▪ ▪ • • • • • • • Incident Updates / Situational Awareness Operational Period schedule; anticipated arrival or release of remains Alterations to workflow and/or procedures Review of sensitivities and considerations when working with remains Review of any known cultural/religious considerations when handling remains ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Follow and adhere to all health and safety protocols. – Instruct Remains Storage Group personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Remains Storage Group personnel adhere to PPE requirements Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Ensure all team personnel are using applicable portions of their position checklists. Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Be aware of Team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – PM related to the accomplishments/issues encountered during the operational period. Report the depletion and restocking needs of your area/station at the end of each operational period. Forms/Job Aids • • Remains storage facility tracking form Activity Log Equipment and Supplies • • • Mortuary shelving Racking Body lift to ensure compliance with OSHA lifting procedures Considerations • • Consider the various types of remains storage that may be utilized based in the incident characterization (scope, scale, and rate of recovery). Consider the use of external facilities for storage if capacity is not sufficient – coordinate with other morgue support functions to ensure facility is properly secured and monitored at all times. Normal day-to-day cases must be segregated from the disaster-related cases. Page 382 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Remains Intake Team Remains Intake Team Purpose / Mission To accession remains into the morgue facility from the scene ▪ Objectives Ensure that remains entering the morgue storage are accessioned properly to track the location of the remains. Assigned Area Intake Station Supervisor Remains Storage Group Supervisor Activation Checklist  Upon notification, arrive at the Disaster Morgue location as directed by the Remains Storage Group Supervisor.  Check in with the Remains Storage Group Supervisor, and receive situation briefing and Remains Intake Team operational requirements and set up instructions.  Participate in Disaster Morgue walk-through with Remains Storage Group Supervisor and receive operational briefing.  Obtain information on the current disaster morgue facility and operations: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Staffing and scheduling information  Determine team staffing requirements and make necessary notifications: − Remains Intake Specialists  Assemble Remains Intake Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Disaster Morgue security protocols and procedures; including credential requirements − Remains Intake Team operations − Staffing and scheduling information  Assign Remains Intake Team personnel to specific tasks. − Identify one Remains Intake Team staff member to serve as the station scribe  Evaluate the space assigned to Remains Intake and determine if adequate for team work flow and needs. − If additional facility space is needed, discuss needs with Remains Storage Group Supervisor.  Ensure Morgue Support Group has deployed appropriate resources to set up station.  Coordinate with Morgue Support Group to set up team equipment and supplies at the designated location.  Ensure that all Remains Intake Team personnel have access to the data management system.  Provide “Just-in-Time” Training to Remains Intake Team staff, as needed.  Identify any additional Remains Intake Team resource needs and communicate all resource requests to Remains Storage Group Supervisor.  Notify Remains Storage Group Supervisor when Remains Intake Team is ready for Page 383 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths the commencement of operations. Operational Responsibilities The Remains Intake Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Remains Intake Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • Upon arrival of the BCP to the disaster morgue location, assist with the transfer of remains from the BCP to the Intake Station. • Record the Remains’ Recovery Tag Number on the Human Remains Pouch in UVISCMS along with the date and time to maintain chain-of-custody of the remains. • Transfer the case to either the Remains Storage Facility or the disaster morgue for processing. − If Triage Team is able to receive the remains, the Remains Intake Team may transfer the case immediately to the Triage Station. General: • Attend all briefings/meetings as coordinated or requested by the Remains Storage Group Supervisor. • Maintain communication with the Remains Storage Group Supervisor regarding Remains Intake Team operations. – Report any issues that arise or process alterations needed to meet Remains Intake Team needs. • Maintain communications with Remains Intake Team personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Remains Intake Team operational and staff schedule. • Ensure all Remains Intake Team personnel check-in and out at the beginning and end of each shift. • Ensure all Remains Intake Team personnel are using applicable portions of their position checklists. • Prepare and maintain Remains Intake Team records and reports, as appropriate. Provide reports regularly to the Remains Storage Group Supervisor, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Remains Intake Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Remains Intake Team personnel adhere to PPE requirements. • Be aware of Remains Intake Team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Morgue Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. • At the end of each operational period, provide a situation report to the Remains Storage Group Supervisor related to the accomplishments/issues encountered during the operational period. Page 384 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Forms/Job Aids • • ICS214 Remains storage facility inventory form Equipment and Supplies • PPE Considerations • The Intake station and the Triage station may be co-located. When they are colocated, the Intake/Triage station fulfills the objectives of both stations using a combined team (typically the Triage Team assumes this role and performs the tasks of both Intake and Triage). Page 385 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 386 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Remains Storage Team Remains Storage Team Purpose / Mission To coordinate the storage of the remains during the postmortem examination process and ensure that all documentation accompanying the remains is complete, and maintain an unbroken chain of custody ▪ Ensure remains are stored in an appropriate manner until they are transferred to stations for processing Maintain current inventory of all storage units with exact location of remains Objectives ▪ Assigned Area Remains storage facility(ies) Supervisor Remains Storage Group Supervisor Activation Checklist  Upon notification, arrive at the Disaster Morgue location as directed by the Remains Storage Group Supervisor.  Check in with the Remains Storage Group Supervisor, and receive situation briefing and Remains Storage Team operational requirements and set up instructions.  Participate in Disaster Morgue walk-through with Remains Storage Group Supervisor and receive operational briefing.  Obtain information on the current disaster morgue facility and operations: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Staffing and scheduling information  Per instruction, perform an assessment of current morgue storage capacity for incoming disaster-related remains and report to Remains Storage Group Supervisor.  Based on assessment make recommendations regarding the needs for Remains Storage augmentation: − Determine ability to meet the requirement to segregate disaster-related cases and daily cases. − Determine additional infrastructure needed in current storage units (i.e. shelving). − Determine need for external remains storage facilities to expand the morgue storage capacity (i.e. refrigerated trailers, etc.).  Identify tracking mechanism to maintain inventory of remains location within the storage units.  Determine team staffing requirements and make necessary notifications: − Remains Storage Specialists  Assemble Remains Storage Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Disaster Morgue security protocols and procedures; including credential requirements − Remains Storage Team operations Page 387 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths        − Remains Storage Inventory mechanism − Staffing and scheduling information Assign Remains Storage Team personnel to specific tasks. – Identify one Remains Storage Team staff member to serve as the station scribe. Ensure Morgue Support Group has deployed appropriate resources to set up and/or augment Remains Storage Facilities. Coordinate with Morgue Support Group to set up team equipment and supplies at the designated location. Ensure each Remains Storage Facility is equipped with an inventory log and a temperature control log. Provide “Just-in-Time” Training to Remains Storage Team staff, as needed. Identify any additional Remains Storage Team resource needs and communicate all resource requests to Remains Storage Group Supervisor. Notify Remains Storage Group Supervisor when Remains Storage Team is ready for the commencement of operations. Operational Responsibilities The Remains Storage Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Remains Storage Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Once the Remains Intake Team has accessioned incoming remains into the Disaster Morgue, the remains will be transferred to the Remains Storage Facility. • Receive remains from the Remains Intake Team and properly store in the Remains Storage Facility. • Update the Remains Storage Facility inventory to reflect the current cases located in the Remains Storage Facility. • Coordinate with Triage Team to identify when Triage Team is ready to receive remains. • Remove requested remains from the Remains Storage Facility. • Ensure Remains Escort Team personnel are available to transfer remains to the Triage Station for processing. • Document the removal of remains from the storage facility, the name of the assigned Escort and the time of removal. • Coordinate with Morgue Group Supervisors to identify need to store remains between stations to prevent bottleneck situations. – Receive notification of storage needs from Group Supervisors. – Identify storage facility that is ready to receive case. – Document receipt of case at remains storage facility, including the time of storage. – Upon request for case, retrieve case and document transition to the morgue flow. • Monitor storage temperature hourly and maintain temperature control log. • Monitor Remains Storage Team personnel to ensure all remains are handled with respect and any known cultural/religious considerations are observed. • Coordinate with Morgue Security Officer to ensure that Remains Storage Facilities are secure at all times and only specified personnel are permitted access. Page 388 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths General: • Attend all briefings/meetings as coordinated or requested by the Remains Storage Group Supervisor. • Maintain communication with the Remains Storage Group Supervisor regarding Remains Storage Team operations. – Report any issues that arise or process alterations needed to meet Remains Storage Team needs. • Maintain communications with Remains Storage Team personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Remains Storage Team operational and staff schedule. • Ensure all Remains Storage Team personnel check-in and out at the beginning and end of each shift. • Ensure all Remains Storage Team personnel are using applicable portions of their position checklists. • Prepare and maintain Remains Storage Team records and reports, as appropriate. Provide reports regularly to the Remains Storage Group Supervisor, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Remains Storage Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Remains Storage Team personnel adhere to PPE requirements. • Be aware of Remains Storage Team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. • At the end of each operational period, provide a situation report to the Remains Storage Group Supervisor related to the accomplishments/issues encountered during the operational period. Form /Job Aids • • Remains Storage Facility Inventory Log Remains Storage Facility Temperature Control Log Considerations • • Site selection criteria for Remains Storage Facility location(s): o Accessible by 18-wheel vehicles o Solid, level ground (preferably paved) o Located near utility infrastructure o Enough room to collocate two of the same teams if a replacement teams is needed Setup Elements and Considerations: o Temperature control is critical to maintaining the forensic integrity of the remains. ▪ 37-44 degrees Fahrenheit o Typically a refrigerated trailer unit or CONEX cold storage unit o Can be established in tent structures, trucks/vans, or body storage facilities Page 389 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths o • Temperature control log should be maintained and constantly monitored by the Team Leader o Properly selected location and storage unit (always out of view) Regarding refrigerated trailer(s): o Identify the most efficient method of storage without damaging the forensic integrity of the remains and maintaining respect (i.e. no stacking) o Place human remains pouch in the refrigerated unit in a “fishbone” position, such that faces are visible and nobody is stacked directly atop another. Bodies should be lined up parallel with the long side of the RSF and placed along each long side, leaving a center aisle for staff to walk through the unit. o Storage Team personnel must be conscious and respectful of religious customs with regard to handling of human remains. Any and all customs identified by the OCME must be observed with care by the Storage Team. Page 390 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Remains Release Team Remains Release Team Purpose / Mission To release remains to final disposition upon identification and approval from the OCME. ▪ Maintain inventory of remains that are ready for release to final disposition Coordinate the transfer of remains from remains storage facility to the funeral director, or other designee Objectives ▪ Assigned Area Remains storage facility Supervisor Remains Storage Group Supervisor Activation Checklist  Upon notification, arrive at the Disaster Morgue location as directed by the Remains Storage Group Supervisor.  Check in with the Remains Storage Group Supervisor, and receive situation briefing and Remains Storage Team operational requirements and set up instructions.  Participate in Disaster Morgue walk-through with Remains Storage Group Supervisor and receive operational briefing.  Obtain information on the current disaster morgue facility and operations: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Staffing and scheduling information  Determine team staffing requirements and make necessary notifications: − Remains Release Specialists  Assemble Remains Release Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Disaster Morgue security protocols and procedures; including credential requirements − Remains Release Team operations − Staffing and scheduling information  Assign Remains Release Team personnel to specific tasks. – Identify one Remains Release Team staff member to serve as the station scribe.  Ensure Morgue Support Group has deployed appropriate resources to set up and/or augment Remains Release Facilities.  Coordinate with Morgue Support Group to set up team equipment and supplies at the designated location.  Provide “Just-in-Time” Training to Remains Release Team staff, as needed.  Identify any additional Remains Release Team resource needs and communicate all resource requests to Remains Storage Group Supervisor.  Notify Remains Storage Group Supervisor when the Remains Release Team is ready for the commencement of operations. Page 391 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Responsibilities The Remains Release Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Remains Release Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Coordinate with the Postmortem QA/QC Group Supervisor to determine which cases have been identified and are ready for release to NOK. • Coordinate with NOK to determine point-of-contact to whom the remains are to be released. • Maintain documentation of remains release upon direction from the Remains Storage Group Supervisor – pending notification of NOK. • When ready for release, bring the identified remains to the Remains Release Area. • Check all ME Case Number labels and tags in comparison with release paperwork and identified decedent name. • Complete all necessary paperwork and obtain required signatures for release. • Upon release of remains, ensure all paperwork and documentation is included with the UVIS-CMS files. General • Attend all briefings/meetings as coordinated or requested by the Remains Storage Group Supervisor. • Maintain communication with the Remains Storage Group Supervisor regarding Remains Release Team operations. – Report any issues that arise or process alterations needed to meet Remains Release Team needs. • Maintain communications with Remains Release Team personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Remains Release Team operational and staff schedule. • Ensure all Remains Release Team personnel check-in and out at the beginning and end of each shift. • Ensure all Remains Release Team personnel are using applicable portions of their position checklists. • Prepare and maintain Remains Release Team records and reports, as appropriate. Provide reports regularly to the Remains Storage Group Supervisor, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Remains Release Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Remains Release Team personnel adhere to PPE requirements. • Be aware of Remains Storage Team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. • At the end of each operational period, provide a situation report to the Remains Storage Group Supervisor related to the accomplishments/issues encountered Page 392 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths during the operational period. Forms/Job Aids • • Remains storage facility inventory form Activity Log Equipment and Supplies • PPE Considerations • • • • • A strict QA/QC program must be implemented and maintained by the PM QA/QC Group Supervisor. No remains should be released without a confirmed identification and check of all associated labels. Remains Release Team personnel must be conscious and respectful at all times with regard to handling of human remains. In some incidents, with protracted operations, the OCME must consider the following when determining the most appropriate temporary and perhaps long-term remains storage solution: − Accessibility for prolonged identification efforts: o The Remains Release Team will require unencumbered physical access to the chosen structure. o Ensuring the viability of forensic artifacts must be paramount in deciding the storage and preservation mechanisms. − The Office of Chief Medical Examiner will need to maintain oversight and management over the remains as long as they remain unidentified and / or unclaimed. As such remains tracking and family outreach mechanisms established at the initiation of an operation must be able to survive personnel attrition and technological advancements. Temporary Long Term Storage • Remains Storage Facility – Refrigerated Trailers – Refrigerated CONEX units – Portable Walk-In Coolers Temporary Interment • In some cases it may be appropriate to temporarily inter remains while the disaster victim identification process is executed. In this case temporary below ground storage/interment can prove an effective mechanism for long term storage. If this mechanism is chosen it is important to thoroughly document the provenience of each remain. Page 393 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 394 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Remains Escort Team Remains Escort Team Purpose / Mission To accompany human remains through the disaster morgue in order to expedite remains processing, reduce confusion among morgue personnel, ensure that all documentation accompanying the remains is complete, and maintain an unbroken chain-ofcustody Objectives ▪ ▪ Assigned Area Various Supervisor Remains Storage Group Supervisor Accompany remains to all assigned morgue stations Ensure that all remains are logged, as well as thoroughly and appropriately documented, at each station through UVIS-CMS Activation Checklist  Upon notification, arrive at the Disaster Morgue location as directed by the Remains Storage Group Supervisor.  Check in with the Remains Storage Group Supervisor, and receive situation briefing and Remains Escort Team operational requirements and set up instructions.  Participate in Disaster Morgue walk-through with Remains Storage Group Supervisor and receive operational briefing.  Obtain information on the current disaster morgue facility and operations: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Staffing and scheduling information  Identify Remains Escort Team staging location where Remains Escorts will wait to be assigned to an OCME case.  Determine team staffing requirements and make necessary notifications: − Remains Escorts  Assemble Remains Escort Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Disaster Morgue security protocols and procedures; including credential requirements − Remains Escort Team operations − Staffing and scheduling information  Coordinate with Morgue Support Group to set up team equipment and supplies at the designated staging location.  Provide “Just-in-Time” Training to Remains Escort Team staff, as needed.  Identify any additional Remains Escort Team resource needs and communicate all resource requests to Remains Storage Group Supervisor.  Notify Remains Storage Group Supervisor when the Remains Escort Team is ready for the commencement of operations. Operational Responsibilities Page 395 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The Remains Escort Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Remains Escort Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Coordinate with the Triage Team to assign a Remains Escort to each individual case at the Triage Station. − Upon request, receive unopened human remains pouch from the Remains Storage Facility and transfer it to the Triage Station. − Coordinate with Triage Team to identify each case that will require a Remains Escort. − Assign additional Remains Escorts to each case, if needed. − Ensure that the Escort is identified in UVIS-CMS. − Escort will be provided with OCME case number labels for any samples taken at subsequent stations. • Direct the assigned Remains Escort to accompany assigned remains through the morgue process to temporary storage or final disposition. − After receiving the remains at Triage, first bring the remains to the scale to be weighed. − Bring the remains to the Forensic Radiology station. − Bring the remains to the Pathology Station, where the Pathology Team. Leader will dictate to which other stations the remains must go. • Bring the remains to each of the stations selected by the Pathology Team Leader. • Transport any documentation and/or files that must accompany the remains through the Disaster Morgue Operation. • Provide OCME case number labels to station practitioners to affix to any samples or evidence taken. • Upon delivering the remains to either temporary storage or final disposition, report to the Triage station to either be assigned to another decedent or to check in with the Remains Escort Team before the end of a shift or the beginning of a break. • Upon release of remains to final disposition, report back to Remains Escort staging area to be assigned to another case. General: • Attend all briefings/meetings as coordinated or requested by the Remains Storage Group Supervisor. • Maintain communication with the Remains Storage Group Supervisor regarding Remains Escort Team operations. – Report any issues that arise or process alterations needed to meet Remains Escort Team needs. • Maintain communications with Remains Escort Team personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Remains Escort Team operational and staff schedule. • Ensure all Remains Escort Team personnel check-in and out at the beginning and end of each shift. • Ensure all Remains Escort Team personnel are using applicable portions of their position checklists. • Prepare and maintain Remains Escort Team records and reports, as appropriate. Provide reports regularly to the Remains Storage Group Supervisor, or as requested. Page 396 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. – Instruct Remains Escort Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Remains Escort Team personnel adhere to PPE requirements. Be aware of Remains Escort Team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Remains Storage Group Supervisor related to the accomplishments/issues encountered during the operational period. Equipment and Supplies • • Gurneys or other appropriate materials in, on, or with which to move remains securely and safely between stations PPE Considerations • • Remains escorts must be conscious and respectful of religious customs with regard to handling of human remains. Any and all customs identified by the OCME must be observed with care by the Remains Escort Team. If Volunteers are used: Volunteers may not be experienced in dealing with human remains, and they may require additional services to help them cope with the psychological impact of this exposure to disaster victims. Page 397 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 398 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Forensic Group Supervisor Forensic Group Supervisor Purpose / Mission To manage all aspects of operations related to decedent forensics (Triage, Forensic Radiography, and all analyses overseen by Pathology) ▪ ▪ Objectives ▪ Coordinate the forensic operations of the disaster morgue to conduct postmortem examinations and collect information to assist in determining identification as well as cause and manner of death Conduct MFM tasks in accordance with established forensic standards – Document, record, and process decedents in a dignified and respectful manner – Support judicial, public health, and investigative objectives and requirements Conduct the rapid return of decedents to their legal next of kin (NOK) Assigned Area Morgue Supervisor Deputy FM Branch Director – PM Supporting Positions / Functions Triage Team Radiography Team Pathology Team Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Deputy FM Branch Director – PM.  Check in with the Deputy FM Branch Director – PM and participate in an operational briefing to receive: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Disaster Morgue Operational Overview − Staffing and scheduling information  Participate in Morgue walk-through with the Deputy FM Branch Director – PM and Group Supervisors/Team Leaders.  Meet with the Deputy FM Branch Director – PM to determine Forensic Group needs based on the incident characterization and the postmortem examination policies: – Identification Policy – Autopsy Policy  Notify the Forensic Group Team Leaders and provide them with instruction to report to the Disaster Morgue: − Triage Team Leader − Radiography Team Leader − Pathology Team Leader  Assemble Forensic Group Team Leaders and staff and provide them: − All necessary information regarding the Mass Fatality Incident (MFI) Page 399 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths            − Forensic Group Operations, staffing, and schedules − Morgue type and Workflow − PPE requirements and use − Health and Safety Plan information − Equipment / supply request procedure − Direct personnel to use their position checklists Meet with the Pathology Team Leader to determine the necessary Units to activate for the collection of postmortem information for identification. Request Forensic Group Team Leaders notify and assemble appropriate subsequent personnel. Perform a walk-through of Disaster Morgue with Team and Unit Leaders to identify the specific locations and review the workflow. Coordinate with the Remains Storage Group Supervisor to determine Remains Storage processes: o Ensure coordination between Triage, Remains Intake and Remains Storage Teams to determine flow of remains from accessioning and storage to the Triage Station. o Ensure coordination between Triage and Remains Escort Teams to determine request process for additional Remains Escorts should multiple cases be created from the contents of a human remains pouch. Coordinate with Morgue Support Group to deploy and set up Forensic Group equipment/supplies. Ensure that Team Leaders set up Forensic Group equipment in the morgue facility. Ensure that Team Leaders test all Forensic Group equipment to be sure all is in working order. Identify any additional equipment/supplies required by remains storage staff and make request to Morgue Support Group. Determine communication needs (i.e., radios, phones) and make request to Morgue Support Group. Advise the Deputy Branch Director – PM of any remains storage issues, foreseeable or actual, and make corrective recommendations. Notify the Deputy FM Branch Director – PM that the Forensic Group is ready for the commencement of operations. Operational Responsibilities The Forensic Group Supervisor is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Forensic Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Coordinate with the Remains Storage Group Supervisor to: – Determine the timeline for remains to be accessioned into the Morgue operation and ready for examination. – Ensure Remains Escorts are available for assignment to each case at the Triage Station. – Temporarily store any cases awaiting examination and to prevent bottlenecking. • Monitor the forensic examination of disaster-related cases to ensure they are continuing to operate efficiently and that and issues are identified and addressed. Page 400 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – – – Ensure the Triage Team is properly receiving the human remains pouch from storage to conduct the initial examination of the content, documentation of findings and assignment of OCME Case Number to each individual case. ▪ The Triage Photography Unit will properly document the contents of each human remains pouch. ▪ The Triage Evidence Unit will collect, document and package all unassociated evidence and personal effects. ▪ A Remains Escort is to be assigned to each case for guidance through the Disaster Morgue operation. Ensure all remains are documented at the Radiography Station. ▪ The Radiography Team will properly document each case and associate the images with the correct OCME Case File. Ensure the Pathology Team performs the appropriate examination to collect data for identification and to determine cause and manner of death. ▪ The Pathology Team will perform an external exam to document trauma to the remains. • The Pathology Photography Unit will properly document the remains. • The Pathology Evidence Unit will collect, document and package all associate evidence and personal effects. • The Pathology Team will determine the subsequent stations required to collect all necessary postmortem data and samples for each case. • The Pathology Team will indicate any cases for internal exam by the Autopsy Unit. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – PM. • Maintain communication with the Deputy FM Branch Director – PM regarding Forensic operations. – Report any issues that arise or process alterations needed to meet Forensic Operational needs. • Maintain communications with Forensic Group personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Forensic Group operational and staff schedule. • Ensure all Forensic Group personnel check-in and out at the beginning and end of each shift. • Ensure all Forensic Group personnel are using applicable portions of their position checklists. • Prepare and maintain Forensic Group records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – PM, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Forensic Group personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Forensic Group personnel adhere to PPE requirements. • Be aware of Forensic Group personnel well-being and maintain communication with the Safety Officer to ensure that assistance, medical or otherwise, is available to Page 401 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • personnel. Coordinate with Morgue Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – PM related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • • • • • • • • • • • • Case Worksheet Fingerprints Worksheet Record Form Forensic Anthropology Worksheet and Record Form Forensic Biology – DNA Worksheet and Record Form Pathology – External Form Pathology – Autopsy Form Pathology Evidence Form – Associated Log Sheet and Record Form Photography Log Specimen Tracking Form Triage Evidence Form – Non Associated Log Sheet and Record Form X–ray – Dental Form X–ray – Request Form X–ray – Specimen Form Considerations • • Maintaining Morgue flow: – Certain stations may require more time to complete examination than others. To prevent a bottleneck/back up of cases – coordinate with the Remains Storage Team to place cases in storage while they are waiting to be received at the next station. Once the station is ready to receive remains – coordinate with the Remains Storage Team to retrieve the remains and bring them to the next station. – Skipping stations to come back to them should not happen as it may cause cases to miss certain stations in the end. – Forensic Group personnel must be conscious and respectful of religious customs with regard to handling of human remains and performing postmortem exams. Any and all customs identified by the OCME must be observed with care by the Forensic Group Personnel. The Intake station and the Triage station may be co-located. When they are colocated, the Intake/Triage station fulfills the objectives of both stations using a combined team (typically the Triage Team assumes this role and performs the tasks of both Intake and Triage). Page 402 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Triage Team Triage Team Purpose/Mission To evaluate remains to determine the existence of commingling and/or non-human remains and assign each individual case an OCME Case Number in order to begin the morgue process ▪ ▪ ▪ ▪ Objectives ▪ ▪ ▪ ▪ Evaluate the remains enclosed in the human remains pouch to determine the existence of commingled remains and/or nonhuman remains Separate remains accordingly into distinct independent cases Ensure contaminated items that could be a hazard to personnel are identified and isolated Ensure unassociated forensic evidence, which could be of value to other investigative agencies, is identified and isolated Ensure all operations are conducted in a safe manner Conduct MFM tasks in accordance with established forensic standards Document, record, and process decedents in a dignified and respectful manner Support judicial, public health, and investigative objectives and requirements Assigned Area Triage Station Supervisor Forensic Group Supervisor Supporting Positions / Functions Triage Evidence Unit Triage Photography Unit Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Forensic Group Supervisor.  Check in with the Forensic Group Supervisor, and receive the following: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Morgue Operations and Triage Team expectations – Staffing and scheduling information  Based on the incident characteristics and the Morgue Operational requirements, determine Triage Team staffing requirements. − Triage Team members − Triage Evidence Unit − Triage Photography Unit  Notify appropriate Triage Personnel and provide them with instructions to report immediately to the Disaster Morgue.  Upon arrival at the morgue, meet with the Triage Team member and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the Triage Station Area Page 403 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths         – Triage operations, staffing, and schedules – Health and Safety briefing – Security briefing – Equipment/supply request procedure – Direct personnel to use their position checklists Assign Triage Team personnel to specific tasks. – Identify one Triage Team staff member to serve as the station scribe Evaluate the morgue space assigned to the Triage Team and determine if adequate for team work flow and needs. − If additional facility space is needed, discuss needs with your Group Supervisor Coordinate with Morgue Support Group and IT Team to deploy Triage Station equipment and supplies at the designated location. Set up Triage Team equipment and supplies at the designated location in the morgue facility. Test all team equipment to be sure all is in working order. Provide “Just-in-Time” training to Triage Team staff as needed. Identify Triage Team resource needs and communicate all resource requests through the Forensic Group Supervisor to the Morgue Support Group Supervisor. Notify the Forensic Group Supervisor when the Triage Team is ready for the commencement of operations. Operational Responsibilities The Triage Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Triage Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • When an unopened body bag is brought to the Triage station by a Remains Escort Team member, scan or record the remains tag to call up the correct recovery file in UVIS-CMS. • Identify and isolate items that could be a hazard to personnel. o Identify the presence of any materials that might be hazardous to disaster morgue staff. Contact the appropriate officers (e.g., Security, Health and Safety) to dispose of the materials. • Ensure the Triage Photography Team documents the contents accordingly. • Separate all human remains from any non-human remains and other unassociated material evidence. • Identify and isolate unassociated forensic evidence that could be of value to other investigative agencies. • Collect all evidence or personal effects (PE) that are unassociated with the remains (that is, they are not spatially associated with the remains) and transfer them to the Triage Evidence Unit for proper documentation, packaging, and storage. • Sort human remains into potentially separate decedents. Any remains that are not attached by soft tissue or cannot be conjoined at a fracture site should be segregated, treated as potentially different individuals, and assigned different OCME case numbers. • Assign each specimen (potentially separate decedent) a unique OCME Case Number according to a simple, intuitive numbering system. o Enter case number in UVIS-CMS for tracking movement through morgue Page 404 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • stations. Identify the assigned Remains Escort that will accompany the remains through the morgue process. o If more than one OCME case is created, request the assignment of additional Remains Escorts to each individual OCME case, and document the assignment in UVIS-CMS. Print or create labels containing the OCME Case Number and an associated barcode for each individual. Affix a label to the morgue tag for scanning at subsequent stations, and give the labels to the remains escort for labeling any samples taken from, or any radiographs taken of, the remains at all subsequent disaster morgue stations. General: • Attend all briefings/meetings as coordinated or requested by the Forensic Group Supervisor. • Maintain communication with the Forensic Group Supervisor regarding Triage Team operations. – Report any issues that arise or process alterations needed to meet Triage Team needs. • Maintain communications with Triage Team personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Triage Team operational and staff schedule. • Ensure all Triage Team personnel check-in and out at the beginning and end of each shift. • Schedule and provide operational briefings with the Triage Team at the beginning and end of each operational period. − Operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; anticipated arrival or release of remains ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with remains ▪ Review of any known cultural/religious considerations when handling remains ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing • Ensure all Triage Team personnel are using applicable portions of their position checklists. • Prepare and maintain Triage Team records and reports, as appropriate. Provide reports regularly to the Forensic Group Supervisor, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Triage Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Triage Team personnel adhere to PPE requirements. • Be aware of Triage Team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Support Group to ensure that all work areas/station are clean and Page 405 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Forensic Group Supervisor related to the accomplishments/issues encountered during the operational period. Equipment and Supplies • • • • • • • • • Portable morgue table UVIS-CMS Triage station Triage morgue cart Trauma shears Body bags Zip ties Blank recovery tags OCME Case Number Tags and Labels PPE Considerations • • The Intake station and the Triage station may be co-located. When they are colocated, the Intake/Triage station fulfills the objectives of both stations using a combined team. The remains container or body bag may be radiographed at any point during the Triage process, including prior to opening the body bag; however, this practice is not necessarily applicable to every incident. − Such radiographs may: ▪ Facilitate more effective sorting at Triage ▪ Obviate staff exposure to hazardous materials ▪ Enable Triage Team members to assess the nature of the remains prior to opening the body bag and beginning the morgue process (which could enable the Triage Team send more intact bodies through the morgue prior to more fragmented remains). Page 406 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Triage Evidence Unit Triage Evidence Unit Purpose/Mission To receive, voucher and secure all unassociated evidence and personal effects (PE) found in the human remains pouch at the Triage Station and maintain chain-of-custody of evidentiary items throughout the morgue operations ▪ ▪ Objectives ▪ Ensure unassociated evidentiary items and personnel effects are properly collected, documented, packaged, vouchered, and secured Ensure items are released to the appropriate authorities or agencies for analysis or returned to next of kin (NOK) Maintain chain-of-custody of items from accession to final disposition Assigned Area Triage Station Supervisor Triage Team Leader Activation Checklist □ Upon notification, arrive at the disaster morgue location as directed by the Triage Team Leader. □ Check in with the Triage Team Leader and receive: □ □ □ □ □ □ □ – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Triage Team operations – Staffing and scheduling information Based on the incident characteristics and the scale of the Triage Station operations, determine the Triage Evidence Unit staffing needs. Based on the incident characterization, coordinate with the local law enforcement and/or investigative authorities to determine evidence protocols specific to the incident. Notify Triage Evidence Unit personnel and provide them with instructions to report to the Disaster Morgue. Ensure that all Triage Evidence Unit personnel have proper credentials to obtain access to the disaster morgue area. Upon arrival at the morgue, meet with the Triage Evidence Unit members and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the Triage Evidence Area – Triage Evidence operations, staffing, and schedules – Health and Safety briefing – Security briefing – Equipment/supply request procedure – Direct personnel to use their position checklists Assign Triage Evidence Unit personnel to specific tasks. – Identify one Triage Evidence Unit staff member to serve as the station scribe Coordinate with IT Team to ensure all necessary personnel have access to the Case Page 407 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths □ □ □ □ □ □ □ □ Management System and that all ancillary items are fully functional (computers, screens, printers, etc.). Evaluate the Triage Station space assigned to Evidence Operations and determine if adequate for the Triage Evidence operational needs. – If additional facility space is needed, discuss needs with the Triage Team Leader. Coordinate with Morgue Support Group and IT Team to setup Triage Evidence Unit equipment and supplies at the designated location. Set up Triage Evidence station equipment and supplies at the designated location in the morgue facility. Ensure all Triage Evidence Unit personnel have access to the Case Management System and/or any Evidence Tracking System being utilized. Test all equipment to be sure all is in working order. Participate in “Just-in-Time” Training opportunities with Triage Team. Identify station resource needs and communicate all resource requests to Triage Team Leader for fulfillment by the Morgue Support Group. Notify Triage Team Leader when you are ready for the commencement of operations. Operational Responsibilities The Triage Evidence Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Triage Evidence Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • The Triage Team will collect all evidence or personal effects (PE) that are unassociated with the remains (that is, they are not spatially associated with the remains – not on or in the remains) and transfer them to the Triage Evidence Unit. • Ensure that the Triage Photography Unit thoroughly photographs all items removed. • Voucher all items properly, in accordance with law enforcement requirements, such that a record of the item exists for the OCME’s office and another exists for law enforcement. • Categorize materials as one of the following: General, Clothing, Personal Effects, and Identification Papers/Materials. • Record a detailed description in Data Management System. Descriptions must be consistent in the terminology used and the level of detail recorded. • Maintain chain-of-custody of all items collected and documented. Release all items, after all items are documented, via photography and written notation, and vouchered appropriately. o Note: Items may be released to appropriate law enforcement representatives or other agency for analysis or secure storage. They may also be released to NOK when appropriate General: • Attend all briefings/meetings as coordinated or requested by the Triage Team Leader. • Maintain communication with the Triage Team Leader regarding Triage Evidence Unit operations. – Report any issues that arise or process alterations needed to meet Triage Evidence Unit needs. Page 408 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • Maintain communications with Triage Evidence Unit personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Triage Evidence Unit operational and staff schedule. Ensure all Triage Evidence Unit personnel check-in and out at the beginning and end of each shift. Ensure all Triage Evidence Unit personnel are using applicable portions of their position checklists. Prepare and maintain Triage Evidence Unit records and reports, as appropriate. Provide reports regularly to the Triage Team Leader, or as requested. Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. – Instruct Triage Evidence Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Triage Evidence Unit personnel adhere to PPE requirements Be aware of Triage Evidence Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Triage Team Leader related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • Activity Log Evidence – Log Sheet and Record Form Equipment and Supplies • • • • UVIS-CMS Triage Evidence Station and ancillary IT equipment Secure storage containers for evidence Plastic evidence bags (preferably tamper-evident) Evidence tape Considerations • • • Item descriptions should be thorough and detailed. – Poor example: “One (1) ring” – Good example: “One (1) yellow metal ring with white stone and ’01.01.01 forever’ engraved on inner surface” Item descriptions must also be consistent and preferably standardized so that they can be searchable. – Prior to the commencement of operations, it would be advisable for all Triage Evidence Unit members to be made aware of what terminology will be used in the disaster morgue for this specific incident. Both the Triage Evidence Unit and the Pathology Evidence Unit should be in agreement regarding the terminology to be used. Any items found believed to have evidentiary purpose should be reported to the law enforcement and/or investigative authority. These materials will be photographed, documented and packaged prior to properly transferring the items to partner Page 409 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • agencies. To release evidence to NOK: – Evidence staff will release PE to the NOK after a written request has been received and reviewed by the OCME’s legal department. – Evidence staff will release evidentiary items to the appropriate law enforcement agency. Law enforcement will be responsible for releasing any evidentiary items to NOK. Valid contact information must be obtained for all individuals, departments, and agencies involved with evidence collection. If multiple agencies are involved and evidence is released to multiple locations, it is imperative that all involved in the response be able to contact those having evidence or PE in their custody. Page 410 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Triage Photography Unit Triage Photography Unit Purpose/Mission To objectively and thoroughly document the passage of all remains at the Triage Station ▪ ▪ Objectives ▪ Document remains at the Triage Station Transfer photos immediately (transfer will preferably be automatic) to the appropriate case file so that they may be used immediately by anyone accessing the file in Data Management System Ensure that photographs are accompanied by appropriate written documentation in a photo log Assigned Area Triage Station Supervisor Triage Team Leader Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Triage Team Leader.  Check in with the Triage Team Leader and receive: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Triage Team operations – Staffing and scheduling information  Based on the incident characteristics and the scale of the Triage Station operations, determine the Triage Photography Unit staffing needs.  Notify Triage Photography Unit personnel and provide them with instructions to report to the Disaster Morgue.  Ensure that all Triage Photography Unit personnel have proper credentials to obtain access to the disaster morgue area.  Upon arrival at the morgue, meet with the Triage Photography Unit members and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the Triage Area – Triage Photography operations, staffing, and schedules – Health and Safety briefing – Security briefing – Equipment/supply request procedure – Direct personnel to use their position checklists  Assign Triage Photography Unit personnel to specific tasks. – Identify one Triage Photography Unit staff member to serve as the station scribe.  Evaluate the Triage Station space assigned to Photography Operations and determine if adequate for the Triage Photography operational needs. – If additional facility space is needed, discuss needs with the Triage Team Leader.  Coordinate with Morgue Support Group and IT Team to setup Triage Photography Unit equipment and supplies at the designated location.  Set up Triage Photography station equipment and supplies at the designated Page 411 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths location in the morgue facility.  Ensure all Triage Photography Unit personnel have access to the Case Management System.  Test all equipment to be sure all is in working order.  Participate in “Just-in-Time” Training opportunities with Triage Team.  Identify station resource needs and communicate all resource requests to Triage Team Leader for fulfillment by the Morgue Support Group.  Notify Triage Team Leader when you are ready for the commencement of operations. Operational Responsibilities The Triage Photography Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated for each case. The Triage Photography Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • When remains enter the Triage station, sorted into individual specimens, each of which will be given an ME case number. − Scan the specimen barcode with the MC-70 (or similar). Doing so will call up the Data Management System case file so that all subsequent photos (until the next barcode is scanned) will be uploaded to the appropriate file. • Photographers should maintain a photo log with the photo number, the Remains Recovery Tag number and the description of the item. • Photograph the Remains Recovery Tag(s) on the body bag. Include a scale bearing the Remains’ Recovery Tag number in every photograph. – Note: All shots in the photo log. Include the photo number, the recovery tag number, the time the photo was taken, and a brief description of the shot. • Photograph the body bag and the remains upon opening the bag. • Document the condition of the remains. These shots will be especially important, as they document the state in which the remains arrived at the disaster morgue, prior to any morgue procedures. • Photograph all evidence or personal effects (PE) removed from the body bag by the Triage Evidence Unit. − These items should be photographed against the center of a piece of neutralcolored background. − The photographer should ensure that the item is placed on the paper such that no splashing fluids stain the paper surface surrounding the item. • Capture any other images as ordered by the Triage Station Lead. • Upon the assignment of an OCME Case Number, photograph the number before the case progresses to other stations. − If remains are comingled at Triage and must be separated into multiple ME cases, photograph each separate case number. General: • Attend all briefings/meetings as coordinated or requested by the Triage Team Leader. • Maintain communication with the Pathology Team Leader regarding Triage Photography Unit operations. – Report any issues that arise or process alterations needed to meet Triage Photography Unit needs. Page 412 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • Maintain communications with Triage Photography Unit personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Triage Photography Unit operational and staff schedule. Ensure all Triage Photography Unit personnel check-in and out at the beginning and end of each shift. Ensure all Triage Photography Unit personnel are using applicable portions of their position checklists. Prepare and maintain Triage Photography Unit records and reports, as appropriate. Provide reports regularly to the Triage Team Leader, or as requested. Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. – Instruct Triage Photography Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Triage Photography Unit personnel adhere to PPE requirements. Be aware of Triage Photography Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Triage Team Leader related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • Photo Log Activity Log Equipment and Supplies • • • • • • • • One camera per station Spare batteries for each camera; Battery charger for each camera Additional memory card / storage for photograph files Flash with batteries for each camera Photo log materials Adhesive scales to which specimen barcode label is printed/affixed Neutral-colored background for photographing objects removed from the body PPE Considerations Photography staffing and the placement of staff members within the disaster morgue will be largely dependent upon staff availability. At minimum, a Triage Photography Unit should be assigned to cover all remains, evidence, and PE at the Triage station, and a second Photography Unit should be assigned to document all remains, evidence, and PE present at the Pathology station. Settings • Aperture: The photographer will want to capture as much depth of field as possible. To maximize depth of field, the camera should be set on an aperture setting of F8 or higher. Page 413 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • Flash: Flash (particularly balance fill flash) should be used; built-in flash is not recommended, but will be a better option than photographing items with no flash whatsoever. Shutter speed: Shutter speed should not be set below 1/60 of a second. ISO: Low ISO settings (typically 100) should be used; higher settings will render a grainy image. Practices • Digital cameras should be used, as they offer far more in capabilities and usability than do film cameras. • In establishing or medium-range shots, the scale and label should be placed at the bottom of the frame. When taking close-ups, however, the scale and label should be placed on the side of the frame nearest the decedent’s feet. This practice will help to orient the viewer. • At the Triage station, all remains should be photographed “as is”. Remains should not be cleaned before being photographed. • Other individuals working alongside the photographer at a given station should avoid being in the frame. • If the photographer requires assistance setting up a shot (e.g., needs someone to hold a case label or stabilize an appendage); the photographer may ask another station staff member to assist. • Where applicable and possible, photographs should be taken at an angle perpendicular to the surface on which the body rests. • All disaster morgue images should exist in multiple locations for backup purposes: – They should remain on the camera’s memory card and be either a) burned to a disc and retained in a physical file or b) saved to a hard drive location. – Images will be uploaded to and saved in the appropriate file. • No photographs should be deleted. If any are deleted, accidentally or otherwise, this should be documented in the photo log. • The forensic photographer should maintain a photo log throughout disaster morgue operations. – The log will be particularly useful when photographing more than one specimen at a time (to avoid losing time switching between ME case numbers, the photographer may capture all images, documenting to which file each belongs, and reconcile the images and their appropriate case numbers later). – It will also be useful when many close-up shots will be taken in rapid succession. A viewer may be unable to recognize the subject of the photographs without some context information. – The log is also important for documenting when and why any photographs have been deleted. As it is considered best practice not to delete any photos taken in the disaster morgue, any deletions, accidental or otherwise, should be noted in detail at the time of their deletion. • No photographs should be taken in the disaster morgue unless by the Photography staff. No candid photographs should be taken in the disaster morgue from the commencement to the conclusion of operations, unless they are taken for the purpose of documenting morgue operations. Page 414 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Radiography Team Forensic Radiography Unit Purpose / Mission To provide radiographs for all remains examined in the disaster morgue to provide an opportunity for investigators to separate commingled remains into individual specimens, to identify nonbiological tissue evidence (e.g., wreckage, shrapnel) that may be invisible to the naked eye, to positively identify individuals, to reconstruct the incident, and to provide a permanent record of the decedent to be housed at the OCME ▪ ▪ ▪ Objectives Capture and appropriately file and log all necessary radiographic images for every morgue specimen Offer aid (limited to radiographic technique, artifacts, positions or procedure, etc.) to anthropologists, pathologists, and deontologists in the interpretation of radiographs Ensure all operations are conducted in a safe manner − Conduct MFM tasks in accordance with established forensic standards − Document, record, and process decedents in a dignified and respectful manner − Support judicial, public health, and investigative objectives and requirements Assigned Area Forensic Radiography Station Supervisor Forensic Group Supervisor Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Forensic Group Supervisor.  Check in with the Forensic Group Supervisor, and receive: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Morgue operations and Forensic Radiography Team expectations – Staffing and scheduling information  Based on the incident characteristics and the Morgue Operational requirements, determine Forensic Radiography Team staffing requirements. − Forensic Radiography Team Members  Upon arrival at the morgue, meet with the Forensic Radiography Team members and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the Forensic Radiography Station Area – Forensic Radiography operations, staffing, and schedules – Health and Safety briefing – Security briefing – Equipment/supply request procedure – Direct personnel to use their position checklists  Assign Radiography Unit personnel to specific tasks. Page 415 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – Identify one Radiography Unit staff member to serve as the station scribe.  Evaluate the morgue space assigned to the Forensic Radiography Team and determine if adequate for team work flow and needs. − If additional facility space is needed, discuss needs with the Forensic Group Supervisor.  Coordinate with Morgue Support Group and IT Team to deploy Forensic Radiography Station equipment and supplies at the designated location.  Set up Forensic Radiography Team equipment and supplies at the designated location in the morgue facility.  Test all Forensic Radiography equipment to be sure all is in working order.  Provide “Just-in-Time” training to Forensic Radiography Team staff as needed.  Identify Forensic Radiography Team resource needs and communicate all resource requests through the Forensic Group Supervisor to the Morgue Support Group Supervisor.  Notify the Forensic Group Supervisor when the Forensic Radiography Team is ready for the commencement of operations. Operational Responsibilities The Radiology Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Radiology Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • When remains are brought to the Forensic Radiography station, scan the specimen barcode or record case number in to call up the specimen file in UVIS-CMS. This will ensure that all radiographs taken are uploaded directly to the correct file. • Radiograph each specimen in appropriate and necessary views as directed. − If possible, remains should be positioned so as to capture images in standard views (to facilitate easier comparison with antemortem images). This endeavor may require the aid of an anthropologist in instances of extreme fragmentation. − Complete radiographs of the abdomen and chest region will be taken, if possible. − To capture radiographs of the skull, anterior position and lateral views of the skull should include a clear view of the sinuses. − Radiographs of the extremities will be taken as needed. • Fully label each radiograph and keep a log of the radiographs taken in the Data Management System file, including: − The ME Case Number − Radiograph Number − Number of Radiographs taken − Name of Radiology Team member who took the radiograph • Conduct additional radiographic at the request of forensic specialists. • Assist other forensic specialists in the interpretation of radiographs, specifically relating to radiographic technique, artifacts, positions or procedure, etc. − Note: The Forensic Radiography Team does not help to analyze the content of the image. The radiology team will convey the findings and present the other morgue personnel with the information. Page 416 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths General: • Attend all briefings/meetings as coordinated or requested by the Forensic Group Supervisor. • Maintain communication with the Forensic Group Supervisor regarding Forensic Radiography Unit operations. – Report any issues that arise or process alterations needed to meet Forensic Radiography Unit needs. • Maintain communications with Forensic Radiography Unit personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Forensic Radiography Unit operational and staff schedule. • Ensure all Forensic Radiography Unit personnel check-in and out at the beginning and end of each shift. • Ensure all Forensic Radiography Unit personnel are using applicable portions of their position checklists. • Prepare and maintain Forensic Radiography Unit records and reports, as appropriate. Provide reports regularly to the Forensic Group Supervisor. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Forensic Radiography Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Forensic Radiography Unit personnel adhere to PPE requirements • Be aware of Forensic Radiography Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. • At the end of each operational period, provide a situation report to the Forensic Group Supervisor related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • X–ray Request Form X–ray Specimen Form Equipment and Supplies • • • • • • UVIS-CMS X-ray station (including computer and data entry mechanisms) Portable X-ray unit − Digital X-ray system (cassettes with digital plates/sensors and reader) or Film-based system (film, cassettes, chemicals, etc) Portable developing unit (if not using a digital X-ray) Portable protective radiation shields Radiation dosimeters PPE Considerations • Consider the use of X–ray at the triage station in addition to identify co-mingled remains and potential hazards. This may require additional support staff (see Triage Team). Page 417 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • When utilizing radiology equipment be sure to set up and utilize proper shielding equipment to prevent continued exposure of personnel to the x-rays. Be sure all personnel are aware of the safety equipment and protocols and adherence of these measures. Radiographs will be examined for potential identification by anthropologists or pathologists experienced in radiographic interpretations. − The Forensic Radiography Team may be requested to assist other forensic specialists with the comparison of postmortem and antemortem radiographs in an attempt to make an identification. − All points of similarity leading to the identification will be documented for review by the Identification Review Committee. Page 418 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Pathology Team Pathology Team Purpose / Mission To complete a thorough external examination of each remain or decedent, removing associated evidence and personal effects (PE), and carefully documenting all necessary information in order to assess decedent identification and the cause and manner of death ▪ ▪ ▪ Objectives Ensure a thorough external examination of each remain or decedent passing through the disaster morgue If ordered by the OCME, ensure an internal examination is completed for specified decedents and document all findings Conduct MFM tasks in accordance with established forensic standards: − Document, record, investigate, recover, and process decedents in a dignified and respectful manner − Accurately determine the cause and manner of death − Perform the accurate and efficient identification of victims − Support judicial, public health, and investigative objectives and requirements Assigned Area Pathology Station Supervisor Forensic Group Supervisor Supporting Positions / Functions Autopsy Unit Pathology Evidence Unit Pathology Photography Unit DNA Unit Fingerprint Unit Forensic Odontology Unit Anthropology Unit Histology Unit Toxicology Unit Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Forensic Group Supervisor.  Check in with the Forensic Group Supervisor, and receive the following: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Morgue Operations and Pathology Team expectations − Staffing and scheduling information  Receive instruction on policies that will affect the Pathology Station and subsequent stations: − Autopsy Policy − Identification Policy  Based on the incident characteristics and the Morgue Operational requirements, Page 419 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths             determine the Pathology Team staffing for the following units: − Autopsy Unit − Pathology Evidence Unit − Pathology Photography Unit − DNA Unit − Fingerprint Unit − Forensic Odontology Unit − Anthropology Unit − Histology Unit − Toxicology Unit Notify Pathology Team personnel and Unit Leaders; provide them with instructions to report immediately to the Disaster Morgue. Upon arrival at the morgue, meet with the Unit Leaders and brief them on the following items: − Incident Characterization and Situational Awareness − Layout of the Pathology Area − Pathology operations, staffing, and schedules − Health and Safety briefing − Security briefing − Equipment/supply request procedure − Direct personnel to use their position checklists Brief Unit Leaders regarding the process by which each case will be routed to the appropriate specialty to gather specific identification information and/or further examination to determine cause and manner of death. Designate Pathology Team members to appropriate positions to assist with external examination. – Designate one team member to serve as a scribe for documentation. Evaluate the morgue space assigned to the Pathology Team and subsequent units; determine if adequate for team work flow and needs. − Request Unit Leaders to evaluate space designated for their respective operations. − If additional facility space is needed, discuss needs with the Forensic Group Supervisor. Coordinate with Morgue Support Group and IT Team to deploy Pathology Station equipment and supplies at the designated location. – Ensure the Morgue Support Group and IT Team deploy the equipment and supplies to the subsequent unit areas to begin set up. Set up Pathology Station equipment and supplies at the designated location in the morgue facility. Instruct Unit Leaders to set up respective station equipment and supplies at their designated location in the Pathology area. – Request Unit Leaders to identify resource needs to support station operations. Identify Pathology Team resource needs and communicate all resource requests through the Forensic Group Supervisor to the Morgue Support Group Supervisor. Instruct Pathology Team personnel to test all team equipment to be sure all is in working order. Provide “Just-in-Time” training to Pathology Team staff as needed. Notify the Forensic Group Supervisor when the Triage Team is ready for the commencement of operations. Page 420 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Responsibilities The Pathology Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Pathology Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • When a case enters the Pathology Station, scan or record the remains tag to ensure that all documentation will be associated with the correct file(s) in Case Management System. • Ensure Pathology Photography documents the case accordingly. • Perform the external examination, which may include (but is not limited to) the following: – Review radiographs associated with the case. – Describe the condition of those remains present. o Document general physical characteristics. o Document specific identifying features (scars, piercings, birthmarks, tattoos, previous injuries or visible signs of pathology, prosthetics or other surgical hardware). o Document injuries and trauma. – If fragmentation is present, perform body inventory. Consult the forensic anthropologist if necessary. – If applicable, complete a body diagram documenting all injuries. • Collect all evidence or personal effect (PE) that are associated with the remains (that is, they are spatially associated with the remains) and transfer them to the Pathology Evidence Unit for proper documentation, packaging and storage. • Take appropriate samples. – DNA samples (dependent on scale of disaster morgue operations) – Toxicological samples (dependent on specific case) o Toxicological samples may be taken in certain external exam-only cases, but such samples are typically taken during the internal exam. • Assess the case to determine which Pathology Team stations are needed for consultation in order to provide identifying information: – Autopsy Unit – Forensic Odontology Unit – DNA Unit – Fingerprint Unit – Anthropology Unit – Histology Unit – Toxicology Unit • Document required Unit consultation in the Case Management System. Brief the Remains Escort to ensure that the case is examined by the appropriate Units. General: • Attend all briefings/meetings as coordinated or requested by the Forensic Group Supervisor. • Maintain communication with the Forensic Group Supervisor regarding Pathology Team operations. – Report any issues that arise or process alterations needed to meet Pathology Page 421 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • • Team needs. Maintain communications with Pathology Team personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Pathology Team operational and staff schedule. Ensure all Pathology Team personnel check-in and out at the beginning and end of each shift. Schedule and provide operational briefings with the Pathology Team at the beginning and end of each operational period. − Operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; anticipated arrival or release of remains ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with remains ▪ Review of any known cultural/religious considerations when handling remains ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Ensure all Pathology Team personnel are using applicable portions of their position checklists. Prepare and maintain Pathology Team records and reports, as appropriate. Provide reports regularly to the Forensic Group Supervisor, or as requested. Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols: – Instruct Pathology Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Pathology Team personnel adhere to PPE requirements. Be aware of Pathology Team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Forensic Group Supervisor related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • • • • • • Activity Log Case Worksheet Pathology - External Form Pathology - Autopsy Form Evidence - Associated Log Sheet and Record Form Photography - Recovery Form Photography - Specimen (by station) Form Equipment and Supplies • • • Autopsy tables Autopsy lights Data management equipment, system Page 422 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • Pathology equipment cart PPE Considerations • Regardless of where DNA samples are collected, all available samples should be taken – at very minimum, both blood and bone samples should be collected from a body – in accordance with DNA collection protocol. o DNA Sampling Considerations: ▪ For a small-scale MFI, DNA samples will be taken by Pathology staff, and there will be no separate DNA sampling station in the morgue. ▪ For an intermediate-scale MFI, a separate DNA sampling station may be established at the discretion of the Pathology Team Leader; he or she may opt, however, to simply collect DNA samples at the Pathology station. ▪ For a large-scale MFI, a separate DNA sampling station should be established as the last station of the morgue. 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Page 424 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Autopsy Unit Autopsy Unit Purpose / Mission To perform internal exams on decedents as instructed by the medical examiner for identification purposes and to determine cause and manner of death ▪ ▪ Objectives If ordered by the OCME, perform a thorough internal examination of decedents passing through the disaster morgue and document all findings Conduct MFM tasks in accordance with established forensic standards − Document, record, investigate, recover, and process decedents in a dignified and respectful manner − Accurately determine the cause and manner of death − Perform the accurate and efficient identification of victims − Support judicial, public health, and investigative objectives and requirements Assigned Area Autopsy Station Supervisor Pathology Team Leader Activation Checklist Prior to the commencement of Morgue Operations, the ME will instruct the Deputy FM Branch Director – PM regarding the policy for conducting autopsies. Typically, the autopsy will be conducted at the same location as the external exam in which the operations will be the responsibility of the Pathology Team; however, in certain circumstances the remains will be isolated in a separate area to conduct the internal exam by an Autopsy Unit.  Upon notification, arrive at the disaster morgue location as directed by the Pathology Team Leader.  Check in with the Pathology Team Leader, and receive: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Morgue Operations and Autopsy Unit expectations – Staffing and scheduling information – Receive instruction on policies that will affect the Autopsy Station: – Autopsy Policy  Based on the incident characteristics and the Morgue Operational requirements, determine Autopsy Unit staffing requirements.  Upon arrival at the morgue, meet with the Autopsy Unit members and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the Autopsy Station Area – Autopsy operations, staffing, and schedules – Health and Safety briefing Page 425 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths         – Security briefing – Equipment/supply request procedure – Direct personnel to use their position checklists Assign Autopsy Unit personnel to specific tasks. – Identify one Autopsy Unit staff member to serve as the station scribe. Evaluate the morgue space assigned to the Autopsy Unit and determine if adequate for unit work flow and needs. – If additional facility space is needed, discuss needs with the Pathology Team Leader. Coordinate with the Morgue Support Group and IT Team to deploy Autopsy Station equipment and supplies at the designated location. Set up Autopsy Unit equipment and supplies at the designated location in the morgue facility Test all unit equipment to be sure all is in working order. Provide “Just-in-Time” training to Autopsy Unit members as needed. Identify Autopsy Unit resource needs and communicate all resource requests through the Pathology Team Leader. Notify the Pathology Team Leader when the Autopsy Unit is ready for the commencement of operations. Operational Responsibilities The Autopsy Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Autopsy Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • If indicated by the Pathologist, the case will be transferred to a separate Autopsy Station for internal examination. • When a case enters the Autopsy Station, scan or record the remains tag to ensure that all documentation will be associated with the correct file(s) in UVIS-CMS. • Review external examination documentation from the Pathology Team. • Perform the autopsy/internal examination, which may include (but is not limited to) the following: – Perform the autopsy according to the method determined by the forensic pathologist. – Retain all necessary organ samples. – Collect samples in coordination with the appropriate Unit personnel. ▪ Toxicological Samples: Toxicological Samples should always be taken when an internal exam is performed. ▪ Histological Samples: Stock tissue samples should always be taken when an internal exam is performed. – If additional associated evidence is found, ensure members of the Pathology Evidence Unit collect each item and complete appropriate documentation. – Return all tissues and organs to the body. – Record all autopsy findings in UVIS-CMS. • Order any additional analyses or procedures at any time. General: • Attend all briefings/meetings as coordinated or requested by the Pathology Team Page 426 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • • Leader. Maintain communication with the Pathology Team Leader regarding Autopsy Unit operations. – Report any issues that arise or process alterations needed to meet Autopsy Unit needs. Maintain communications with Autopsy Unit personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Autopsy Unit operational and staff schedule. Ensure all Autopsy Unit personnel check-in and out at the beginning and end of each shift. Ensure all Autopsy Unit personnel are using applicable portions of their position checklists. Prepare and maintain Autopsy Unit records and reports, as appropriate. Provide reports regularly to the Pathology Team Leader, or as requested. Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. – Instruct Autopsy Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Autopsy Unit personnel adhere to PPE requirements. Be aware of Autopsy Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Pathology Team Leader related to the accomplishments/issues encountered during the operational period. Forms / Job Aids • • Pathology – Autopsy Form Activity Log Equipment and Supplies • • • • • • Autopsy tables Autopsy lights Data Management System Autopsy station Specimen containers PPE Pathology equipment cart, tools: Considerations • When possible, the same pathologist performing the external exam on a decedent should also perform the internal exam for that decedent; if the morgue is operating in a DDICP workflow, the internal exam will occur as the very last station in the morgue, and the pathologist performing both the external and internal exams will accompany the remains into the separate autopsy suite. Page 427 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 428 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Fingerprint Unit Fingerprint Unit Purpose / Mission To acquire suitable-quality friction ridge impressions from human remains ▪ ▪ ▪ Objectives ▪ Record as much friction ridge detail as possible from each of the decedent’s hands to maximize potential for effecting an identification Document friction ridge detail via digital photographs and written notes in UVIS-CMS Conduct MFM tasks in accordance with established forensic standards − Document, record, investigate, recover, and process decedents in a dignified and respectful manner − Perform the accurate and efficient means for victim identification − Support judicial, public health, and investigative objectives and requirements Conduct the rapid return of decedents to their legal NOK Assigned Area Fingerprint station Supervisor Pathology Team Leader Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Pathology Team Leader.  Check in with the Pathology Team Leader and receive: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Pathology Team operations – Staffing and scheduling information  Receive instruction on policies that will affect the Fingerprint Station and subsequent stations: – Identification Policy  Based on the incident characteristics and the scale of the Fingerprint Station operations, determine unit staffing requirements.  Notify Fingerprint Unit personnel and provide them with instructions to report to the Disaster Morgue.  Ensure that all Fingerprint Unit personnel have proper credentials to obtain access to the disaster morgue area.  Upon arrival at the morgue, meet with the Fingerprint Unit members and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the Fingerprint Unit Area – Fingerprint Unit operations, staffing, and schedules – Health and Safety briefing – Security briefing Page 429 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths           – Equipment/supply request procedure – Direct personnel to use their position checklists Assign Fingerprint Unit personnel to specific tasks. – Identify one Fingerprint Unit staff member to serve as the station scribe. Coordinate with IT Team to ensure all necessary personnel have access to UVISCMS and that all ancillary items are fully functional (computers, screens, printers, etc.). Evaluate the Fingerprint Station space assigned and determine if adequate for Fingerprint Operations. − If additional facility space is needed, discuss needs with the Pathology Team Leader. Coordinate with Morgue Support Group and IT Team to setup Fingerprint Unit equipment and supplies at the designated location. Set up Fingerprint Station equipment and supplies at the designated location in the morgue facility. Ensure all Fingerprint Unit personnel have access to the Case Management System Test all equipment to be sure all is in working order. Participate in “Just-in-Time” Training opportunities with Pathology Team. Identify station resource needs and communicate all resource requests to Pathology Team Leader for fulfillment by the Morgue Support Group. Notify Pathology Team Leader when the Fingerprint Unit is ready for the commencement of operations. Operational Responsibilities The Fingerprint Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Fingerprint Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • When remains are brought to the Fingerprint station, scan or record the OCME Case Number to ensure that all fingerprint operations are associated with the correct file(s) in UVIS-CMS. • Assess the condition of the friction ridge detail to determine if they are suitable for printing, and document all observations in UVIS-CMS. − Be aware of complicating factors, including: ▪ Decomposition ▪ Adipocerous or water damage ▪ Mummification ▪ Skin slippage ▪ Fire damage • If acquiring friction ridge impressions from the victim is possible, determine the appropriate methodology and procedures to be utilized. • Attempt to acquire suitable quality impressions from the decedent. – Record as much friction ridge detail as possible (i.e., hands and feet) in order to maximize the potential for effecting an identification. • Take appropriate photographs to document the victim’s friction ridge surfaces. • Photographs to be taken: − Establishing shots − Medium-range shots Page 430 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths − − Close-ups Macro (1:1 photographs; life-size reproduction ratio) General: • Attend all briefings/meetings as coordinated or requested by the Pathology Team Leader. • Maintain communication with the Pathology Team Leader regarding Fingerprint Unit operations. – Report any issues that arise or process alterations needed to meet Fingerprint Unit needs. • Maintain communications with Fingerprint Unit personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Fingerprint Unit operational and staff schedule. • Ensure all Fingerprint Unit personnel check-in and out at the beginning and end of each shift. • Ensure all Fingerprint Unit personnel are using applicable portions of their position checklists. • Prepare and maintain Fingerprint Unit records and reports, as appropriate. Provide reports regularly to the Pathology Team Leader, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Fingerprint Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Fingerprint Unit personnel adhere to PPE requirements. • Be aware of Fingerprint Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. • At the end of each operational period, provide a situation report to the Pathology Team Leader related to the accomplishments/issues encountered during the operational period. Forms / Job Aids • • Fingerprint Worksheet Record Form Activity Log Equipment and Supplies • • • • • • One camera and one MC-70, MC-75, or other wireless EDA with the required specifications Fingerprint kits Portable morgue table Data Management System Law Enforcement station Tables and chairs PPE Page 431 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Considerations • • • Numerous civilian and criminal fingerprint databases exist. These databases can be searched for antemortem records to compare with postmortem prints taken in the morgue. When searching these databases for a possible identification, limiting one’s search to certain databases and omitting others may limit one’s potential to get a hit, as the databases are populated with different profiles. Those performing the search will need to be mindful of this issue and take calculated steps to maximize their potential to effect identification. The Fingerprint Unit may use a standard ten-print card to records the friction ridge detail from digits (fingers) or they may opt to use a major case print card, also known as complete friction ridge exemplars. – The latter contains not only the usual ten impressions, but also the friction ridge detail on the palm, writer’s palm (side of the hand) and fingertips. The major case print card is typically used by law enforcement when investigating an incident determined to be criminal in nature. It is recommended that responders treat every MFI as a criminal act until it is proven otherwise. Staff at the Fingerprint station should also be allowed to suggest the use of the major case print card if they feel it would be in the best interest of the investigation or overall operations. Depending on the condition of the remains (i.e., if they are decomposed, exhibit water or fire damage, etc.), alternative techniques may be required acquire suitablequality friction ridge detail sufficient for analysis. – Working with decedents to acquire friction ridge impressions can be challenging. Gently massaging may help to recondition and restore the friction ridges on the hand. In addition, rather than ink and roll one surface at a time, the process may be facilitated with the use of an ink roller to ink multiple areas of friction ridge detail that are of interest and subsequently recorded onto a print card. – If digits cannot be successfully acquired from an intact hand, the Unit may need to consult the pathologist and get his or her permission to disarticulate the finger(s) from the others. – As it can be difficult to roll a decedent’s finger across a print card, a metal postmortem card strip holder (fingerprinting spoon) can be used to facilitate the rolling of the print card over the finger. The print card strip is inserted through the slots in the concave spoon, and the card surface is rolled around the friction ridge detail. – A PVC pipe or other wide cylinder can be used to facilitate rolling handprints onto a major case print card. The print card is fastened to the cylinder using rubber bands. All friction ridge detail should be inked. The whole hand is then printed onto the card, beginning at the base of the palm (near the wrist) and rolling toward the fingertips. Once the palm and all digits have been printed in this fashion, the writer’s palm and the fingertips should then be printed (the card will need to be carefully positioned to capture the fingertips). – If skin slippage is apparent, the layer of skin sloughing off (the epidermis) may be carefully removed. The epidermis will retain the victim’s friction ridges. Once the skin has been removed, the fingerprint technician, wearing fresh latex or nitrile gloves (preferably double-layered), can shape the skin to his or her own finger and roll the print onto a print card. This process is referred to as de-gloving. It is important to note that friction ridge patterns Page 432 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • acquired from de-gloved skin have the potential to vary greatly in size compared to that of normal/ uncompromised friction ridge skin. Thus, it is recommended that if an AFIS search fails to produce any potential candidates, the print should be searched again at 70% of its original size. – If the skin surface is desiccated or the friction ridges, for whatever reason, are no longer suitable for recording, water can be brought to a boil (using an electric kettle, for example) and the friction detail from the dermal layer can be submerged into the boiling water in intervals of around 5-10 seconds; in which the friction ridge detail should be assessed after each submersion to determine the resulting quality. This process elicits thermodynamic and osmotic responses that often result in much pronounced and distinctive friction ridge detail. However this technique should be exercised with caution and considered destructive as prolonged exposure/ submersion in boiling water may irreversibly damage the friction ridges. Additionally, when recording friction ridge detail from the dermal layer it is important to communicate this information to the friction ridge examiner, as the ridges from the dermal layer will appear as “outlines” when compared to that of the same ridges of the epidermal layer. – If postmortem friction ridges are too delicate to handle without further damaging (often observed in cases in which the remains are mummified and/ or subjected to fire); mikrosil casting material can be used to make a mold/ cast of the friction ridge detail and subsequently photographed at a 1:1 reproduction ratio/ magnification. – Other techniques exist for special cases. Upon characterization of the MFI and assessment of the condition of the remains, the Fingerprint Unit Leader should ensure that the Unit is made aware of potential and necessary techniques for use in the disaster morgue. The comparison of postmortem and antemortem fingerprint records within UVISCMS may occur at the Fingerprint Station, by the Antemortem Fingerprint Records Team or by a separate DVI Reconciliation Team assigned to a separate location. All potential identifications by comparison of fingerprint records will require confirmation by the Identification Review Committee. Page 433 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 434 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Forensic Odontology Unit Forensic Odontology Unit Purpose / Mission To collect, radiograph, and analyze postmortem dental evidence that will be compared to antemortem dental records in order to identify disaster victims ▪ ▪ Objectives Gather postmortem dental data by thoroughly examining, charting, photographing, and radiographing all specimens that enter the Forensic Odontology station in the disaster morgue Conduct MFM tasks in accordance with established forensic standards − Document, record, investigate, recover, and process decedents in a dignified and respectful manner − Perform the accurate and efficient identification of victims − Conduct the rapid return of decedents to their legal NOK Assigned Area Forensic Odontology station Supervisor Pathology Team Leader Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Pathology Team Leader.  Check in with the Pathology Team Leader and receive: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Pathology Team operations and Forensic Odontology Unit expectations – Staffing and scheduling information  Receive instruction on policies that will affect the Forensic Odontology Station and subsequent stations: – Identification Policy  Based on the incident characteristics and the scale of the Pathology Station Operations, determine Forensic Odontology Unit staffing requirements.  Notify Forensic Odontology Unit personnel and provide them with instructions to report to the Disaster Morgue.  Ensure that all Forensic Odontology Unit personnel have proper credentials to obtain access to the disaster morgue area.  Upon arrival at the morgue, meet with the Forensic Odontology Unit members and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the Forensic Odontology Station Area – Dental operations, staffing, and schedules – Health and Safety briefing – Security briefing – Equipment/supply request procedure – Direct personnel to use their position checklists Page 435 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Assign Forensic Odontology Unit personnel to specific tasks. – Identify one Forensic Odontology Unit staff member to serve as the station scribe.  Coordinate with IT Team to ensure all necessary personnel have access to UVISCMS and that all ancillary items are fully functional (computers, screens, printers, etc.).  Evaluate the Forensic Odontology Station space assigned to the Forensic Odontology Unit and determine if adequate for operations. – If additional facility space is needed, discuss needs with the Pathology Team Leader.  Coordinate with Morgue Support Group and IT Team to setup Forensic Odontology Station equipment and supplies at the designated location.  Set up Forensic Odontology Station equipment and supplies at the designated location in the morgue facility.  Ensure all Forensic Odontology Unit personnel have access to UVIS-CMS.  Test all unit equipment to be sure all is in working order.  Provide “Just-in-Time” training to unit staff as needed.  Identify Forensic Odontology Station resource needs and communicate all resource requests to the Pathology Team Leader for fulfillment by the Morgue Support Group.  Notify the Pathology Team Leader when the Forensic Odontology Unit is ready for the commencement of operations. Operational Responsibilities The Forensic Odontology Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Forensic Odontology Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • When remains are brought to the Forensic Odontology Station, scan or record the specimen barcode to call up the specimen file in UVIS-CMS. • Perform the dental examination; chart all observations in UVIS-CMS or UDIM. − Visual Examination and Charting: ▪ All dental information will be recorded directly in standard format and nomenclature. ▪ Photographic documentation must be taken of all dentition. − Radiographic Examination: ▪ A complete radiographic survey of the remains should be recorded using an intraoral sensor and software (e.g., DEXIS). ▪ All radiographs should be saved utilizing the OCME case number as the label and then uploaded to the appropriate location. ▪ Once loaded in UVIS-CMS, the Unit should verify that the images are assigned to the correct record. − If necessary, create dental models to assist in the identification of a decedent. ▪ If using this method, standard impression materials will be used (follow manufacturer’s instructions) and universal infectious control procedures will be followed. • If applicable, compare antemortem and postmortem dental records within UVIS-CMS at the Forensic Odontology morgue station. This comparison may also be performed by forensic odontologists assigned to a separate location to aid the DVI Team in Page 436 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • antemortem and postmortem comparison. Ensure consensus among the Forensic Odontology Unit before submitting any potential dental identification for DVI review. General: • Attend all briefings/meetings as coordinated or requested by the Pathology Team Leader. • Maintain communication with the Pathology Team Leader regarding Forensic Odontology Unit operations. – Report any issues that arise or process alterations needed to meet Forensic Odontology Unit needs. • Maintain communications with Forensic Odontology Unit personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Forensic Odontology Unit operational and staff schedule. • Ensure all Forensic Odontology Unit personnel check-in and out at the beginning and end of each shift. • Ensure all Forensic Odontology Unit personnel are using applicable portions of their position checklists. • Prepare and maintain Forensic Odontology Unit records and reports, as appropriate. Provide reports regularly to the Pathology Team Leader, or as requested. • Monitor use of supplies and notify Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Forensic Odontology Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Forensic Odontology Unit personnel adhere to PPE requirements. • Be aware of Forensic Odontology Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. • At the end of each operational period, provide a situation report to the Pathology Team Leader related to the accomplishments/issues encountered during the operational period. Forms / Job Aids • • Activity Log X–ray Dental Form Equipment and Supplies • • • • • • • One camera and one MC-70, MC-75, or other wireless EDA with the required specifications Portable morgue table Case Management System Dental station Dental morgue cart with Complete Forensic Odontology instrumentation kit Aribex NOMAD (handheld X-Ray System for Dental Applications); Extra battery pack DEXIS digital X-ray hardware (sensor and components) and software Dental radiographic “lead shielding” and portable partitions Page 437 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • Dental impression materials (if necessary) Radiographic flatbed scanner PPE Considerations • • • • • It should be kept in mind that the Forensic Odontology Unit in the morgue represents just one function of the forensic odontologists who work in MFM operations. Forensic odontologists also work in the Victim Identification Center (VIC) within the Family Assistance Center (FAC) to gather antemortem dental records for the individuals on the manifest and to compare antemortem and postmortem data to make victim identifications. This document focuses solely on the role of the forensic odontology staff within the disaster morgue. The charting, radiographing, and comparison processes at the Forensic Odontology station may be complicated by the condition of the remains (e.g., remains that are macerated, fragmented, badly burned, or decomposed); special precautions may need to be taken or special methods applied. Certain identification features may prove inaccessible without facial dissection or jaw resection. These procedures may be performed only with permission. Personnel safety is a high priority. When using any device to capture radiographs, staff must be sure to follow all safety instructions so as to limit the risk of exposure to radiation. The comparison of postmortem and antemortem dental records within UVIS-CMS may occur at the Forensic Odontology Station, by the Antemortem Dental Records Team or by a separate DVI Reconciliation Team assigned to a separate location. All potential identifications by comparison of dental records will require confirmation by the Identification Review Committee. Page 438 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths DNA Unit DNA Unit Purpose / Mission To collect the best quality DNA samples possible from all remains in the disaster morgue in an effort to make scientific identifications of victims • • Objectives Obtain and appropriately store as many DNA samples as possible from all remains for further testing Conduct MFM tasks in accordance with established forensic standards – Document, record, investigate, recover, and process decedents in a dignified and respectful manner – Perform the accurate and efficient identification of victims – Support judicial, public health, and investigative objectives and requirements • Conduct the rapid return of decedents to their legal NOK Assigned Area DNA Sampling Station Supervisor Pathology Team Leader Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Pathology Team Leader.  Check in with the Pathology Team Leader and receive: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Pathology Team operations and DNA Unit expectations – Staffing and scheduling information  Receive instruction on policies that will affect the DNA Station and subsequent stations: – Identification Policy  Based on the incident characteristics and the scale of the Pathology Station Operations, determine DNA Unit staffing requirements.  Notify DNA Unit personnel and provide them with instructions to report to the Disaster Morgue.  Ensure that all DNA Unit personnel have proper credentials to obtain access to the disaster morgue area.  Upon arrival at the morgue, meet with the DNA Unit members and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the DNA Station Area – DNA operations, staffing, and schedules – Health and Safety briefing – Security briefing – Equipment/supply request procedure Page 439 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – Direct personnel to use their position checklists  Assign DNA Unit personnel to specific tasks. – Identify one DNA Unit staff member to serve as the station scribe.  Evaluate the DNA Station space assigned to the DNA Unit and determine if adequate for DNA Operational needs. – If additional facility space is needed, discuss needs with the Pathology Team Leader.  Coordinate with Morgue Support Group and IT Team to deploy DNA Station equipment and supplies at the designated location.  Set up DNA Station equipment and supplies at the designated location in the morgue facility.  Ensure all DNA Unit personnel have access to UVIS-CMS.  Test all unit equipment to be sure all is in working order.  Provide “Just-in-Time” training to unit staff as needed.  Identify DNA Station resource needs and communicate all resource requests to the Pathology Team Leader for fulfillment by the Support Group.  Notify the Pathology Team Leader when the DNA Unit is ready for the commencement of operations. Operational Responsibilities The DNA Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The DNA Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • When remains are brought to the DNA Sampling station, scan or record the specimen barcode to call up the correct specimen file in UVIS-CMS. • Assess the remains and determine what sample(s) will be the most likely to yield results. • Ensure that a DNA Unit member photographically documents all materials to be sampled and all samples before, during, and after the sampling process. • Collect all of the following, if applicable and possible (Aim to collect seven to ten grams per sample. Four grams may suffice, but extra material should be taken to account for the potential need for further testing): − A buccal swab − A deep muscle tissue sample − A bone sample − A bladder swap (in particular cases) • If the blood is in adequate sampling condition, collect a blood sample; however, a blood sample may be taken at the Pathology station. • Collect a tooth sample, if applicable. • Log all samples in UVIS-CMS. • Package all samples appropriately. ▪ Label each sample with a barcode or label bearing the appropriate OCME case number. ▪ Package samples appropriately for transfer to laboratory for testing. − Coordinate with the Pathology Evidence Unit to ship the packages to the appropriate laboratory and to maintain chain-of-custody of samples. Page 440 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths General: • Attend all briefings/meetings as coordinated or requested by the Pathology Team Leader. • Maintain communication with the Pathology Team Leader regarding DNA Unit operations. – Report any issues that arise or process alterations needed to meet DNA Unit needs. • Maintain communications with DNA Unit personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the DNA Unit operational and staff schedule. • Ensure all DNA Unit personnel check-in and out at the beginning and end of each shift. • Ensure all DNA Unit personnel are using applicable portions of the FOG and their position checklists. • Prepare and maintain DNA Unit records and reports, as appropriate. Provide reports regularly to the Pathology Team Leader, or as requested. • Monitor use of supplies and notify Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct DNA Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all DNA Unit personnel adhere to PPE requirements. • Be aware of DNA Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Morgue Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. • At the end of each operational period, provide a situation report to the Pathology Team Leader related to the accomplishments/issues encountered during the operational period. Forms / Job Aids • • Forensic Biology – DNA Worksheet and Record Activity Log Equipment and Supplies • • • • • One camera and one MC-70, MC-75, or other wireless EDA with the required specifications Portable morgue table Case Management System DNA station DNA Sampling supplies: – Buccal swabs – Storage envelopes for buccal swabs – Specimen cups – Falcon tubes (50 ml) DNA Sampling Tools: – Scalpels – Forceps – Dremel cutting wheels Page 441 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • – Autopsy saw blades – Autopsy saw and/or Dremel saw and replacements parts The tools used at the DNA station should be disposable (i.e., disposable scalpel and saw blades) if at all possible. If such tools will not be available, the DNA Unit must have the following to clean all tools between decedents: – 10% bleach – Ethanol – Water PPE Considerations • • • • • • It should be kept in mind that the DNA Unit in the morgue represents just one function of the of DNA operations within MFM operations. DNA personnel also work in the Victim Identification Center (VIC) within the Family Assistance Center (FAC) to gather antemortem DNA samples and references for the individuals on the manifest and to compare antemortem and postmortem data to make victim identifications. This document focuses solely on the role of the DNA staff within the disaster morgue. DNA Sampling Unit members should be cognizant of the conditions of the DNA samples collected. Analysts can often tell by the appearance and odor of the tissue whether or not it will likely yield results. Bone samples will take far longer than blood or buccal samples to process in the laboratory (bone can take two to three days to obtain a DNA extract for testing, whereas blood or buccal samples can yield an extract for testing in a matter of hours). This fact should be taken into consideration when sampling; nevertheless, all available samples should be collected. In sampling bone, cortical bone is optimal (as opposed to trabecular bone), but the DNA Sampling unit should collect whatever samples are available. Teeth should only be sampled if necessary. This is usually only done if the teeth are the only samples recovered (i.e., intact in a mandible), and the decision to collect a tooth sample is dependent on the condition of the tooth. If a tooth sample is the only sample that can be recovered, unrestored teeth with roots are preferable. The sample(s) should have been examined previously by a forensic odontologist at the Forensic Odontology station, and radiographs and photographs of the tooth should have been taken. DNA testing can destroy the morphology of the tooth, and the tooth may be consumed in DNA testing; therefore, ensure that the tooth has been well documented prior to DNA sampling. The comparison of postmortem and antemortem DNA records within UVIS-CMS may occur at the Morgue DNA Station, by the Antemortem DNA Team or by a separate DVI Reconciliation Team assigned to a separate location. All potential identifications by comparison of DNA records will require confirmation by the Identification Review Committee. Page 442 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Pathology Photography Unit Pathology Photography Unit Purpose / Mission To objectively and thoroughly document the passage of all remains at the Pathology Station of the disaster morgue ▪ ▪ ▪ Objectives ▪ Document all exams and procedures performed on all remains at each station of the disaster morgue, from Triage through DNA (with the exception of Forensic Radiology) Transfer photos immediately (transfer will preferably be automatic) to the appropriate case file so that they may be used immediately by anyone accessing the file in UVIS-CMS Ensure that photographs are accompanied by appropriate written documentation in a photo log Conduct MFM tasks in accordance with established forensic standards – Document, record, investigate, recover, and process decedents in a dignified and respectful manner – Support judicial, public health, and investigative objectives and requirements Assigned Area Pathology team stations, as needed and assigned Supervisor Pathology Team Leader Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Pathology Team Leader.  Check in with the Pathology Team Leader and receive: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Pathology Team operations − Staffing and scheduling information  Based on the incident characteristics and the scale of the Pathology Station operations, determine the Pathology Photography Unit staffing needs.  Notify Pathology Photography Unit personnel and provide them with instructions to report to the Disaster Morgue.  Ensure that all Pathology Photography Unit personnel have proper credentials to obtain access to the disaster morgue area.  Upon arrival at the morgue, meet with the Pathology Photography Unit members and brief them on the following items: − Incident Characterization and Situational Awareness − Layout of the Pathology Area − Pathology Photography operations, staffing, and schedules − Health and Safety briefing − Security briefing − Equipment/supply request procedure − Direct personnel to use their position checklists  Assign Pathology Photography Unit personnel to specific tasks. Page 443 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths −         Identify one Pathology Photography Unit staff member to serve as the station scribe. Evaluate the Pathology Station space assigned to Photography Operations and determine if adequate for the Pathology Photography operational needs. − If additional facility space is needed, discuss needs with the Pathology Team Leader. Coordinate with Support Group and IT Team to setup Pathology Photography Unit equipment and supplies at the designated location Set up Pathology Photography station equipment and supplies at the designated location in the morgue facility. Ensure all Pathology Photography Unit personnel have access to UVIS-CMS. Test all equipment to be sure all is in working order. Participate in “Just-in-Time” Training opportunities with Pathology Team. Identify station resource needs and communicate all resource requests to Pathology Team Leader for fulfillment by the Support Group. Notify Pathology Team Leader when you are ready for the commencement of operations. Operational Responsibilities The Pathology Photography Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated for each case. The Pathology Photography Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • When remains enter the Pathology station, scan the specimen barcode with the MC70. Doing so will call up the UVIS-CMS case file so that all subsequent photos (until the next barcode is scanned) will be uploaded to the appropriate file. • Include a scale bearing the remains’ ME case number in every photograph. – Note: All shots in the photo log. Include the photo number, the ME case number, the time the photo was taken, and a brief description of the shot. • Photograph all evidence or personal effects (PE) removed from the remains by the Pathology Team and given to the Evidence Unit for vouchering. These items should be photographed against the center of a piece of neutral-colored paper. Photographer should ensure that the item is placed on the paper such that no splashing fluids stain the paper surface surrounding the item. • Take overall photographs of the body, including: – Lateral views, both sides of the head, trunk, and legs; – Anterior views of the head, trunk, and legs (anterior shots of the face are especially important); and, – Posterior views of the head, trunk, and legs. • Take overall photographs of the body after the body and table have been thoroughly cleaned and dried. • Photograph any individualizing features and/or injuries present. – Show the location of the feature or injury (by establishing shots and mediumrange shots) before taking close-up views. – Ensure that there is an anatomical landmark in the frame so that each injury can be properly placed when images are reviewed. – If photographing any organs, bullets, or other evidence/objects outside the body, place the object on a neutral-colored background. Page 444 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Capture any other images as ordered by the Pathology Team. General: • Attend all briefings/meetings as coordinated or requested by the Pathology Team Leader. • Maintain communication with the Pathology Team Leader regarding Pathology Photography Unit operations. – Report any issues that arise or process alterations needed to meet Pathology Photography Unit needs. • Maintain communications with Pathology Photography Unit personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Pathology Photography Unit operational and staff schedule. • Ensure all Pathology Photography Unit personnel check-in and out at the beginning and end of each shift. • Ensure all Pathology Photography Unit personnel are using applicable portions of their position checklists. • Prepare and maintain Pathology Photography Unit records and reports, as appropriate. Provide reports regularly to the Pathology Team Leader, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Pathology Photography Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Pathology Photography Unit personnel adhere to PPE requirements. • Be aware of Pathology Photography Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Morgue Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. • At the end of each operational period, provide a situation report to the Pathology Team Leader related to the accomplishments/issues encountered during the operational period. Forms / Job Aids • • Photo Log Activity Log Equipment and Supplies • • • • • • • One camera per Pathology Station Spare batteries for each camera Battery charger for each camera Additional memory card / storage for photography files Flash with batteries for each camera Photo log materials Adhesive scales to which specimen barcode label is printed/affixed Page 445 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • Neutral-colored background for photographing objects removed from the body PPE Considerations • All photographers in the morgue should ideally have morgue photography experience. Settings • Aperture: The photographer will want to capture as much depth of field as possible. To maximize depth of field, the camera should be set on an aperture setting of F8 or higher. • Flash: Flash (particularly balance fill flash) should be used; built-in flash is not recommended, but will be a better option than photographing items with no flash whatsoever. • Shutter speed: Shutter speed should not be set below 1/60 of a second. • ISO: Low ISO settings (typically 100) should be used; higher settings will render a grainy image. Practices • Digital cameras should be used, as they offer far more in capabilities and usability than do film cameras. • In establishing or medium-range shots, the scale and label should be placed at the bottom of the frame. When taking close-ups, however, the scale and label should be placed on the side of the frame nearest the decedent’s feet. This practice will help to orient the viewer. • Unless a decedent needs to be photographed as received, the body should be cleaned of all bodily fluids, dirt, debris, etc., and thoroughly dried before photos are taken. Dirt and blood can obscure injuries and may become distracting to those viewing the images; the body and autopsy table must be completely dry to avoid flash reflecting off any wet surfaces. Although some photographers may help with light clean-up to get the best photograph, Photography Unit members are not obligated to clean, dry, or move the bodies. • In addition to cleaning the body, the autopsy table needs to be cleared of all tools, hoses, and bags, cleaned, and thoroughly dried prior to taking any photographs. • Other individuals working alongside the photographer at a given station should avoid being in the frame. • If the photographer requires assistance setting up a shot (e.g., needs someone to hold a case label or stabilize an appendage); the photographer may ask an autopsy technician or other station staff member to assist. • Where applicable and possible, photographs should be taken at an angle perpendicular to the surface on which the body rests. • All disaster morgue images should exist in multiple locations for backup purposes: − They should remain on the camera’s memory card and be either: o Burned to a disc and retained in a physical file o Saved to a hard drive location − Images will be uploaded to and saved in the appropriate file. • No photographs should be deleted. If any are deleted, accidentally or otherwise, this should be documented in the photo log. • The forensic photographer should maintain a photo log throughout disaster morgue Page 446 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • operations. The log will be particularly useful when photographing more than one specimen at a time (to avoid losing time switching between ME case numbers, the photographer may capture all images, documenting to which file each belongs, and reconcile the images and their appropriate case numbers later). It will also be useful when many close-up shots will be taken in rapid succession. A viewer may be unable to recognize the subject of the photographs without some context information. The log is also important for documenting when and why any photographs have been deleted. As it is considered best practice not to delete any photos taken in the disaster morgue, any deletions, accidental or otherwise, should be noted in detail at the time of their deletion. No photographs should be taken in the disaster morgue unless by the Photography staff or by trained personnel. No candid photographs should be taken in the disaster morgue from the commencement to the conclusion of operations, unless they are taken for the purpose of documenting morgue operations. The forensic station personnel may choose to take photographs at their respective stations, i.e. DNA, Dental, etc. All photography should be coordinated by the Pathology Photography Lead. Each photographer, or personnel taking photographs, must maintain a photo log to ensure the photos are correctly associated with the appropriate case. 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Page 448 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Pathology Evidence Unit Pathology Evidence Unit Purpose / Mission To receive, voucher, and secure all associated evidence and personal effects (PE) found in the human remains pouch at the Pathology Station and maintain chain-of-custody of evidentiary items throughout the morgue operations ▪ ▪ Objectives ▪ Ensure associated evidentiary items and personnel effects are properly collected, documented, packaged, vouchered, and secured Ensure items are released to the appropriate authorities or agencies for analysis or returned to next of kin (NOK) Maintain chain-of-custody of items from accession to final disposition Assigned Area Pathology Station Supervisor Pathology Team Leader Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Pathology Team Leader.  Check in with the Pathology Team Leader and receive: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Pathology Team operations − Staffing and scheduling information  Based on the incident characteristics and the scale of the Pathology Station operations, determine the Pathology Evidence Unit staffing needs.  Based on the incident characterization, coordinate with the local law enforcement and/or investigative authorities to determine evidence protocols specific to the incident.  Notify Pathology Evidence Unit personnel and provide them with instructions to report to the Disaster Morgue.  Ensure that all Pathology Evidence Unit personnel have proper credentials to obtain access to the disaster morgue area.  Upon arrival at the morgue, meet with the Pathology Evidence Unit members and brief them on the following items: − Incident Characterization and Situational Awareness − Layout of the Pathology Evidence Area − Pathology Evidence operations, staffing, and schedules − Health and Safety briefing − Security briefing − Equipment/supply request procedure − Direct personnel to use their position checklists  Assign Pathology Evidence Unit personnel to specific tasks. − Identify one Pathology Evidence Unit staff member to serve as the station scribe. Page 449 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Coordinate with IT Team to ensure all necessary personnel have access to UVISCMS and that all ancillary items are fully functional (computers, screens, printers, etc.).  Evaluate the Pathology Station space assigned to Evidence Operations and determine if adequate for the Pathology Evidence operational needs. − If additional facility space is needed, discuss needs with the Pathology Team Leader.  Coordinate with Support Group and IT Team to setup Pathology Evidence Unit equipment and supplies at the designated location.  Set up Pathology Evidence station equipment and supplies at the designated location in the morgue facility.  Ensure all Pathology Evidence Unit personnel have access to UVIS-CMS and/or any Evidence Tracking System being utilized.  Test all equipment to be sure all is in working order.  Participate in “Just-in-Time” Training opportunities with Pathology Team.  Identify station resource needs and communicate all resource requests to Pathology Team Leader for fulfillment by the Support Group.  Notify Pathology Team Leader when you are ready for the commencement of operations. Operational Responsibilities The Pathology Evidence Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. Pathology Evidence Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • When a case is brought to the Pathology station, the Pathology Team will scan or record the OCME Case Number to ensure that all Pathology examinations/operations are associated with the correct file(s) in the Case Management System. • The Pathology Team will collect all evidence or personal effects (PE) that are associated with the remains (that is, they are spatially associated with the remains) and transfer them to the Pathology Evidence Unit. • Ensure that the Pathology Photography Unit thoroughly photographs all items removed. • Voucher all items properly, in accordance with law enforcement requirements, such that a record of the item exists for the OCME office and another exists for law enforcement. • Categorize materials as one of the following: General, Clothing, Personal Effects, Identification Papers/Materials. • Record a detailed description in UVIS-CMS according to the descriptions made by the Pathology Team. Descriptions must be consistent in the terminology used and the level of detail recorded. • Maintain chain-of-custody of all items collected and documented. Release all items, after all items are documented, via photography and written notation, and vouchered appropriately. o Note: Items may be released to appropriate law enforcement representatives or other agency for analysis or secure storage. They may also be released to NOK when appropriate Page 450 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths General: • Attend all briefings/meetings as coordinated or requested by the Pathology Team Leader. • Maintain communication with the Pathology Team Leader regarding Pathology Evidence Unit operations. – Report any issues that arise or process alterations needed to meet Pathology Evidence Unit needs. • Maintain communications with Pathology Evidence Unit personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Pathology Evidence Unit operational and staff schedule. • Ensure all Pathology Evidence Unit personnel check-in and out at the beginning and end of each shift. • Ensure all Pathology Evidence Unit personnel are using applicable portions of their position checklists. • Prepare and maintain Pathology Evidence Unit records and reports, as appropriate. Provide reports regularly to the Pathology Team Leader, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Pathology Evidence Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Pathology Evidence Unit personnel adhere to PPE requirements. • Be aware of Pathology Evidence Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • Coordinate with Morgue Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. • At the end of each operational period, provide a situation report to the Pathology Team Leader related to the accomplishments/issues encountered during the operational period. Forms / Job Aids • • Evidence – Log Sheet and Record Form Activity Log Equipment and Supplies • • • • Pathology Evidence Station and ancillary IT equipment Secure storage Containers for evidence Plastic evidence bags (preferably tamper-evident) Evidence tape Considerations • • Item descriptions should be thorough and detailed. – Poor example: “One (1) ring”. – Good example: “One (1) yellow metal ring with white stone and ’01.01.01 forever’ engraved on inner surface”. Item descriptions must also be consistent and preferably standardized so that they can be searchable. – Prior to the commencement of operations, it would be advisable for all Page 451 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • Pathology Evidence Unit members to be made aware of what terminology will be used in the disaster morgue for this specific incident. Both the Triage Evidence Unit and the Pathology Evidence Unit should be in agreement regarding the terminology to be used. Any items found believed to have evidentiary purpose should be reported to the law enforcement and/or investigative authority. These materials will be photographed, documented and packaged prior to properly transferring the items to partner agencies. To release evidence to NOK: – Evidence staff will release PE to the NOK after a written request has been received and reviewed by the OCME’s legal department. – Evidence staff will release evidentiary items to the appropriate law enforcement agency. Law enforcement will be responsible for releasing any evidentiary items to NOK. Valid contact information must be obtained for all individuals, departments, and agencies involved with evidence collection. If multiple agencies are involved and evidence is released to multiple locations, it is imperative that all involved in the response be able to contact those having evidence or PE in their custody. Page 452 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Anthropology Unit Anthropology Unit Purpose / Mission To augment the analysis of human remains at Pathology by providing focused and comprehensive forensic anthropological documentation of human remains processed in the disaster morgue ▪ Assess the remains and provide the pathologist a biological profile, comprising estimations of the decedent’s sex, age at death, ancestry, and stature, as appropriate Identify and document any individualizing characteristics that may aid in the decedent identification process, including surgical hardware or prosthetic devices Objectives ▪ Assigned Area Anthropology Station Supervisor Pathology Team Leader Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Pathology Team Leader.  Check in with the Pathology Team Leader and receive: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Anthropology Unit operations − Staffing and scheduling information  Based on the incident characteristics and the scale of the Pathology Station operations, determine the Anthropology Unit staffing needs.  Notify Anthropology Unit personnel and provide them with instructions to report to the Disaster Morgue.  Ensure that all Anthropology Unit personnel have proper credentials to obtain access to the disaster morgue area.  Upon arrival at the morgue, meet with the Anthropology Unit members and brief them on the following items: − Incident Characterization and Situational Awareness − Layout of the Pathology Evidence Area − Anthropology operations, staffing, and schedules − Health and Safety briefing − Security briefing − Equipment/supply request procedure − Direct personnel to use their position checklists  Assign Anthropology Unit personnel to specific tasks. − Identify one Anthropology Unit staff member to serve as the station scribe.  Coordinate with IT Team to ensure all necessary personnel have access to UVISCMS and that all ancillary items are fully functional.  Evaluate the Anthropology Station space assigned to Anthropology Operations and determine if adequate for the operational needs. − If additional facility space is needed, discuss needs with the Pathology Team Page 453 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Leader.  Coordinate with Support Group and IT Team to setup Anthropology Unit equipment and supplies at the designated location.  Set up Anthropology Unit equipment and supplies at the designated location in the morgue facility.  Ensure all Anthropology Unit personnel have access to UVIS-CMS.  Test all equipment to be sure all is in working order.  Participate in “Just-in-Time” Training opportunities with Pathology Team.  Identify station resource needs and communicate all resource requests to Pathology Team Leader for fulfillment by the Support Group.  Notify Pathology Team Leader when you are ready for the commencement of operations. Operational Responsibilities The Anthropology Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Anthropology Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • When the Anthropology Unit has been asked to consult on a case at Pathology, scan the OCME Case Number in the Anthropology module of the UVIS-CMS station to call up the correct case file. • Assess the remains themselves and the radiographs of the remains. • Coordinate with the Pathology Forensic Photography unit to capture additional photographs, if needed. • Based on the assessment of the remains and radiographs, complete the following: − Evaluate and document the condition of the remains, describing the anatomical features present. − Compile a biological profile of the decedent, including estimations of the individual’s sex, age at death, ancestry, and forensic stature. • Evaluate any evidence of trauma in order to distinguish between antemortem, perimortem, and postmortem insults to the remains. • Identify any evidence of pathology, as it may be matched to antemortem medical records. • Identify any other individualizing features present, including surgical hardware or prosthetic devices (which may bear serial or lot numbers, or other manufacturer information, which can help to lead the DVI team to identification). • Thoroughly document all findings in UVIS-CMS. Consistency and standardization of terminology is crucial, as numerous entities of diverse backgrounds will review this information. • Complete the following (upon specific request): − Assist in taking radiographs (to ensure proper alignment of the specimen). − Obtain DNA Samples from bone in coordination with the DNA Unit. − Interpret trauma in consultation with Pathology Team. General: • Attend all briefings/meetings as coordinated or requested by the Pathology Team Leader. • Maintain communication with the Pathology Team Leader regarding Anthropology Page 454 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • operations. – Report any issues that arise or process alterations needed to meet Anthropology needs. Maintain communications with Anthropology Unit personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Anthropology Unit operational and staff schedule. Ensure all Anthropology Unit personnel check-in and out each shift Ensure all Anthropology Unit personnel are using applicable portions of their position checklists. Prepare and maintain Anthropology Unit records and reports, as appropriate. Provide reports regularly to the Pathology Team Leader, or as requested. Monitor use of supplies and notify Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols – Instruct Anthropology Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Anthropology Unit personnel adhere to PPE requirements. Be aware of Anthropology Unit personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Pathology Team Leader related to the accomplishments/issues encountered during the operational period. Forms / Job Aids • • Forensic Anthropology Worksheet and Record Form Activity Log Equipment and Supplies • • • • • • One camera and one MC-70, MC-75, or other wireless EDA with the required specifications Data Management System for Anthropology station PPE Tools Tables Chairs Considerations • • • Failing to distinguish between trauma inflicted before, during, and after the MFI can result in skewed interpretations of the cause of death and of the character of the incident itself. The circumstances of the incident and the incident response, as well as the condition of the remains, may dictate the extent to which an anthropological examination will be possible and/or useful. Certain analyses may be performed on dental evidence; the Anthropology Unit may choose to work with the Forensic Odontology Unit when analyzing dentition. Page 455 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 456 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Histology Unit Histology Unit Purpose / Mission To collect histology samples when instructed by the Pathology Team and transport to the Forensic Histology Laboratory for future analytical testing ▪ Objectives Conduct analytical testing as requested by respective pathology in order to assist in the determination of cause and/or manner of death Assigned Area Pathology Station / Forensic Histology Laboratory Supervisor Pathology Team Leader Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Pathology Team Leader.  Check in with the Pathology Team Leader and receive: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Histology Unit operations − Staffing and scheduling information  Based on the incident characterization and the scale of the Pathology Station Operations, determine the Histology Unit staffing needs.  Notify Histology Unit personnel and provide them with instructions to report to the Disaster Morgue.  Ensure that all Histology Unit personnel have proper credentials to obtain access to the disaster morgue area.  Upon arrival at the morgue, meet with the Histology Unit and brief them on the following items: − Incident Characterization and Situational Awareness − Layout of the Triage Evidence Area − Triage Evidence operations, staffing, and schedules − Health and Safety briefing − Security briefing − Equipment/supply request procedure − Direct personnel to use their position checklists  Assign Histology Unit personnel to specific tasks. − Identify one Histology Unit staff member to serve as the station scribe.  Coordinate with IT Team to ensure all necessary personnel have access to UVISCMS and that all ancillary items are fully functional (computers, screens, printers, etc.).  Evaluate the space at the Pathology Station assigned to Histology operations and determine if adequate for the Histology workflow and needs. − If additional facility space is needed, discuss needs with the Pathology Team Leader.  Coordinate with Support Group and IT Team to setup Histology Unit equipment and supplies at the designated location. Page 457 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Set up Histology Unit equipment and supplies at the designated location in the morgue facility.  Ensure all Histology Unit personnel have access to UVIS-CMS.  Test all unit equipment to be sure all is in working order.  Provide “Just-in-Time” Training opportunities with the Pathology Team.  Identify Histology Unit resource needs and communicate all resource requests through the Pathology Team Leader to the Support Group Supervisor.  Notify the Pathology Team Leader when the Histology Unit is ready for the commencement of operations. Operational Responsibilities The Histology Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Histology Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: ▪ When a body bag enters the Pathology station, the Pathology Team will scan or record the OCME Case Number to ensure that all Pathology operations are associated with the correct file(s) in UVIS-CMS. ▪ As directed by the Pathologist, take appropriate histological samples. ▪ Document samples taken in UVIS-CMS. ▪ Label all samples with the OCME case number. ▪ Package samples appropriately for transfer to Forensic Histology Laboratory. – Coordinate with the Pathology Evidence Unit to ship the packages to the Forensic Histology Laboratory and to maintain chain-of-custody of samples. General: • Attend all briefings/meetings as coordinated or requested by the Pathology Team Leader. • Maintain communication with the Pathology Team Leader regarding Histology Unit operations. – Report any issues that arise or process alterations needed to meet Histology Unit needs. • Maintain communications with Histology Unit personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Histology Unit operational and staff schedule • Ensure all Histology Unit personnel check-in and out at the beginning and end of each shift. • Ensure all Histology Unit personnel are using applicable portions of their position checklists. • Prepare and maintain Histology Unit records and reports, as appropriate. Provide reports regularly to the Pathology Team Leader, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Histology Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Histology Unit personnel adhere to PPE requirements. • Be aware of Histology Unit personnel well-being and maintain communication with Page 458 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Pathology Team Leader related to the accomplishments/issues encountered during the operational period. Page 459 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 460 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Toxicology Unit Toxicology Unit Purpose / Mission To collect toxicology samples when instructed by the Pathology Team and transport to the Forensic Toxicology Laboratory for future analytical testing. ▪ Objectives Conduct analytical testing as requested by respective pathologist in order to assist in the determination of cause and/or manner of death Assigned Area Pathology Station / Forensic Toxicology Laboratory Supervisor Pathology Team Leader Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Pathology Team Leader.  Check in with the Pathology Team Leader and receive: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Toxicology Unit operations – Staffing and scheduling information  Based on the incident characterization and the scale of the Pathology Station Operations, determine the Toxicology Unit staffing needs.  Notify Toxicology Unit personnel and provide them with instructions to report to the Disaster Morgue.  Ensure that all Toxicology Unit personnel have proper credentials to obtain access to the disaster morgue area.  Upon arrival at the morgue, meet with the Toxicology Unit and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the Triage Evidence Area – Triage Evidence operations, staffing, and schedules – Health and Safety briefing – Security briefing – Equipment/supply request procedure – Direct personnel to use their position checklists  Assign Toxicology Unit personnel to specific tasks. – Identify one Toxicology Unit staff member to serve as the station scribe.  Coordinate with IT Team to ensure all necessary personnel have access to UVISCMS and that all ancillary items are fully functional (computers, screens, printers, etc.).  Evaluate the space at the Pathology Station assigned to Toxicology operations and determine if adequate for the Toxicology workflow and needs. – If additional facility space is needed, discuss needs with the Pathology Team Leader.  Coordinate with Morgue Support Group and IT Team to setup Toxicology Unit equipment and supplies at the designated location. Page 461 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Set up Toxicology Unit equipment and supplies at the designated location in the morgue facility.  Ensure all Toxicology Unit personnel have access to UVIS-CMS  Test all unit equipment to be sure all is in working order.  Provide “Just-in-Time” Training opportunities with the Pathology Team.  Identify Toxicology Unit resource needs and communicate all resource requests through the Pathology Team Leader to the Support Group Supervisor.  Notify the Pathology Team Leader when the Toxicology Unit is ready for the commencement of operations. Operational Responsibilities The Toxicology Unit is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Toxicology Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: ▪ When a body bag enters the Pathology station, the Pathology Team will scan or record the OCME Case Number to ensure that all Pathology operations are associated with the correct file(s) in UVIS-CMS. ▪ As directed by the Pathologist, take appropriate toxicological samples. ▪ Document samples taken in UVIS-CMS. ▪ Label all samples with the OCME case number. ▪ Package samples appropriately for transfer to Forensic Toxicology Laboratory. – Coordinate with the Pathology Evidence Unit to ship the packages to the Forensic Toxicology Laboratory and to maintain chain-of-custody of samples. General: • Attend all briefings/meetings as coordinated or requested by the Pathology Team Leader. • Maintain communication with the Pathology Team Leader regarding Toxicology Unit operations. – Report any issues that arise or process alterations needed to meet Toxicology Unit needs. • Maintain communications with Toxicology Unit personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Toxicology Unit operational and staff schedule. • Ensure all Toxicology Unit personnel check-in and out at the beginning and end of each shift. • Ensure all Toxicology Unit personnel are using applicable portions of their position checklists. • Prepare and maintain Toxicology Unit records and reports, as appropriate. Provide reports regularly to the Pathology Team Leader, or as requested. • Monitor use of supplies and notify Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct Toxicology Unit personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Toxicology Unit personnel adhere to PPE requirements • Be aware of Toxicology Unit personnel well-being and maintain communication with Page 462 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • ▪ the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Pathology Team Leader related to the accomplishments/issues encountered during the operational period. Page 463 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 464 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Morgue Support Group Supervisor Morgue Support Group Supervisor Purpose / Mission To coordinate with other Morgue Group Supervisors to provide logistical support of facilities, equipment, supplies and Information Technology aspects of morgue operations ▪ Objectives ▪ Coordinate with Deputy FM Branch Director – PM to ensure the appropriate equipment, vehicles, and supplies are available to support morgue operations Ensure that all operations are conducted in a safe and efficient manner Assigned Area Morgue Supervisor Deputy FM Branch Director – PM Supporting Positions / Functions Facilities Team Supply Team Equipment Team Information Technology Team Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Deputy FM Branch Director – PM.  Check in with the Deputy FM Branch Director – PM and participate in an operational briefing to receive: – Incident Characterization and Situational Awareness – Morgue Operations and Morgue Support Group Expectations  Based on the Morgue Type, Location, Scale, and workflow determine morgue set up and support needs. – Identify Morgue Facilities, Supply, Equipment, and IT Team Leaders and make necessary notifications. – Identify immediate needs to ensure morgue site is prepared for mobilization of equipment. ▪ Identify areas to be cleaned and cleared ▪ Identify staging areas for equipment and supplies  Assemble the Morgue Support Group Team Leaders and staff and provide them: – All necessary information regarding the Mass Fatality Incident (MFI) – Forensic Group Operations, staffing, and schedules – Morgue type and Workflow – PPE requirements and use – Health and Safety Plan information – Equipment / supply request procedure – Direct personnel to use their position checklists  Participate in Morgue walk-through with the Deputy FM Branch Director – PM and Group Supervisors / Team Leaders. – Sketch a layout of the Morgue, including stations and flow – Identify locations for security check-in and check-out stations – Identify locations for forensic examination station locations – Identify location for ancillary functions (morgue command center / administrative Page 465 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths area, staff respite area, etc.)  Establish contact with the Agency Operations Center through the Deputy FM Branch Director – PM to confirm process for requesting resources not available in the disaster morgue cache.  Request the Information Technology Team conduct an assessment of the facility’s infrastructure and determine the need for augmentation.  Instruct Morgue Support Group to perform initial set up operations: – Instruct the Facilities Team to clean, clear, and prepare the facility for the deployed equipment and supplies. − Instruct the Equipment and Supplies Teams to assess the equipment and supplies necessary to support operations. – Request the Information Technology Team conduct an assessment of the facility’s infrastructure and determine the need for augmentation to support UVISCMS. – Request the Information Technology Team to conduct an assessment of the communication capabilities within the morgue and determine the need for augmentation.  Coordinate with the Morgue Security Officer to support efforts to secure the morgue facility. – Deploy resources for the immediate establishment of check-in and check-out stations. – Deploy resources to assist with the establishment of perimeters, roadblocks, etc.  Coordinate with the Remains Storage Group Supervisor to support remains storage needs. – Receive request for additional equipment and/or supplies to augment the current morgue storage capacity. – If additional Remains Storage Facilities are required, ensure infrastructure is present and identify staging locations for the units.  Coordinate with the Health and Safety Officer to support requirements and protocols: – Determine Personal Protective Equipment (PPE) requirements for staff. – Ensure adequate supplies of PPE are available for morgue personnel at the donning station and proper receptacles are present for doffing of PPE. – Support the reconciliation of any identified unsafe conditions.  Coordinate with the Forensic Group Supervisor to support the establishment of examination stations. – Identify locations of each forensic examination workstation based on the type and workflow of the morgue.  Identify signage needs to appropriately label, provide direction and other messaging throughout the morgue. – Request the Morgue Facilities Team to develop and hang required signage.  Establish timeline for the deployment and set up of equipment.  Upon deployment of equipment and supplies to the various areas, instruct morgue support personnel to assist in the set up of each station.  Coordinate with Morgue Group Supervisors to identify resource gaps and determine ability to fulfill requests. – If unable to fulfill requests, submit a request to the Agency Operations Center for sourcing.  Instruct Morgue Information Technology Team to provide Just-in-Time Training to personnel regarding the use of UVIS-CMS and/or the communications equipment (radios, etc.). Page 466 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Determine Morgue Support Group communication needs (i.e., radios, phones)  Advise the Deputy Branch Director – PM of any Morgue Support Group issues, foreseeable or actual, and make corrective recommendations.  Notify the Deputy FM Branch Director – PM that the Morgue Support Group is ready for the commencement of operations. Operational Responsibilities The Morgue Support Group Supervisor is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Morgue Support Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • • • • • • Monitor equipment and supply usage throughout the Morgue Operation. – Request Morgue personnel report resource needs for fulfillment utilizing the indicated protocols. – Instruct Morgue Support Group personnel to replenish supplies and equipment at the end of each operational period, or as needed. – Monitor levels of equipment and supplies in Disaster Morgue cache, resupply as needed. – If unable to fulfill requests, submit a request to the Agency Operations Center for sourcing. Monitor the information technology infrastructure of the morgue operation. – Instruct the Morgue IT Team to continue to provide Just-in-Time Training as needed. – Instruct the Morgue IT Team to troubleshoot any problems that arise. – Brief the Deputy FM Branch Director – PM of any issues that may affect morgue operations. Participate in all Disaster Morgue briefings and walk-throughs. – Determine the type and quantity of equipment sufficient to set up and continue the Morgue operation for each operational period. When possible, fulfill resource requests from Morgue Group Supervisors. If the Morgue Support Group cannot fulfill a request: – Coordinate with the Agency Operations Center to procure the requested resources through contract or resource request submitted to the Emergency Operations Center (EOC). Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – PM. Brief Deputy FM Branch Director – PM on any logistics issues or changes in procedure. Prepare and maintain facility, supply, equipment records and reports as appropriate. Manage all Morgue Support Group personnel. Develop and maintain the Morgue Support Group operational and staff schedule. Assemble, brief and assign work locations and preliminary work tasks to Morgue Support Group Teams/personnel. Ensure all personnel observe established level of operational safety and adhere to all health and safety protocols. Maintain communications with Morgue Support Group personnel on issues related to changes to or deviations from established disaster specific processing procedures. Be aware of Support Group personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, Page 467 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • is available to personnel. Ensure all Group personnel are using applicable portions of their position checklists. At the end of each operational period, ensure Morgue is thoroughly cleaned and resupplied. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – PM related to the accomplishments/issues encountered during the operational period. Considerations • • The morgue type and location will dictate the logistical requirements to establish and maintain operations. When possible, it is recommended that morgue operations be conducted within the jurisdiction’s normal facility; however, depending on the incident characteristics, this may not be possible. The Morgue Support Group Supervisor should, to the best ability, compile a Disaster Portable Morgue Unit (DPMU), a deployable stockpile of equipment and supplies to establish and support morgue operations. The DPMU may also include temporary structures that will serve as the facility itself and/or to supplement remains storage capability. The DPMU should be stored in a single location prepared to deploy upon notice; regular maintenance and inventory of equipment and supplies will be required. Page 468 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Morgue Facilities Team Morgue Facilities Team Purpose / Mission To maintain a Disaster Morgue facility to support postmortem operations ▪ Objectives Evaluate, prepare, and maintain disaster morgue facility to support morgue operations Assigned Area Morgue Facility Supervisor Morgue Support Group Supervisor Activation Checklist  Upon notification, arrive at the Disaster Morgue location as directed by the Morgue Support Group Supervisor.  Check in with the Morgue Support Group Supervisor, and receive situation briefing and Morgue Facilities Team operational requirements and set up instructions.  Participate in Disaster Morgue walk-through with the Morgue Support Group Supervisor and receive operational briefing. – Obtain information on the current disaster morgue facility and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ Morgue security protocols and credential/access requirements ▪ Staffing and scheduling information  Determine team staffing requirements and make necessary notifications.  Assemble Morgue Facilities Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Disaster Morgue security protocols and procedures; including credential requirements − Morgue Facilities Team operations − Staffing and scheduling information  Based on the Incident Characterization, the Morgue type and workflow, and the instruction of the Morgue Support Group Supervisor, evaluate the potential morgue facility to: – Ensure the proper infrastructure is present to support morgue operations. – Determine the ability to augment the facility to meet the needs of the morgue operation.  Per instruction from the Morgue Support Group Supervisor, clean and prepare the facility for the deployment of morgue equipment and supplies.  Coordinate with the Health and Safety Officer to determine infrastructure requirements to support health and safety protocols. – Determine optimal temperature for morgue operations. – Ensure proper lighting for morgue operations. – Ensure all trip hazards are moved.  Develop schedule for cleaning the morgue facility each operational period, including restrooms and ancillary areas.  Receive all resource requests from the Morgue Support Group Supervisor and fulfill Page 469 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths as possible.  Identify any facilities issues to the Morgue Support Group Supervisor for resolution.  Notify Morgue Support Group Supervisor when Morgue Facilities Team is ready for the commencement of operations. Operational Responsibilities The Morgue Facilities Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Morgue Facilities Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • • Monitor and maintain facility at all morgue operations. – Monitor infrastructure, identify damages and notify Morgue Support Group Supervisor of anticipated repair needs. – Respond to requests from the Morgue Support Group Supervisor. – Maintain cleaning schedule. – Monitor temperature and airflow. – Provide regular reports to the Morgue Support Group Supervisor regarding the condition of the morgue facility and the need for augmentation and/or repairs. Attend all briefings/meetings as coordinated or requested by the Morgue Support Group Supervisor. Ensure all team personnel are using applicable portions of their position checklists. Develop and maintain the Morgue Supply Team operational and staff schedule. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Ensure all team personnel are using applicable portions of their position checklists. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Morgue Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Page 470 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Morgue Supplies Team Morgue Supplies Team Purpose / Mission Order, receive, distribute, and store supplies to support Disaster Morgue operations ▪ Objectives ▪ Receive and respond to supply orders from authorized morgue staff Maintain inventory of supplies and equipment Assigned Area Morgue Facility / Storeroom Supervisor Morgue Support Group Supervisor Activation Checklist  Upon notification, arrive at the Disaster Morgue location as directed by the Morgue Support Group Supervisor.  Check in with the Morgue Support Group Supervisor, and receive situation briefing and Morgue Supply Team operational requirements and set up instructions.  Participate in Disaster Morgue walk-through with the Morgue Support Group Supervisor and receive operational briefing. – Obtain information on the current disaster morgue facility and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ Morgue security protocols and credential/access requirements ▪ Staffing and scheduling information  Determine team staffing requirements and make necessary notifications.  Assemble Morgue Supply Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Disaster Morgue security protocols and procedures; including credential requirements − Morgue Supply Team operations − Staffing and scheduling information  Evaluate the space assigned to Morgue Supply staging and determine if adequate for team work flow and needs. − If additional facility space is needed, discuss needs with Morgue Support Group Supervisor.  Conduct an initial inventory of the supply stockpile and develop schedule for updating supply inventory.  Per the instruction of the Morgue Support Group Supervisor, deploy required supplies to the necessary locations.  Receive all resource requests from the Morgue Support Group Supervisor and fulfill as possible.  Identify supply gaps or depletion to the Morgue Support Group Supervisor for replenishment.  Notify Morgue Support Group Supervisor when Supplies Team is ready for the commencement of operations. Operational Responsibilities Page 471 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The Morgue Supplies Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Morgue Supplies Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • Monitor and maintain supplies levels at all morgue operations. − Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. − Respond to requests from the Morgue Support Group Supervisor. − Maintain an inventory of the morgue supply cache. − Provide regular reports to the Morgue Support Group Supervisor regarding the inventory levels of supplies and the need to receive/order additional supplies. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Attend all briefings/meetings as coordinated or requested by the Morgue Support Group Supervisor. Ensure all team personnel are using applicable portions of their position checklists. Develop and maintain the Morgue Supply Team operational and staff schedule. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Morgue Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Page 472 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Morgue Equipment Team Morgue Equipment Team Purpose / Mission To order, receive, distribute, and store equipment to support disaster morgue operations ▪ Objectives ▪ Receive and respond to equipment orders from authorized morgue staff Maintain inventory of equipment Assigned Area Morgue Facility Supervisor Morgue Support Group Supervisor Activation Checklist  Upon notification, arrive at the Disaster Morgue location as directed by the Morgue Support Group Supervisor.  Check in with the Morgue Support Group Supervisor, and receive situation briefing and Morgue Equipment Team operational requirements and set up instructions.  Participate in Disaster Morgue walk-through with the Morgue Support Group Supervisor and receive operational briefing. – Obtain information on the current disaster morgue facility and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ Morgue security protocols and credential/access requirements ▪ Staffing and scheduling information  Determine team staffing requirements and make necessary notifications.  Assemble Morgue Equipment Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Disaster Morgue security protocols and procedures; including credential requirements − Morgue Equipment Team operations − Staffing and scheduling information  Evaluate the space assigned to Morgue Equipment staging and determine if adequate for team work flow and needs. − If additional facility space is needed, discuss needs with Morgue Support Group Supervisor.  Conduct an initial inventory of the equipment cache prior to deployment to stations. – Determine type and amount of equipment available in disaster morgue cache. – Develop schedule for updating equipment inventory.  Per the instruction of the Morgue Support Group Supervisor, deploy required equipment to the necessary locations. – Coordinate with morgue personnel to set up stations at designated locations. – Coordinate with the morgue personnel to test all equipment to be sure all is in working order.  Provide “Just-in-Time” Training on equipment for morgue personnel, if needed.  Receive all resource requests from the Morgue Support Group Supervisor and fulfill as possible. Page 473 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Identify equipment gaps or depletion to the Morgue Support Group Supervisor for replenishment.  Notify Morgue Support Group Supervisor when Morgue Equipment Team is ready for the commencement of operations. Operational Responsibilities The Morgue Equipment Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Morgue Equipment Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • Monitor and maintain equipment at all morgue operations. – Monitor use of equipment, identify damaged/inoperable equipment and notify Morgue Support Group Supervisor of anticipated repair and/or replenishment needs. – Respond to requests from the Morgue Support Group Supervisor. – Maintain an inventory of the morgue equipment cache. – Provide regular reports to the Morgue Support Group Supervisor regarding the inventory levels of equipment and the need to receive/order additional equipment. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Attend all briefings/meetings as coordinated or requested by the Morgue Support Group Supervisor. Ensure all team personnel are using applicable portions of their position checklists. Develop and maintain the Morgue Equipment Team operational and staff schedule. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Morgue Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Page 474 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Morgue Information Technology Team Morgue Information Technology Team Purpose / Mission To provide Information Technology and Telecommunications support to the morgue operation ▪ Objectives ▪ Establish and maintain Information Technology and Telecommunications support of morgue operations, including the operation of UVIS-CMS to manage the postmortem data Provide Just-in-Time training to morgue personnel regarding the proper use of UVIS-CMS and other technologies Assigned Area Morgue Facility Supervisor Morgue Support Group Supervisor Activation Checklist  Upon notification, arrive at the Disaster Morgue location as directed by the Morgue Support Group Supervisor.  Check in with the Morgue Support Group Supervisor, and receive situation briefing and Morgue Information Technology Team operational requirements and set up instructions.  Participate in Disaster Morgue walk-through with the Morgue Support Group Supervisor and receive operational briefing. – Obtain information on the current disaster morgue facility and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ Morgue security protocols and credential/access requirements ▪ Staffing and scheduling information  Perform assessment of morgue facility infrastructure to determine the ability to support UVIS-CMS. – Identify necessary augmentation of the facility infrastructure to support UVISCMS.  Determine team staffing requirements and make necessary notifications. Consider creating units responsible for the following areas: – Desktop: Responsible for managing all desktop equipment needs – Server: Responsible for managing all server and telephony needs – Network: Responsible for managing all network needs – Applications: Responsible for managing all application needs  Assemble Morgue IT Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − Disaster Morgue security protocols and procedures; including credential requirements − Morgue IT Team operations to establish and maintain UVIS-CMS and/or communications capabilities − Staffing and scheduling information  Provide instruction to the Morgue IT Team to set up equipment necessary to establish the IT infrastructure. Page 475 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths –     Coordinate with the Morgue Support Group to deploy all equipment and supplies necessary to establish the necessary IT infrastructure. – Instruct Morgue IT Team to assist forensic personnel to set up UVIS-CMS equipment at each station. – Instruct Morgue IT Team to test UVIS-CMS and ancillary equipment to ensure all is functional. – Ensure all morgue personnel receive “Just-in-Time” Training on UVIS-CMS to ensure that they are able to properly enter all postmortem data. Instruct Morgue IT Team to establish necessary communications methods. – Coordinate with Morgue Group Supervisors to determine communications needs. – Coordinate with the Morgue Support Group to deploy all equipment and supplies necessary to establish the necessary communications infrastructure. – Instruct Morgue IT Team to test all radios and/or other communications tools to ensure all are functional. – Instruct Morgue IT Team to distribute radios and/or other communications tools. – Ensure all morgue personnel receive “Just-in-Time” Training on radio-use to ensure that they are able to properly communicate with other morgue personnel. Receive all resource requests from the Morgue Support Group Supervisor and fulfill as possible. Report any Morgue IT issues to the Morgue Support Group Supervisor for resolution. Notify Morgue Support Group Supervisor when Morgue IT Team is ready for the commencement of operations. Operational Responsibilities The Morgue IT Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Morgue IT Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • Monitor and maintain Information Technology and Telecommunications to support morgue operations. – Monitor infrastructure, identify damages and notify Morgue Support Group Supervisor of anticipated repair needs. – Order and receive IT equipment and supplies as needed; coordinate with the Morgue Equipment and Supplies Teams as needed. – Respond to requests from the Morgue Support Group Supervisor. – Maintain personnel to assist morgue personnel with data entry and/or record keeping issues. – Provide regular reports to the Morgue Support Group Supervisor regarding Information Technology and Telecommunications; identify the need for augmentation and/or repairs. Consider staffing an IT Help Desk to serve as a central point-of-contact for any ITrelated issues. Attend all briefings/meetings as coordinated or requested by the Morgue Support Group Supervisor. Ensure all team personnel are using applicable portions of their position checklists. Develop and maintain the Morgue IT Team operational and staff schedule. Page 476 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Ensure all team personnel are using applicable portions of their position checklists Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Morgue Support Group Supervisor related to the accomplishments/issues encountered during the operational period. 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Page 478 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Postmortem Quality Assurance/Quality Control Group Supervisor Postmortem Quality Assurance / Quality Control (PM QA/QC) Group Supervisor Purpose / Mission To manage all aspects of postmortem data quality assurance and quality control • • Objectives • Establish and monitor quality control measures related to postmortem operations and data entry Conduct MFM tasks in accordance with established forensic standards – Document, record, investigate, recover, and process decedents in a dignified and respectful manner – Accurately determine the cause and manner of death – Perform the accurate and efficient identification of victims – Support judicial, public health, and investigative objectives and requirements Ensure all postmortem documentation is complete and the case has been examined by the appropriate personnel Assigned Area Morgue / Exit Area Supervisor Deputy FM Branch Director – Postmortem Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the Deputy FM Branch Director – PM.  Check in with the Deputy FM Branch Director – PM and participate in an operational briefing to receive: − Incident Characterization and Situational Awareness − Health and safety protocols and requirements − Morgue security protocols and credential/access requirements − Disaster Morgue Operational Overview − Staffing and scheduling information  Participate in Morgue walk-through with the Deputy FM Branch Director – PM and other Group Supervisors / Team Leaders to identify morgue workflow and set up requirements.  Meet with the Deputy FM Branch Director – PM to determine Quality Assurance / Quality Control policies and procedures based on incident characterization and morgue type/workflow. o Determine data entry procedures. o Determine chain-of-custody requirements to maintain integrity of evidence and other materials. o Determine Exit Review process and procedures. o Determine documentation and approval requirements for the release of remains.  Determine PM QA/QC Group staffing needs based on morgue type and size, incident characteristics and operational periods.  Notify the Exit Review Team Leader and other personnel; provide with instruction to Page 479 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths report to the Disaster Morgue.  Assemble PM QA/QC Group personnel and provide them: o All necessary information regarding the mass fatality incident o PM QA/QC Group operations, staffing and schedules o Morgue Type and Workflow o Health and Safety Requirements / PPE Use o Equipment / supply request procedure o Direct personnel to use their position checklists  Ensure Exit Review Team Leader has implemented procedure to review and confirm case files prior to completion of postmortem examination and release of remains.  Evaluate morgue space assigned to the PM QA/QC Group; determine if adequate for group operations and needs. o Request the Exit Review Team to evaluate space designated in the morgue. o If additional space is needed, discuss needs with the Deputy FM Branch Director – PM.  Coordinate with Morgue support Group and IT Team to deploy PM QA/QC Group equipment and supplies at the designated locations. o Ensure that PM QA/QC Group personnel set up appropriate equipment in the morgue facility. o Instruct PM QA/QC Group personnel test all equipment to be sure all is in working order. o Instruct personnel to identify any additional equipment / supplies required and make request to Morgue Support Group.  Determine communication needs (i.e., radios, phones) and make request to Morgue Support Group.  Brief Morgue Personnel regarding QA/QC process and requirements. o Review data entry instructions. o Review case/record management instructions. o Request Morgue Personnel identify any QA/QC questions or issues prior to or during operations.  Advise the Deputy Branch Director – PM of any QA/QC issues, foreseeable or actual, and make corrective recommendations.  Notify the Deputy FM Branch Director – PM that the PM QA/QC Group is ready for the commencement of operations. Operational Responsibilities The PM QA/QC Group is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The PM QA/QC Group should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Maintain robust quality assurance and quality control program. – Monitor Exit Review Station to ensure they are properly reviewing each case for duplication, error and or missing casework. ▪ Ensure the OCME Case numbers documented on all casework are consistent and match the OCME Case number assigned to the remains. ▪ Review casework to determine if there are multiple files for any specific specialty (i.e. multiple dental radiographs). Page 480 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ▪ – Ensure each case was properly routed to the examination stations designated by the Pathology Team Leader. ▪ Review paperwork to ensure no data entry inconsistencies or errors exist. ▪ Upon identification of inconsistency in documentation, coordinate with appropriate forensic personnel to complete proper examination and/or decipher between duplicated casework. Prior to the release of remains, review all associated paperwork against identification reports. ▪ Ensure OCME Case numbers documented on all casework is consistent with identification reports. ▪ Ensure appropriate personnel are present for the confirmation of release of remains. ▪ Ensure all documentation and reports are signed by the appropriate personnel to authorize release of remains. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – PM. • Maintain communications with Deputy FM Branch Director – PM regarding PM QA/QC Group operations. – Report any issues that arise or process alterations needed to meet PM QA/QC needs. • Maintain communications with PM QA/QC Group personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the PM QA/QC Group operational and staff schedule. • Ensure all PM QA/QC Group personnel check-in and out at the beginning and end of each shift. • Schedule and provide operational briefings with the PM QA/QC Group at the beginning and end of each operational period. – Consider inviting Forensic Group Supervisor to ensure they are aware of the QA/QC briefing materials. – The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational period schedule; including anticipated case volume ▪ Alterations to workflow and/or procedures ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing • Ensure all PM QA/QC Group personnel are using applicable portions of their position checklists. • Prepare and maintain PM QA/QC records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – PM, or as requested. • Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. – Instruct PM QA/QC Group personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all PM QA/QC Group personnel adhere to PPE requirements. • Be aware of PM QA/QC Group personnel well-being and maintain communication Page 481 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Be aware of PM QA/QC Group personnel well-being and ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Morgue Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – PM related to the accomplishments/issues encountered during the operational period. Forms / Job Aids • • Case Worksheet Activity Log Considerations • • • • • If a station-based workflow is utilized, the PM QA/QC Group Supervisor should establish an Exit Review Station at the end of the morgue workflow. Each case should be evaluated at the completion of postmortem examination to ensure that all necessary examinations and documentation have been completed prior to the identification and release of remains. If any duplication or errors are discovered, the case must be redirected to the necessary stations. The PM QA/QC Group Supervisor should review the proper data entry methods prior to the commencement of postmortem operations. This includes ensuring all personnel that will contribute to data entry participate in Case Management System Just-in-Time Training opportunities. The Remains Escort should be instructed to route each case according to the designated morgue workflow. Cases should not skip stations or examinations; if there is a wait for the next station, Remains Escorts should be instructed to return case to the appropriate Remains Storage Facility until space is available. Remains should only be released upon the confirmation that all OCME Case Numbers match on tags, paperwork and reports. When it is determined that remains are ready for release, the PM QA/QC Group should ensure that the proper personnel are present to confirm the release. In order to prevent errors, it is suggested that personnel present sign a report maintaining chain-of-custody. Persons present, may include but are not limited to: Remains Release Team Leader, Forensic Group Supervisor, PM QA/QC Group Supervisor, Funeral Director (or other point-of-contact identified by the Next of Kin). Page 482 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Exit Review Team Exit Review Team Purpose / Mission To perform a QA/QC check on all morgue processing just prior to the body’s release from the disaster morgue facility in order to ensure all forensic analyses are complete and consistent and all paperwork is accounted for *Note: The Exit Review Team does not serve to question the quality of the analyses performed • Perform a QA/QC check on all morgue processing just prior to the body’s release from the disaster morgue facility Ensure that all forensic analyses are complete and consistent Ensure complete case files are compiled and maintained Objectives • • Assigned Area Exit Review Station Supervisor Postmortem QA/QC Group Supervisor Activation Checklist  Upon notification, arrive at the disaster morgue location as directed by the PM QA/QC Group Supervisor.  Check in with the PM QA/QC Group Supervisor, and receive: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – Morgue security protocols and credential/access requirements – Morgue Operations and Exit Review Team expectations – Staffing and scheduling information  Receive instruction on policies that will affect the Exit Review Station: – QA/QC Policies and Procedures – Identification Policy  Evaluate the morgue space assigned to the Exit Review Team and determine if adequate for team work flow and needs. – If additional facility space is needed, discuss needs with the PM QA/QC Group Supervisor.  Based on the incident characteristics and the Morgue Operational requirements, determine Exit Review Team staffing requirements.  Upon arrival at the morgue, meet with the Exit Review Team members and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the Exit Review Area – Exit Review operations, staffing, and schedules – Health and Safety briefing – Security briefing – Equipment/supply request procedure – Direct personnel to use their position checklists  Coordinate with the Morgue Support Group and IT Team to deploy Exit Review Station equipment and supplies at the designated location.  Set up Exit Review equipment and supplies at the designated location in the morgue Page 483 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths facility.  Test all Exit Review team equipment to be sure all is in working order.  Provide “Just-in-Time” training to Exit Review members as needed.  Identify Exit Review resource needs and communicate all resource requests through the PM QA/QC Group Supervisor.  Notify the PM QA/QC Group Supervisor when the Exit Review Team is ready for the commencement of operations. Operational Responsibilities The Exit Review Team is responsible for the following items throughout the morgue operations. Several of these items will be ongoing or repeated through the course of the response. The Exit Review Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • When the remains are brought to Exit Review, scan (or record) the barcode on the remains container to call up the case file in UVIS-CMS. • Check to ensure that the OCME case number on the UVIS-CMS case file, and as scanned at every station, matches the number on the remains currently at Exit Review. • Check all the stations originally indicated by the Pathology Team against the stations through which the remains have passed to be sure that no vital analyses have been omitted. – At Pathology, the pathologist examining the remains will have selected all the stations to which the remains should be brought. Not all stations will be necessary for all remains (e.g., decedents lacking dentition need not visit the Forensic Odontology station). – If the remains have failed to pass through any of the assigned stations, instruct the Remains Escort to bring the remains to that station (or stations) before returning to Exit Review. • When the remains have passed through all assigned stations, check to ensure that all necessary documentation (written, photographic, and radiographic) is present and properly saved (or filed, if the process is paper-based). • Check the case file for duplicate analyses. Duplicate analyses should be deleted only after a thorough review is conducted to ensure that the deletion will not result in any lost information. • Check for analyses from other remains that may have been mistakenly uploaded to the current specimen file. Such misfiled materials should be moved to the correct file at this time. • When this review is complete and logged as such in UVIS-CMS, instruct the remains escort to bring the remains to temporary storage or to be prepared for final disposition, as appropriate. General: • Attend all briefings/meetings as coordinated or requested by the PM QA/QC Group Supervisor. • Maintain communication with the PM QA/QC Group Supervisor regarding Exit Review operations. – Report any issues that arise or process alterations needed to meet Exit Review needs. Page 484 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • Maintain communications with Exit Review Team personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Exit Review Team operational and staff schedule. Ensure all Exit Review personnel check-in and out at the beginning and end of each shift. Ensure all Exit Review Team personnel are using applicable portions of their position checklists. Prepare and maintain Exit Review records and reports, as appropriate. Provide reports regularly to the PM QA/QC Group Supervisor, or as requested. Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. – Instruct Exit Review Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Exit Review Team personnel adhere to PPE requirements. Be aware of Exit Review Team personnel well-being and maintain communication with the Morgue Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Morgue Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the PM QA/QC Group Supervisor related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • Activity Log Equipment and Supplies • • UVIS-CMS Exit Review station General office supplies Considerations • • • • Any human or technical errors must be caught as early as possible (preferably before the remains are released from the morgue) in order to prevent potential misidentifications. For several types of evidence, such as DNA samples or friction ridge prints, both of which will rapidly degrade postmortem, this critical window is the only opportunity that morgue personnel will have to collect samples and document observations. It cannot, therefore, be overemphasized how important it is to ensure the accuracy and completeness of the case file prior to the remains’ exit from the morgue facility; it will be much more difficult, and sometimes impossible, to rectify mistakes at a later time. If utilizing a paper-based system, the paperwork should remain with the case at all times. The Remains Escort will be responsible for ensuring that the paperwork remains with the case at all times. Each station will provide additional paperwork that will be added to the casework to the file. The Exit Review Team Leader, as well as all Team members, must possess a broad knowledge of the various morgue stations as well as of the overall DVI process. Given their training, members of certain professions (e.g., anthropologists, medicolegal investigators) may be particularly well suited for such a role. 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Page 486 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Contamination Control Group Supervisor Contamination Control Group Supervisor Purpose / Mission To ensure safe medicolegal operations in contaminated environments or when handling biologically contaminated remains ▪ Determine necessary alterations to the morgue operation in order to operate safely with biological contamination Facilitate the execution of contaminated morgue protocols to ensure personnel are operating safely to examine remains Objectives ▪ Assigned Area Morgue Supervisor Deputy FM Branch Director – PM Activation Checklist  Upon notification and deployment, receive incident characterization and initial information concerning the type and scope of contamination.  Receive briefing from Deputy FM Branch Director – PM regarding Morgue processing protocols and priorities.  Coordinate with Scene Contamination Control Group Supervisor and partner agencies, specifically HAZMAT-specific agencies/divisions, to obtain additional information regarding the type and scale of contamination.  Participate in morgue decision-making process to determine the optimal type, location and workflow based on the contamination present.  Participate in Morgue walk-through with the Deputy FM Branch Director – PM and Group Supervisors / Team Leaders.  Participate in coordinated decision-making process with Health and Safety personnel to determine the handling of contaminated remains.  Identify required PPE for all personnel operating in contaminated zones.  Identify stay time allowances for personnel operating in contaminated zones due to PPE constraints.  Identify training requirements for morgue personnel.  Coordinate with Deputy FM Branch Director – PM to identify the need for additional Contaminated Control Group personnel to complete the objectives.  Make recommended altered protocols to the Deputy FM Branch Director – PM.  Recommend the establishment of control/evaluation points to measure the contamination level of cases entering the morgue facility.  Recommend additional Remains Storage Facilities requirements to ensure the separation of remains by contamination levels.  Identify monitoring and evaluation process to determine when cases are ready to begin examination  Identify additional partner agencies and/or resources necessary to complete morgue operations  Coordinate with the Morgue Support Group Supervisor to determine the equipment and supplies needed to support contamination control operations.  Ensure equipment is complete; all necessary equipment and supplies are staged in an easily accessed location.  Test all equipment to ensure functionality prior to the commencement of operations. Page 487 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Ensure Morgue personnel receive proper Just-in-Time Training on the proper use of equipment and the proper handling of contaminated remains.  Brief Forensic Group Supervisor regarding the alterations to postmortem examination procedures and requirements for the safe handling of contaminated remains while maintaining the ability to collect information to determine identification and cause and manner of death.  Brief Remains Storage Group Supervisor regarding the storage requirements for contaminated remains.  Notify the Deputy FM Branch Director – PM when the Contamination Control Group is ready for the commencement of operations. Operational Responsibilities The Contamination Control Group Supervisor is responsible for the following items throughout the processing of the morgue. Several of these items will be ongoing or repeated through the course of the operation. The Contamination Control Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Monitor Morgue operations and compliance with contamination control requirements. – Assign Contaminated Control Group personnel to Morgue areas or stations, as needed to monitor operations within each zone. – Brief morgue personnel on contamination control protocols, methods and health and safety requirements for operations in their respective areas. – Ensure all personnel have access to the proper PPE and are trained to operate in the PPE. – Ensure proper monitoring of personnel utilizing PPE and the maintenance of proper stay times. – Ensure documentation of the start times for personnel operating in contaminated areas and they leave the area in the time defined. • Coordinate with Forensic Group Supervisor to ensure operations are conducted in accordance with medicolegal standards to the best extent possible. • Coordinate with the Postmortem Quality Assurance/Quality Control Group Supervisor to ensure that all alterations to morgue protocols meet QA/QC requirements. • Coordinate with the Remains Storage Group to ensure remains are evaluated upon removal from the BCP and accession to the morgue facility. • Coordinate with Remains Storage Group to ensure remains are stored in the appropriate Remains Storage Facility. Ensure all remains are properly tracked throughout the morgue process. • Maintain communication with Scene Contamination Control Group Supervisor to determine any changes in the contamination of incoming cases. • Maintain communication with the Deputy FM Branch Director – Postmortem to determine any alterations to morgue protocols. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – PM. • Maintain communication with the Deputy FM Branch Director – PM regarding medicolegal operations in the contaminated scene. Page 488 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – • • • • • • • • Report any issues that arise or process alterations needed to meet contamination control needs. Maintain communications with scene personnel on issues related to changes to or deviations from established procedures. Develop and maintain the Contamination Control Group operational and staff schedule. Ensure all Contamination Control Group personnel check-in and out at the beginning and end of each shift. Ensure all Contamination Control Group personnel are using applicable portions of their position checklists. Prepare and maintain Contamination Control Group records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – PM, or as requested. Monitor use of supplies and notify Morgue Support Group Supervisor of anticipated replenishment needs. Be aware of scene personnel well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – PM related to the accomplishments/issues encountered during the operational period. Best Practices and Considerations • • • All deviations from standard medicolegal operations must be reported to the Deputy FM Branch Director – PM, FM Branch Director, and approved by the Chief Medical Examiner. If the OCME agency does not have internal HAZMAT capabilities or subject matter expertise, the Contaminated Control Group Supervisor position may instead be coordinated with the jurisdiction’s HAZMAT response agency. This position must coordinate with medicolegal personnel to ensure the proper handling of contaminated remains and the safety of all personnel in the morgue facility. The FM Branch leadership must prioritize the safety of OCME personnel during all scene operations. Page 489 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 490 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Antemortem Processing Operations Deputy Fatality Management Branch Director – Antemortem Processing Deputy Fatality Management (FM ) Branch Director – Antemortem Processing (AM) Purpose/Mission To manage all aspects of victim identification operations pertaining to antemortem interviews and information sharing including antemortem data collection and analysis ▪ ▪ ▪ Objectives ▪ ▪ ▪ Establish jurisdictional authority with regard to victim identification operations Provide family and friends of potential victims with a single, centralized mechanism for reporting and communicating directly with the government Provide families with factual and timely information in a compassionate manner, in advance of any public media release of decedent information Conduct VIC tasks in accordance with established forensic standards or best practices Coordinate with partner agencies to establish, set up and operate the Victim Information Center. Communicate with the FM Branch Director and other Deputy FM Branch Directors regarding VIC Operations, information updates, etc. Assigned Area Victim Information Center (VIC) Supervisor FM Branch Director Supporting Positions / Functions VIC Security Officer VIC Safety Officer OCME Liaison JFSOC Representative Interview Group Supervisor Antemortem Records Management Group Supervisor Antemortem Quality Assurance/Quality Control Group Supervisor VIC Support Group Supervisor Activation Checklist  Upon receipt of notification request briefing with FM Branch Director and Disaster Response Coordinator to discuss current incident characteristics and activation of mass fatality management (MFM) plan. – See Incident Characterization Form. – Verify with OCME Executive Leadership what identification modalities will be used and acceptable.  Based on briefing make recommendations on the VIC operations that should be activated and report recommendation to the FM Branch Director.  Establish contact with Family Assistance Center (FAC) Coordinating Agency and Page 491 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths         identify jurisdictional authority over DVI and intention to participate in FAC site selection development, if activated, and VIC set up. Establish time of the interagency FAC call to determine the activation of a FAC operation. – Participate in FAC Interagency Team call. – Brief out on OCME decisions regarding VIC Operations. Based on FAC interagency call conclusions, report the following to the FM Branch Director: – FAC Activation decision – FAC Location – FAC Operational Timeline – Co-location of VIC within the FAC Based on the above decisions, determine the following: – Immediate personnel activations needed – VIC reporting time – VIC set up requirements – Operational periods/staffing patterns – Identify objectives for VIC operations, the completion of which will signal demobilization Relay this information and the decisions to key VIC staff. Verify with OCME Executive Leadership what identification modalities will be used and acceptable. Make appropriate notifications to VIC Leadership below and confirm 24 hour contact numbers. Provide the following information to the VIC Leadership (Consider holding a conference call to report this information to the group as a whole). – Scenario briefing including incident characterization – Instruction to activate subsequent VIC personnel (activate phone tree) – Identify the VIC type and workflow – Identify staffing patterns/shifts /operational periods – Identify location of VIC and any limitations to VIC operations – Identify necessary credentials to enter the VIC – Instruct personnel on the time to report to the VIC – Instruct personnel on the time the VIC must be operational and expected operational periods – Time for initial set up walk through – Request a report back from Group Supervisors with confirmation on mobilization efforts to stand up the VIC operation, within an incident specific amount of time. Report backs should contain the following information: o ETA for subordinate personnel to VIC o ETA for supplies/equipment to be delivered to the VIC per the incident brief o ETA for set up of infrastructure of VIC (if additional infrastructure needed) o ETA for full operational readiness o Identify any concerns regarding VIC 100% operational within directed timeline Establish contact with the external agencies required to support decedent identification and provide: – Time for interagency staff to report to the VIC Page 492 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths              – Necessary credentials to enter the VIC – Operational periods for VIC operations – Time of initial walk–through for the set-up of the VIC operation Report to VIC site to begin set up. Meet with FAC Health and Safety Officer to obtain risk analysis and health and safety plan for the FAC. Meet with FAC Security Officer to identify security needs and establish credentialing check points for VIC. Perform walk–through of the VIC with Group Supervisors: – Review VIC workflow and set up considerations – Determine facility or site limitations to VIC Operations – Identify areas that need to be cleared or cleaned prior to set up – Identify family waiting area – Identify family interview rooms – Identify family notification room(s) – Identify areas to be utilized for Antemortem Records Management – Identify staff respite area – Identify VIC layout to initiate set up (upon completion of cleaning) – Request the deployment of VIC equipment/supplies needed by the VIC Support Group – Communications plan and distribution of radios, if needed Clearly define the roles and responsibilities of all agencies setting up and operating the VIC fostering a collective approach to providing client support. Hold operational briefing with VIC leadership personnel to discuss: – Team organizational structure, staffing and chain of command – Media issues and policies – Operational work cycles (include schedules for briefings, breaks) – Process for requesting supplies and equipment – Incident Characterization updates or changes Provide the OCME Executive Leadership updates on any changes related to VIC Operations. Request VIC Group Supervisors coordinate with staff to identify gaps in resources and make resource requests. – Push resource requests to the VIC Support Group to fulfill gaps from the cache. – If the VIC Support Group is unable to fulfill the request push it to the Agency Operations Center for sourcing. Ensure credentialing system has been established to maintain constant accountability for the personnel present in the VIC. Establish and maintain communications with the Deputy FM Branch Director – Scene and Deputy FM Branch Director – PM. Establish contact with the Manifest Development Group to coordinate the process by which they will determine which families will require antemortem interviews. Confirm UVIS-CMS is accessible and operational. Notify the FM Branch Director when VIC is ready to commence operations. Operational Responsibilities The Deputy FM Branch Director – AM is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Deputy FM Branch Director – AM should identify the tasks Page 493 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • • • • • • Conduct beginning of shift and end of shift briefings with VIC Group Supervisors, JFSOC Representative, and OCME Liaison. Monitor VIC Operations and evaluate on-going work flow performance to include: – Coordinate with the OCME Liaison to provide information for regular family briefings. – Coordinate with the JFSOC representative to ensure interagency coordination with other agencies within the FAC operation. – Instruct Interview Group Supervisor to assemble and manage Teams to systematically schedule and conduct antemortem interviews with families indicated by the Manifest Development Team. – Instruct the Antemortem Group Supervisor to assemble and manage Teams to ensure antemortem information is collected, analyzed and stored according to standard protocols. Maintain communication with the Manifest Development Group to determine which families will require antemortem interviews. If possible, when postmortem information is available, instruct personnel to compare antemortem data to make potential identifications. All potential identifications must be documented and submitted to the Identification Review Committee for confirmation. Coordinate with the AM QA/QC Group Supervisor to monitor the antemortem interview and data entry process. Identify staffing schedules based on Operational Periods, VIC requirements, and staffing availability. – Be aware of changes in staffing for partner agencies and maintain up-todate contact information. – Ensure all personnel report to the VIC, as directed and check-in and checkout at the beginning and end of their shift, respectively. Ensure proper resources are available to complete VIC operations; delegate the VIC Support Group Supervisor to manage resource requests from VIC personnel. If procurement of assets is needed, submit requests to Agency Operations Center for sourcing. Manage issues that arise during VIC operations, including interagency coordination. Establish a regular meeting schedule for individuals in the VIC. Each meeting should serve to: – Provide situational awareness and updates regarding the incident. – Identify issues and correct any problems before they become major. – Convey operational protocols/procedures to VIC personnel. – Establish work schedule for current operational period, including required breaks. – Identify lines of communication. Ensure VIC facility is thoroughly cleaned and resupplied at end of every operational period. Ensure all operations are conducted in a safe, efficient and effective manner. Ensure all personnel are using applicable portions of their position checklists. Maintain communication with the Deputy FM Branch Directors of Scene and PM to ensure up-to-date information pertaining to the incident and the ability to make identifications. Page 494 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Provide information regularly to the Agency Operations Center for inclusion in the Situation Report and as requested for incident-specific planning. Forms/Job Aids • • Incident Characterization Form Activity Log Page 495 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 496 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Victim Identification Center Security Officer Victim Identification Center Security Officer Purpose / Mission To provide for facility security and the security of all equipment and personnel in the VIC operations ▪ Objectives Ensure VIC facilities are secure for the entirety of the operation Assigned Area Various areas / patrol Check-in and check-out Supervisor Deputy Fatality Management Branch Director – AM Activation Checklist  Upon notification, arrive at the VIC location as directed by the Deputy FM Branch Director – AM.  Meet with the Deputy FM Branch Director – AM and receive: – Incident Characterization and Situational Awareness – VIC Operations and Security Expectations  Perform site security assessment based on the location, facility characteristics, and incident characteristics. Brief the Deputy FM Branch Director – VIC on the results of the assessment. – Identify immediate needs to secure the VIC facility: ▪ Establishment of perimeters surrounding the VIC. ▪ Access points for VIC personnel (check-in / check-out station). ▪ Potential interagency representatives to be present in the VIC. ▪ Accepted credentials/identification for VIC personnel and/or credentialing system to create identification for all VIC personnel.  Based on the incident characteristics and the scale of the VIC Security operations, determine Security staffing requirements.  Notify security staff and provide them with instructions to report immediately to the VIC.  Upon arrival at the VIC, meet with the Security personnel and brief them on the following instruction/information: – Incident Characterization and situational awareness – Results of the Security site assessment – Security operations, staffing, and schedules – Equipment / Supply request procedure – Security incident reporting procedure  Establish Security measures in anticipation of VIC activation. Optimally, security measures should be in place prior to the arrival of VIC personnel. – Establish and staff Check-in and Check-out stations for VIC personnel. – Establish and staff necessary roadblocks to curtail vehicle access to the area. – Ensure all facility access points are secure and staff surveillance patrols as needed. – Ensure that all non-entry and other advisory signs are placed at all appropriate locations.  Participate in VIC walk-through with the Deputy FM Branch Director – AM and Group Supervisors/Team Leaders. Page 497 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Provide Security Briefing to VIC personnel, if requested to do so by the Deputy FM Branch Director – AM. – Identify credentials required to enter the VIC. – Identify the available access points and location of check-in and check-out locations. Emphasize the requirement of personnel accountability. – Identify mechanism for reporting potential breaches in VIC security.  Determine security communication needs (i.e., radios, phones, video surveillance) and make request to VIC Support Group.  Identify equipment/supplies required by Security Staff and make request to VIC Support Group.  Advise the Deputy FM Branch Director – AM of any security issues, foreseeable or actual, and make corrective recommendations.  Notify the Deputy FM Branch Director – AM when VIC is secure and ready for the commencement of operations. Operational Responsibilities The VIC Security Officer is responsible for the following items throughout the antemortem operations. Several of these items will be ongoing or repeated through the course of the response. The VIC Security Officer should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Obtain a list of authorized VIC personnel that will be allowed access to the facility. • Monitor personnel accountability and that all VIC personnel are utilizing check-in and check-out points. – Ensure VIC Security staff is posted at check-in and check-out points at all times. – Ensure only authorized personnel have access to the VIC and proximal facilities as needed. – If utilizing a credentialing system to create identification for VIC personnel, monitor functionality. – Monitor current VIC personnel roster at all times at all checkpoints. • Ensure security personnel monitor the perimeter at all times. • Keep thorough written documentation of all patrols taken by the VIC Security Team. • For any incident or breach in VIC security: – Notify the Deputy FM Branch Director – AM of the incident. – Take corrective actions to address the issue. – Complete an incident report. • Remove any unauthorized persons entering the VIC facility. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – AM. • Maintain communication with the Deputy FM Branch Director – AM regarding Security Team operations. – Report any issues that arise or process alterations needed to meet Security Team needs. • Maintain communications with Security Team personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Security Team operational and staff schedule. Page 498 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • Ensure all Security Team personnel check-in and out at the beginning and end of each shift. Schedule and provide operational briefings with the Security Team at the beginning and end of each operational period. − Operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; anticipated arrival or release of remains ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with remains ▪ Review of security procedures; perimeter and road blocks; credential requirements, etc. ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Ensure all Security Team personnel are using applicable portions of their position checklists. Prepare and maintain Security Team records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – AM, or as requested. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols – Instruct Security Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Security Team personnel adhere to PPE requirements Be aware of Security Team personnel well-being and maintain communication with the VIC Safety Officer to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with VIC Support Group to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – AM related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • • • Activity Log Security log book Incident report form Personnel check-in and check-out form Equipment and Supplies • • • • • Checkpoint tables Office supplies Chairs Credentialing System and ancillary supplies (if needed) Communication needs (i.e., radios, phones, video surveillance) Considerations • VIC security may want to issue identification badges unique to the incident. Confusion may arise if personnel are instructed to use their day-to-day work Page 499 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • identification, as members of numerous different agencies may be present in the VIC and as the identification badges will not list each staff member’s correct position. Following a mass fatality incident, it is likely that media/press will attempt to access the VIC site and/or interview OCME personnel. It is critical that security is aware of the presence of media personnel and is able to prevent their access from sensitive locations. Consider coordinating with the OCME Executive Leadership to require the Disaster Response Coordinator identify a specific location for scheduled incident media briefings. Information is only released by the OCME as dictated by the Public Information Officer. In the case that the OCME does not have adequate security personnel to staff all required areas, the Security Officer may utilize law enforcement, auxiliary, or private contractor personnel to supplement the security staff. The VIC Security Team should always be aware of VIC staff members’ well-being and maintain communication with the VIC Health and Safety Team to ensure that assistance, medical or otherwise, is available to VIC personnel. Page 500 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Victim Information Center Safety Officer Victim Information Center Safety Officer Purpose / Mission To minimize the potential risk of injury to FM personnel during VIC Operations ▪ ▪ Ensure all Fatality Management VIC operations are conducted in a safe manner Ensure compliance with established health and safety protocols Monitor staff for influenza Suggested Qualifications ▪ ▪ Knowledge of health and safety regulations Member of the OCME Health and Safety Team Assigned Area Victim Information Center Supervisor Deputy FM Branch Director – AM ▪ Objectives Activation Checklist  Upon notification arrive at the VIC as directed by the Deputy FM Branch Director – AM.  Receive incident characterization, with specific attention to the hazardous conditions present.  Communicate with Agency Safety Officer to determine relevant Health and Safety Plans and Protocols already in development or in place.  Perform site risk assessment to identify Health and Safety procedures specific to FM VIC Personnel.  Identify, or receive report of, potential unsafe conditions, foreseeable or actual and make corrective actions/recommendations. Report all issues to the Deputy FM Branch Director – AM.  Provide FM Health and Safety requirements and any supporting documentation to the Deputy FM Branch Director – AM.  Provide risk assessment materials and reports to the Agency Safety Officer for inclusion in any Health and Safety Plans being developed.  Identify resources required to ensure the safety of VIC personnel.  Determine health and safety staffing needs based on VIC location, make notifications and provide instructions.  Coordinate with VIC Support Group Supervisor to determine the availability of sufficient amounts of PPE supplies.  Establish PPE donning and doffing areas.  Determine health and safety communications needs (i.e. radios, phones) and make request to the VIC Support Group.  Prior to commencing operations, provide health and safety briefing to all VIC personnel. Health and Safety briefing should include:  Identify Safety measures and point out potential risks/hazards.  Identify required PPE for all VIC personnel, identify locations for donning and doffing of PPE and demonstrate proper use, if needed.  Identify Health and Safety Incident reporting protocol. Operational Responsibilities Page 501 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The VIC Safety Officer is responsible for the following items throughout the antemortem operations. Several of these items will be ongoing or repeated through the course of the response. The VIC Safety Officer should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Prior to the commencement of operations and at the beginning of each operational period, provide health and safety briefings to VIC personnel. – Identify Safety measures and point out potential risks/hazards. – Identify required PPE for all VIC personnel, identify locations for donning and doffing of PPE and demonstrate proper use, if needed. – Identify Health and Safety Incident reporting protocol. • Monitor VIC operations for health and safety protocol compliance. – Ensure that all personnel are wearing appropriate personal protective equipment (PPE) and adhering to the HASP at all times. – Take any necessary corrective actions as quickly as possible. • Continue to communicate with Agency Safety Officer and ensure FM specifics are included in the Health and Safety Plan. • Complete an incident report for any breach in Health and Safety Protocols. The appropriate supervisory staff must be alerted in the event of such an incident and report any unsafe conditions and corrective recommendations to the Deputy FM Branch Director – AM. • Any unsafe conditions and actions taken should be documented appropriately for record management. • Monitor PPE and other supply stockpile available for FM VIC personnel. – When needed, make resource request to VIC Support Group for additional PPE cache. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – VIC. • Maintain communication with the Deputy FM Branch Director – AM regarding Health and Safety requirements and observations. – Report any issues that arise or process alterations needed to meet Health and Safety needs. • Maintain communications with Health and Safety personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Health and Safety operational and staff schedule. • Ensure all Health and Safety personnel check-in and out at the beginning and end of each shift. • Prepare and maintain Health and Safety records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – AM, or as requested. • Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. • Be aware of Health and Safety personnel well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the Deputy FM Branch Director – AM related to the accomplishments/issues encountered during the Page 502 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths operational period. Forms / Job Aids • • Health and Safety Plan (as developed by the Safety Officer) Activity Log Best Practices and Considerations • The VIC Safety Officer is responsible for ensuring safe work practices by the FM VIC Personnel. These should include: – Proper PPE worn at all times. – Proper handling of biological materials by adequately trained personnel. – Personnel must be taking appropriate food and rest breaks to ensure health and prevent exhaustion. – Personnel must utilize safe lifting and moving techniques to prevent injury. Page 503 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 504 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths NYC Office of Chief Medical Examiner (OCME) Liaison NYC Office of Chief Medical Examiner (OCME) Liaison Purpose/Mission Objectives To serve as the NYC Office of Chief Medical Examiner Liaison ▪ Coordinate data collection activities with law enforcement and provide liaison with various FAC Assigned Area Victim Information Center (VIC) Supervisor Deputy FM Branch Director – AM Activation Checklist  Upon notification, arrive at the VIC location as directed by the Deputy FM Branch Director – AM.  Check in with the Deputy FM Branch Director – AM and receive briefing on the incident and the VIC operation.  Acquire required credentials and ensure credentials are visible at all times.  Participate in VIC walk-through with the Deputy FM Branch Director – AM and other Group Supervisors to identify the layout and flow of the VIC.  Locate work area and request the deployment of necessary equipment and supplies to support operations.  Coordinate with the VIC IT Team to obtain access to UVIS-CMS.  Establish contact with the Agency Operations Center to ensure the receipt of information regarding the Medicolegal Investigation at the Scene and the Postmortem Operations at the Morgue. – Through the Deputy FM Branch Director – AM, establish contact with the Deputy FM Branch Directors for Scene and PM to ensure the receipt of the most current information.  Meet with Interview Group Supervisor regarding process to request OCME support of Interviews to respond to family’s requests for medical examiner specific information regarding their loved ones.  Meet with the VIC JFSOC Liaison to identify the determined schedule for Family Briefings.  Identify the location of the Family Briefing room and take time to walk through that space prior to conducting any family briefings.  Establish contact with other investigative agency representatives that will conduct family briefings to determine briefing agenda.  Advise the Deputy Branch Director - AM of any ME Liaison position issues, foreseeable or actual, and make corrective recommendations.  Notify the Deputy FM Branch Director – AM that the ME Liaison position is ready for the commencement of operations. Operational Responsibilities The OCME Liaison is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The OCME Liaison should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • Attend all briefings / meetings as coordinated or requested by the JFSOC Manager and Deputy FM Branch Director – AM. Page 505 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • Maintain communication with Agency Operations Center and Deputy FM Branch Directors for Scene, PM, and AM to capture the status and/or progress of FM Operations for use in Family Briefings. Compile talking points for the Family Briefing for review with other investigative agencies and the Agency Public Information Officer to ensure consistency of information. Participate in all Family Briefings by speaking to family group on behalf of the OCME and relaying the following: – Characterization of the Mass Fatality Incident – Overview of the Victim Identification Process – Status of remains recovery efforts – Status of the identification efforts – Process for families to schedule and participate in antemortem interviews – Answer any general questions from the family group Upon request, meet privately with families to answer specific questions related to the recovery, processing, identification and disposition of a certain case. Respond to requests and issues from the Deputy FM Branch Director – AM. Prepare and maintain records and reports as appropriate. Identify position/station resource needs and communicate all resource requests to the VIC Support Group Supervisor. Provide documentation and/or reports as requested by the JFSOC Manager regarding FM Operations in coordination with the VIC JFSOC Liaison. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – AM related to the accomplishments/issues encountered during the operational period. Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other relevant incident information. Considerations • • • • • • • • • • The Family Briefing will be coordinated by the NYC Emergency Management, the FAC Coordinating Agency. A regular schedule should be established for briefings and the schedule should be communicated to families – generally, briefings should occur at least twice daily, but can be held as frequently as needed. Briefings should be provided to families present at the FAC as well as those away from the FAC (perhaps via a conference call). All information must be communicated to families before any statements are made to the press. Briefing messages should be coordinated with other investigative agencies and the Agency Public Information Officer to ensure consistency of information. Present information in terms family members can understand. Include a questions and answer period after each briefing. Do not answer questions related to specific cases; instead, plan to privately meet with the family following the briefing to answer any questions they have. Provide copies of transcripts and any related information handouts for families. A physical study of the briefing room should be performed prior to the families’ presence in the room. This includes: testing of acoustics, equipment and layout of seating. The briefing should be designed, practiced and memorized. Try not to read this briefing from a script; this may create difficulties with eye contact, voice and sincerity. Page 506 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Joint Family Support Operations Center (JFSOC) Representative Joint Family Support Operations Center (JFSOC) Representative Purpose/Mission To serve as the Victim Information Center liaison to the Joint Family Support Operations Center (JFSOC), if applicable ▪ Objectives Represent the Victim Information Center in the JFSOC as a management function of the Family Assistance Center (FAC) operation Assigned Area Joint Family Support Operations Center (JFSOC) Supervisor Deputy FM Branch Director – AM Activation Checklist The Joint Family Support Operations Center (JFSOC) serves as the management function of the Family Assistance Center (FAC). If the Victim Information Center is activated within the FAC, the Deputy FM Branch Director – AM will need to identify a liaison to represent the Antemortem Operations in the JFSOC. If a FAC is not activated and the VIC is activated as a stand-alone operation, then this position will not be necessary.  Upon notification, arrive at the VIC location as directed by the Deputy FM Branch Director – AM.  Check in with the Deputy FM Branch Director – AM and receive briefing on the incident and the VIC operation.  Acquire required credentials and ensure credentials are visible at all times.  Identify location of the JFSOC within the FAC and establish contact with the JFSOC Manager  Identify VIC JFSOC Liaison work area and evaluate the space to determine if adequate for work needs. – If additional space is needed, discuss needs with the JFSOC Manager  Coordinate with the VIC Support Group, VIC IT Team and FAC Support Team to ensure all equipment and supplies needed are deployed and set up at station within the JFSOC. – Coordinate with Support Teams to test all equipment, specifically IT equipment, to ensure all are in working order.  Attend initial JFSOC Briefing and report out on: – VIC objectives – VIC Activation and Set up process and schedule – Current VIC Resource requests – VIC interagency coordination – Recommendation on Public Messaging to families and friends of potential victims  Provide briefing to the Deputy FM Branch Director – AM regarding FAC operations and updates on any VIC-related items.  Develop regular reporting schedule with the Deputy FM Branch Director – AM.  Develop a contact list of all VIC personnel and partner agency personnel that may be needed during the operation. Page 507 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Operational Responsibilities The Joint Family Support Operations Center (JFSOC) Representative is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Joint Family Support Operations Center (JFSOC) Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • • • • • Attend all briefings / meetings as coordinated or requested by the JFSOC Manager and Deputy FM Branch Director – AM. Maintain communication with the Deputy FM Branch Director – AM regarding the JFSOC operations. − Provide brief on all JFSOC decision-making regarding FAC and/or VIC operations. − Outline the schedule of FAC activities for each operational period, including Family Briefings. − Report any issues that arise that may affect the VIC Operations. − Request any information to be briefed to the JFSOC. Coordinate with partner agencies represented in the JFSOC based on the needs of the VIC Operations. − Identify any requests from family members that require OCME action. Coordinate with OCME Liaison to: − Identify time of family briefing − Report any family requests for information regarding a specific case and/or the identification process Brief JFSOC members regarding VIC Operations: − Provide status/progress update of VIC Operations − Submit VIC Resource Requests that may be fulfilled by partner agencies − Identify any issues that may affect VIC Operations − Identify any alterations to VIC Operations Participate in the development of public messaging, in coordination with the AgencyPublic Information Officer for the FAC Operation, which will be disseminated to families and friends of potential victims of the incident specifically regarding. Respond to requests and issues from the Deputy FM Branch Director – AM. Prepare and maintain records and reports as appropriate. Provide documentation and/or reports as requested by the JFSOC Manager regarding FM Operations in coordination with the VIC JFSOC Liaison. Identify position/station resource needs and communicate all resource requests to the VIC Support Group Supervisor. At the end of each operational period, provide a situation report to the Deputy FM Branch Director – AM related to the accomplishments/issues encountered during the operational period. Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other relevant incident information. Considerations • A key component of the FAC model is the inclusion of a Joint Family Support Operations Center (JFSOC). The JFSOC serves as the operation center for managing the FAC and the response to victim needs. The objectives are to ensure effective communication between agencies responsible for the provision of family assistance services; ensure efficient delivery of family assistance services by Page 508 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • ▪ identifying needs, gaps, and by avoiding duplication of services; and coordinate/manage resource requests. The management team should include senior representatives from all key agencies and organizations with a defined role who can make decisions and allocate or access resources. The JFSOC is intended for agency representatives and is not appropriate for family members. The JFSOC continuously monitors events, reactions, and needs of families and establishes a process for receiving, acting on, and disseminating information. The JFSOC sets priorities, liaises with the Incident Command, receives/summarizes/disseminates daily status reports, directs resources and services, vets agency participation, ensures victim privacy, and sets the agendas for family briefings. The JFSOC also plans for the transition from the FAC to remote and long––‐term victim/family specific services and future provision of contact and information from the investigative agency. This transition occurs once victims have been identified and families return home to plan funerals/burials and continue in their process of grief and recovery. If a FAC is not established, the JFSOC will not be activated. The OCME Liaison will support this function from the VIC. Page 509 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 510 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Interview Group Supervisor Interview Group Supervisor Purpose/Mission To coordinate antemortem interviews and ensure the efficient and effective flow of families/friends through the antemortem data gathering process ▪ ▪ Objectives ▪ Establish a system that allows for the accurate and efficient acquisition of antemortem data to facilitate the victim identification process Provide families with factual and timely information in a compassionate manner Coordinate with the Manifest Development Group Liaison to ensure that all families participate in the antemortem data collection process, as needed, in an efficient and effective manner Assigned Area Victim Information Center Supervisor Deputy FM Branch Director – AM Supporting Positions / Functions Reception Team Interview Team Activation Checklist  Upon notification arrive at the VIC location as directed by the Deputy FM Branch Director – AM.  Check in with the Deputy FM Branch Director – AM and receive situation briefing and set up instructions.  Obtain information on the current VIC facility and operations: − Health and safety protocols and requirements − Security procedures and credential/access requirements ▪ Coordinate with the Deputy FM Branch Director – AM and the Manifest Development Group Liaison to determine the scope of antemortem interview needs and time until the first interview is needed. ▪ Participate in VIC walk-through with the Deputy FM Branch Director – AM and other Group Supervisors to identify the layout and flow of the VIC. ▪ Based on interview needs, determine the reception and interview staffing requirements and communicate to the Deputy FM Branch Director – AM. ▪ Assign and notify Team Leaders to report to the VIC: − Reception Team Leader − Interview Team Leader  Request Team Leaders to notify team members and provide them with instructions to report to the VIC.  Conduct a walk-through of the VIC with Interview Group Team Leaders and brief them on the following items: − Incident Characterization and Situational Awareness − Layout of the VIC Reception Area and Interview Rooms − Interview Group operations, staffing, and schedules − VIC Workflow Page 511 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths   ▪            − Health and Safety briefing − Security briefing − Equipment/supply request procedure − Direct personnel to use their position checklists Ensure that all Reception and Interview personnel have proper credentials to obtain access to the VIC area. Request that Reception and Interview personnel have credentials visible at all times. Ensure that the Reception and Interview Team Leaders have assigned Reception and Interview Specialists to their respective stations with the instruction to familiarize themselves with the station layout. Coordinate with the VIC Support Group to ensure the proper equipment, supplies, and IT applications are deployed to the appropriate areas for the Reception, Interview rooms and the Interview Group Supervisor Station. Request Reception and Interview Teams coordinate with IT Team to ensure all necessary personnel have access to the data management system and all ancillary items are fully functional (computers, screens, printers, etc.). Request Reception and Interview Teams report resource needs for fulfillment by the VIC Support Group. Coordinate with interagency liaisons to ensure proper coverage of mental health personnel within the VIC. Coordinate with the FAC coordinating agency to ensure that families are assigned Family Representatives to escort them through the FAC facility and to know who they will be coordinating with to schedule interviews and make requests to the families. Coordinate with the Deputy FM Branch Director – AM and the Missing Persons Liaison to ensure Missing Persons Team personnel (of the Manifest Development Group) are present for the antemortem interview process. Establish contact with JFSOC Representative to identify agencies that will provide social services needs to families, and identify liaisons within each agency for reference. Schedule Just-in-Time Training for Reception and Interview Group personnel. − Ensure they are comfortable with the data management system and all ancillary equipment. − Ensure specialists are comfortable with the antemortem interview questions − Ensure they understand the sensitivity of the operation and when working with families. Ensure that the Interview Group Supervisor Station has been set up appropriately. Obtain UVIS-CMS access and perform a check of the system and ancillary equipment. Initiate the VIC Antemortem Interview Scheduling System which will allow for the coordinated scheduling of antemortem interviews and follow-up interviews as needed throughout the VIC operation. Establish contact with Missing Persons Liaison to identify families that will require antemortem interviews. − Identify any identified translation needs and make appropriate requests. (i.e. translators, language hotlines). − Identify any identified cultural or religious considerations and make appropriate requests (i.e. clergy representative). − Identify any additional special considerations and make appropriate arrangements. Page 512 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths − Identify points of contact for resources should additional special needs arise.  Perform a walk-through with all Interview Group personnel and partner agencies/liaisons to identify flow of families from reception to the scheduled/assigned interview rooms. Identify method for team leaders to coordinate with specialist to identify needs, concerns, etc. while interacting with families and maintaining sensitivity considerations.  Coordinate with the Antemortem Records Management Group Supervisor to determine the protocols for collecting personal effects, evidence, dental/medical records and DNA exemplars or samples. – Brief Interview Team(s) on protocols. – Ensure Interview Team(s) are equipped with necessary materials to collect, document, and submit collected materials.  Brief the Reception Team, Interview Team and Family Representatives regarding the process for bringing families to the interview rooms and waiting for them to complete the interview process before escorting them out of the VIC.  Perform final walk-through to ensure that Reception stations and Interview Rooms are operational and ready to receive families.  Notify Deputy FM Branch Director – AM when reception stations and Interview stations are operational. Operational Responsibilities The Interview Group Supervisor is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Interview Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Manage AM interview queue. − Coordinate with the Manifest Development Group to determine the families that will require AM Interviews and the status of the family: ▪ Families present at the FAC that require interviews will have AM Interviews scheduled through the assigned Family Representative. ▪ Families not present at the FAC that require interviews will be contacted by Missing Persons personnel to schedule an AM Interview and arrange their arrival to the FAC. − Schedule families for AM interviews at the earliest and most convenient time. − Assist in the coordination to obtain additional information from families after the initial AM Interview. − Assist in the coordination to obtain information from families unable to come to the VIC in-person. − Monitor the waiting for interview queue and determine the average wait time, interview time, and make recommendations to the Deputy FM Branch Director – AM for improvements. • Ensure that Reception Team Leader(s) is managing Reception Specialists to conduct the greeting of family members to the VIC and scheduling of AM interviews. − Reception personnel will greet family members and the Family Representative upon arrival to the VIC. − Reception personnel will check to see if the family has already been scheduled for an AM interview. If not, the Reception personnel will utilize the VIC AM Interview Scheduling System to schedule an AM interview at the Page 513 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths earliest and most convenient time. Reception personnel will communicate with the family and the Family Representative to answer any questions they may have regarding the AM interview process and the scheduling process. − Family members and Family Representatives will be instructed to sit in the waiting room or return at their scheduled interview time. − Upon confirmation that the designated interview room is available and the Interview Specialist is ready the Reception personnel will instruct the Family Representative to guide the family to the interview room. − Following the AM Interview, the Reception Personnel will coordinate with the family members and Family Representative to schedule any follow-up interviews/meetings needed. Ensure that Interview Team Leader(s) is managing Interview Specialists to conduct AM interviews: − Interview personnel should be well versed with the AM Interview questions and the data entry process in the data management system. − Once assigned an interview, the Interview personnel will familiarize themselves with any available information related to the family being interviewed. − Interview should be conducted jointly between OCME and NYPD Missing Persons personnel. − Interview Team Leaders should assist interview specialists to provide any resources needed to conduct the interviews appropriately. − Request Interview Team Leader to monitor the functionality of all Interview Station equipment and report any issues that arise. − Coordinate with Interview Team Leader(s) to monitor the mental health of Interview Specialists. Upon the completion of an Antemortem Interview, ensure all documentation is properly collected and packaged to be submitted to the Antemortem Records Group. − Ensure that Interview Team successfully finalizes the interview in the data management system. − Ensure that all evidence and personal effects are properly documented and submitted in coordination with the Evidence Team to maintain chain-ofcustody. − Ensure that all medical, dental or other records are properly documented and submitted to the appropriate Antemortem Records personnel. Continue to coordinate with the Manifest Development Group, Reception Team Leader, and Interview Team Leader to identify special needs of particular families known to be coming in for interviews (cultural, religious, language) and to make appropriate arrangements. Coordinate with OCME Liaison to support antemortem interviews: − Request that the OCME Liaison remain available to communicate directly with the families to answer any questions regarding the identification process. − • • ▪ ▪ General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – AM. • Maintain communication with the Deputy FM Branch Director – AM regarding the reception and interview process. Page 514 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths − • • • • • • • • Report any issues that arise or process alterations needed to meet interview needs. Develop and maintain the Interview Group operational and staff schedule. Ensure all Interview Group personnel check-in and out at the beginning and end of shift. Schedule and provide operational briefings with Reception Team and Interview Teams at the beginning and end of each operational period. − Consider inviting Family Representative Liaison, Manifest Development Liaison to ensure that partner agencies/organizations are aware of the briefing materials. − The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; scheduled AM interviews and anticipated walk-in AM interviews ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Identification of liaisons and points of contact for various resources (translators, mental health, etc.) ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Prepare and maintain reception and interview records and reports as appropriate. Provide reports regularly to the Deputy FM Branch Director – AM, or as requested. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. − Follow all Universal Precautions against exposure to communicable disease and biohazards. Coordinate with VIC Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period. At the end of each operational period, provide a situation report to your direct supervisor related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • Antemortem interview forms Activity Log Considerations • • • The Manifest Development Group is responsible for the compilation of investigative information, missing persons reports and hospital reports to develop the manifest of potential fatalities related to the incident. Utilizing this list, the Manifest Development Group will identify the families that will need to participate in an Antemortem Interview in an attempt to reconcile the identifications of decedents. It is best to schedule all the family and friends to be at the same interview. It is best to consider the family’s wishes when identifying who should be in the interview. Some families will request to be separate from other members of the family. Each interview takes approximately 2.5 hours and each interviewer should be provided a mandatory 30 minute break following the interview. Prior to each interview the specialist must ensure the interview station is clean, set up properly and all Page 515 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • equipment is fully operational. These issues should not be troubleshot during an interview. − It will take significant personnel resources to support the interviewer specialists, entering all data, coordinating family interviews, and moving people to appropriate rooms. In addition to the initial interview it usually takes a second visit to gather all data on the interview form and/or to collect requested evidence, samples or records from the family. The Interview Group Supervisor must ensure that the families have scheduled follow up appointments with the Reception Team, optimally prior to leaving the FAC. Page 516 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Reception Team Reception Team Purpose/Mission To direct reception activities of the family members as they arrive at the VIC • Objectives ▪ Manage Reception Team to coordinate with the Family Representative and/or the family to schedule necessary antemortem interviews at the earliest and most convenient time Monitor family waiting areas to attend to any immediate family needs Assigned Area Victim Information Center – Reception Area Supervisor Interview Group Supervisor Activation Checklist  Upon notification, arrive at the VIC location as directed by the Interview Group Supervisor.  Check in with the Interview Group Supervisor, and receive situation briefing and Reception Team operational requirements and set up instructions.  Obtain information on the current VIC facility and operations: − Health and safety protocols and requirements − Security procedures and credential/access requirements  Determine team staffing requirements and make necessary notifications: – Reception Specialists  Participate in VIC walk-through with Interview Group Supervisor and receive operational briefing.  Assemble Reception Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − VIC security protocols and procedures; including credential requirements − Reception Team operations − Staffing and scheduling information  Ensure all Reception Team personnel have proper credentialing and request that identification be visible at all times.  Evaluate the space assigned to your area/station and determine if adequate for team work flow and needs. − Ensure VIC Support Group and IT Team have deployed appropriate resources to set up station. − If additional facility space is needed, discuss needs with Interview Group Supervisor.  Coordinate with VIC Support Group and IT Team to set up team equipment and supplies at the designated location.  Ensure that all Reception Team personnel have access to the data management system.  Provide “Just-in-Time” Training to Reception Team staff, as needed.  Coordinate with VIC Support Group and IT Team to ensure all ancillary equipment (computers, screens, printers, etc.) are fully functional; request replacement and/or Page 517 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths repair of malfunctioning equipment.  Ensure that all family waiting areas are set-up and adequate for families.  Coordinate with Interview Group Supervisor to meet with the Family Representatives to review the VIC Reception process and workflow prior to families’ arrivals.  Ensure Reception Team personnel have a list of contacts at each station in the case that additional resources are needed when working with a family.  Identify any additional Reception Team resource needs and communicate all resource requests to Interview Group Supervisor.  Notify Interview Group Supervisor when reception team is ready for the commencement of operations. Operational Responsibilities The Reception Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Reception Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Manage Reception Specialists to conduct the greeting of family members to the VIC and scheduling of AM interviews. – Reception personnel will greet family members and the Family Representative upon arrival to the VIC. – Reception personnel will check to see if the family has already been scheduled for an AM interview. If not, the Reception personnel will utilize the VIC AM Interview Scheduling System to schedule an AM interview at the earliest and most convenient time. – Reception personnel will communicate with the family and the Family Representative to answer any questions they may have regarding the AM interview process and the scheduling process. – Family members and Family Representatives will be instructed to sit in the waiting room or return at their scheduled interview time. – Monitor family waiting areas to attend to any immediate family needs, ensure there are reasonable wait times, and recommend the expansion or modification of operations when necessary. – Upon confirmation that the designated interview room is available and the Interview Specialist is ready the Reception personnel will instruct the Family Representative to guide the family to the interview room. – Following the AM Interview, the Reception Personnel will coordinate with the family members and Family Representative to schedule any follow-up interviews/meetings needed. General: • Respond to requests and issues from the Interview Group Supervisor. • Attend all briefings/meetings as coordinated or requested by the Interview Group Supervisor. • Maintain communication with the Interview Group Supervisor regarding the Reception process. − Report any issues that arise or process alterations needed to meet reception needs. • Develop and maintain the Reception Team operational and staff schedule. Page 518 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • Ensure all Reception Team personnel check-in and out at the beginning and end of shift. Schedule and provide operational briefings with the Reception Team at the beginning and end of each operational period. − Operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; anticipated arrival of family groups ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Review of any known cultural/religious considerations ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Follow and adhere to all health and safety protocols. – Instruct Reception Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. Prepare and maintain VIC Reception records and reports as appropriate. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Ensure all Reception Team personnel are using applicable portions of their position checklists. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Be aware of Reception Team personnel well-being and maintain communication with the appropriate organizations to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Interview Group Supervisor related to the accomplishments/issues encountered during the operational period. Report the depletion and restocking needs of your area/station at the end of each operational period. Considerations ▪ ▪ ▪ ▪ The Interview Group Supervisor will coordinate with the Manifest Development Group to determine the families that will need to participate in the antemortem interview process. The Interview Group Supervisor will develop the Antemortem Interview queue based on the families that are available to be scheduled for interviews. The Reception Team must coordinate with the Interview Team to maintain a workable process for checking in families arriving at the VIC for an antemortem interview and ensuring the Interview Specialist and the Interview Room are ready to receive them. Families should not be brought to the Interview Room until it is cleaned following the previous interview and the Interview Specialist is ready. The Reception Team should coordinate with the Family Representative to ensure that the family is aware of the scheduled interview time and instruct the family to either wait in the provided waiting area or exit the VIC and return at the scheduled time. The family representative will escort the family to the interview room when prompted and will remains outside the room until the completion of the interview. Family representatives should not enter the interview team unless requested specifically by Page 519 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ▪ the family. Reception Team members should, to their best ability, include notes in the appointment regarding additional support needed for the interview (translators, religious/cultural representatives). The Reception Team should also coordinate with the Family Representative to troubleshoot any additional needs that are observed once the family enters the VIC. Page 520 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Interview Team Interview Team Purpose/Mission To manage antemortem interviews and antemortem data collection ▪ Manage Interview Team to conduct antemortem interviews to accurately and efficiently acquisition antemortem data to facilitate the victim identification process Ensure discretion and confidentiality of all verbal and written documentation concerning the deceased, NOK, and family members Objectives ▪ Assigned Area Victim Information Center – Antemortem Interview Rooms Supervisor Interview Group Supervisor Activation Checklist  Upon notification, arrive at the VIC location as directed by the Interview Group Supervisor.  Check in with the Interview Group Supervisor, and receive situation briefing and Interview Team operational requirements and set up instructions.  Obtain information on the current VIC facility and operations: – Health and safety protocols and requirements – Security procedures and credential/access requirements  Determine interview team staffing requirements and make necessary notifications: • Interview specialists  Participate in VIC walk-through with Interview Group Supervisor and receive operational briefing.  Assemble Interview Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − VIC security protocols and procedures; including credential requirements − Interview Team operations − Staffing and scheduling information  Ensure all Interview Team personnel have proper credentialing and request that identification be visible at all times.  Evaluate the space assigned to your area/station and determine if adequate for team work flow and needs. − Ensure VIC Support Group and IT Team have deployed appropriate resources to set up station. − If additional facility space is needed, discuss needs with Interview Group Supervisor.  Coordinate with VIC Support Group and IT Team to set up equipment and supplies at the designated location.  Ensure that all Interview Team personnel have access to the data management system. Instruct Interview Specialists to review the data management system and interview questions prior to operations.  Provide “Just-in-Time” Training to Interview Team staff, as needed.  Coordinate with VIC Support Group and IT Team to ensure all ancillary equipment Page 521 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths      (computers, screens, printers, etc.) are fully functional; request replacement and/or repair of malfunctioning equipment. Ensure that all interview rooms are set-up and adequate for families (chairs, tissues, etc.). Coordinate with Interview Group Supervisor to meet with the Family Representatives to review the VIC Interview process and workflow prior to families’ arrivals. Ensure Interview Team personnel have a list of contacts at each station in the case that additional resources are needed when interviewing with a family. Identify any additional Interview Team resource needs and communicate all resource requests to Interview Group Supervisor. Notify Interview Group Supervisor when reception team is ready for the commencement of operations. Operational Responsibilities The Interview Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Interview Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Manage Interview Team to conduct antemortem interviews: − Interview personnel should be well versed with the AM Interview questions and the data entry process in UVIS-CMS. − Once assigned an interview, the Interview personnel will familiarize themselves with any available information related to the family being interviewed. − Interview should be conducted jointly between OCME and NYPD Missing Persons detectives. − During the interview, the Interview Specialist will collect any personal effects, medical/dental records, or other materials presented by the family to assist in the identification process. These materials must be documented and packaged appropriate for submission to the Antemortem Records Management Group. − During the interview, the family may be asked to provide DNA samples in the form of exemplars (of the missing person) or a sample from a blood-relative for kinship. These samples must be collected according to the standard protocols outlined by the Antemortem DNA Team and submitted for analysis. − If the family did not bring the materials to the interview there are additional options to obtain necessary records and samples: ▪ The family can schedule a follow-up appointment at the VIC to return with the requested items. ▪ The family can be provided with packaging to collect materials, package according to instructions and submit materials. ▪ The family can provide the interview specialist with the contact information of the medical office for the Antemortem Records Management Group to obtain records. ▪ The Interview Specialist may coordinate with the Interview Group Supervisor and the Antemortem Records Management Group to arrange for collection of materials at the family’s home or other location. Page 522 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths − • • • • Interview Team Leaders will assist interview specialists to provide any resources needed to conduct the interviews appropriately. − Monitor the functionality of all Interview Station equipment and report any issues that arise to the Interview Group Supervisor and VIC Support Group − Monitor the mental health of Interview Specialists. Upon the completion of an Antemortem Interview, ensure all materials and documentation are properly collected and packaged to be submitted to the Antemortem Records Group. − Ensure that Interview Specialists successfully finalizes the interview in the data management system. − Ensure that all evidence and personal effects are properly documented and submitted in coordination with the Evidence Team to maintain chain-ofcustody. − Ensure that all medical, dental or other records are properly documented and submitted to the appropriate Antemortem Records personnel. Upon completion of an Antemortem Interview, ensure that Interview Specialists clean and restore the station to its original state. Ensure that Interview Specialists take a minimum 30 minute break between antemortem interviews; staff should take breaks in the staff respite area segregated from family areas. At conclusion of every interview ensure transfer all personal effects and documentation is provided to the appropriate Team within the Antemortem Records Management Group in accordance with chain of custody protocol. – All of these items must be accessioned properly by Records Management Team to ensure accurate and current tracking of the items location and custody. General: • Respond to requests and issues from the Interview Group Supervisor. • Attend all briefings/meetings as coordinated or requested by the Interview Group Supervisor. • Maintain communication with the Interview Group Supervisor regarding the Interview process. − Report any issues that arise or process alterations needed to meet reception needs. • Develop and maintain the Interview Team operational and staff schedule. • Ensure all Interview Team personnel check-in and out at the beginning and end of shift. • Schedule and provide operational briefings with the Interview Team at the beginning and end of each operational period. − Operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; anticipated arrival of family groups ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Review of any known cultural/religious considerations ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing • Follow and adhere to all health and safety protocols. Page 523 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – • • • • • • • Instruct Interview Team personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. Prepare and maintain VIC Interview records and reports as appropriate. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Ensure all Interview Team personnel are using applicable portions of their position checklists. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Be aware of Interview Team personnel well-being and maintain communication with the appropriate organizations to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Interview Group Supervisor related to the accomplishments/issues encountered during the operational period. Report the depletion and restocking needs of your area/station at the end of each operational period. Forms/Job Aids • • Activity Log Antemortem Interview Form Equipment and Supplies • Each interview station requires: – Sufficient table space – One chair for each interviewer, police officer, family member or friend – Comfort items (water, tissues) – Administrative supplies (pads, pens, printer ink/cards) – Forensic supplies (DNA kits, preprinted interview forms & DNA consent forms) Considerations • • • • Interview Team members should be trained on how to interact sensitively with family members. Antemortem Interviews should be conducted jointly by a trained Interview Specialist and a member of the Manifest Development Group, typically an NYPD Missing Persons Detective. The joint interview enables both parties to obtain information needed for the medicolegal and investigative process, respectively. In addition, the joint interview prevents the family from having to repeatedly answer the same questions to different agencies. Interview Specialists should work in pairs to allow for one person to conduct the interview while the other performs data entry into UVIS-CMS. Separating these tasks allows for the person asking the question to maintain direct contact with the family members. It is recommended that the interview station be laid out to minimize the movements of the interview specialist. The interview specialists should be able to remain focused on the family members while entering data, printing, scanning etc. In addition, it is recommended that the station set up include a dual screen to enable the family to observe the data entry process. Allowing the family to observe this process will allow them to verify all information and prevent data entry errors. Page 524 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • Despite the family having a view of the information, the Interview Specialists must verbally confirm the accuracy of the entered information. The Reception Team must coordinate with the Interview Team to maintain a workable process for checking in families arriving at the VIC for an antemortem interview and ensuring the Interview Specialist and the Interview Room are ready to receive them. Families should not be brought to the Interview Room until it is cleaned following the previous interview and the Interview Specialist is ready. The family representative will escort the family to the interview room when prompted and will remains outside the room until the completion of the interview. Family representatives should not enter the interview team unless requested specifically by the family. The Interview Specialist must maintain an awareness of the family members’ mental health and well-being during the interview process. If needed, and at the confirmed request of the family, the Interview Specialists may coordinate with the Interview Team Leader to arrange for the presence of mental health personnel and/or religious or cultural representatives during the interview process. Reception Team members should, to their best ability, include notes in the appointment regarding additional support needed for the interview (translators, religious/cultural representatives). The Reception Team should also coordinate with the Family Representative to troubleshoot any additional needs that are observed once the family enters the VIC. 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Page 526 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Antemortem Records Management Group Supervisor Antemortem Records Management Group Supervisor Purpose/Mission To manage the collection, documentation, and analysis of antemortem data as a part of the VIC operation • • Objectives • Establish a system that allows for the accurate and efficient acquisition of antemortem data to facilitate the victim identification process Manage the comparison of antemortem and postmortem information to affect victim identifications Ensure a quality assurance and quality control process is in place Assigned Area Victim Information Center – Disaster Victim Identification Area Supervisor Deputy FM Branch Director – AM Supporting Positions / Functions Antemortem DNA Team Antemortem Dental Team Medical Records Team Evidence Team Antemortem Fingerprint Team Records Management Team Activation Checklist  Upon notification, arrive at the VIC location as directed by the Deputy FM Branch Director – AM.  Check in with the Deputy FM Branch Director – AM and receive situation briefing and set up instructions.  Obtain information on the current VIC facility and operations: − Health and safety protocols and requirements − Security procedures and credential/access requirements  Participate in VIC walk-through with the Deputy FM Branch Director – AM and other Group Supervisors to identify the layout and flow of the VIC.  Coordinate with the Deputy FM Branch Director – AM to determine the scope of Antemortem Records Management needs.  Based on the incident characteristics, the VIC layout and the determined antemortem records management needs, determine the staffing requirements.  Assign and notify Antemortem Records Management Teams to report to the VIC: − Antemortem DNA Team − Antemortem Dental Team − Medical Records Team − Evidence Team − Antemortem Fingerprint Team − Records Management Team  Request Team Leaders to notify team members (specialists) and provide them with instructions to report to the VIC.  Conduct a walk-through of the VIC with Antemortem Records Management Group Team Leaders and brief them on the following items: − Incident Characterization and Situational Awareness Page 527 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths − −            Layout of the VIC Antemortem Records Management Area Antemortem Records Management Group operations, staffing, and schedules − VIC Workflow − Health and Safety briefing − Security briefing − Equipment/supply request procedure − Direct personnel to use their position checklists Ensure that all Antemortem Records Group personnel have proper credentials to obtain access to the VIC area. Request that Antemortem Records Group personnel have credentials visible at all times. Coordinate with the VIC Support Group to ensure the proper equipment, supplies and IT applications are deployed to the appropriate areas to support Antemortem Records Group operations. Request Antemortem Records Teams coordinate with the VIC Equipment and Supplies Teams to determine the layout of their respective stations, to set up equipment and stage supplies. Request Antemortem Records Teams coordinate with IT Team to ensure all necessary personnel have access to UVIS-CMS and all ancillary items are fully functional (computers, screens, printers, etc.). Ensure that teams test all DVI Group equipment, processes and systems to ensure functionality prior to commencement of VIC Operations. Determine communication needs (i.e., radios, phones) and make request to the VIC Support Group (Communication Team). Request Antemortem Records Teams report resource needs for fulfillment by the VIC Support Group. Identify any additional equipment/supplies required by Antemortem Records Teams and make request to VIC Support Group. Coordinate with the Interview Group Supervisor to determine the protocols for collecting personal effects, evidence, dental/medical records and DNA exemplars or samples during the Antemortem Interview processes. − Ensure Interview Team(s) and Records Management Teams are aware of proper protocols for collecting samples. − Ensure Interview Team(s) are equipped with necessary materials to collect, document and submit collected materials to the Records Management Group. − Identify process for requesting Records Management Group personnel to provide subject matter expertise and answer any families’ questions regarding the antemortem record collection and identification processes. − Brief all appropriate personnel on protocols. Coordinate with the Antemortem Quality Assurance / Quality Control Group Supervisor to identify protocols to check UVIS-CMS files for duplication and/or error. − Brief Antemortem Records Group personnel on QA/QC protocols to prevent error. Schedule Just-in-Time Training for Antemortem Records Group personnel. − Ensure they are comfortable with UVIS-CMS and all ancillary equipment. − Ensure specialists are comfortable with the antemortem sample collection, documentation and analysis. − Ensure they understand the sensitivity of the operation and when working with families. Page 528 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Advise the Deputy Branch Director – AM of any Antemortem Records Group issues, foreseeable or actual, and make corrective recommendations.  Perform final walk-through to ensure that the Antemortem Records Team stations are operational and ready to commence operations.  Notify the Deputy FM Branch Director – AM that the Antemortem Records Group is ready for the commencement of operations. Operational Responsibilities The Antemortem Records Group Supervisor is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Antemortem Records Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Coordinate with the Manifest Development Group, Reception Team Leader and Interview Team Leader to identify special needs of particular families known to be coming in for interviews (cultural, religious, language) and to make appropriate arrangements. • Manage the Antemortem Records collection, documentation and analysis process. – Coordinate the transition of antemortem records from the Interview Team to the Evidence Team with proper documentation and packaging to maintain chain-of-custody. – Ensure that Antemortem Records Teams make contacts to collect antemortem data, as needed. – Support the collection of any antemortem data not available at the VIC by collection in person or mail. – Ensure that all medical, dental or other records are properly documented and submitted to the appropriate Antemortem Records Teams. (i.e. all dental radiographs are submitted to the AM Dental Team). – Ensure all Antemortem Records Teams are properly scanning and documenting the antemortem data in UVIS-CMS according to protocol. – Once the records are uploaded to the relative antemortem case-file for analysis, all original records will be transferred to the Records Management Team for appropriate storage, management, and release. • If possible, instruct the Antemortem Records Group personnel to reconcile received antemortem information with postmortem information available in UVIS-CMS and the victim manifest as available from the Manifest Development Group. – Potential identifications will be documented by the appropriate Antemortem Records Team for submission to the Identification Review Committee. • Coordinate with the Antemortem Quality Assurance / Quality Control Group Supervisor to ensure all UVIS-CMS files are compiled appropriately without duplication and/or error. General: • Attend all briefings/meetings as coordinated or requested by the Deputy FM Branch Director – AM. • Maintain communication with the Deputy FM Branch Director – AM regarding the antemortem records collection, documentation and analysis process. – Report any issues that arise or process alterations needed to meet Page 529 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • antemortem data collection needs. Develop and maintain the Antemortem Records Group operational and staff schedule. Ensure all Antemortem Records Group personnel check-in and out at the beginning and end of each shift. Schedule and provide operational briefings with Antemortem Records Group at the beginning and end of each operational period. – Consider inviting the Interview Group and any other partner agencies/organizations to ensure they are aware of the briefing materials. – The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational period schedule; scheduled antemortem interviews and anticipated walk-in antemortem interviews that will require records collection ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Identification of liaison and points-of-contact for various resources ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Prepare and maintain Antemortem Records Group records and reports as appropriate. Provide reports regularly to the Deputy FM Branch Director – AM, or as requested. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. − Follow all Universal Precautions against exposure to communicable disease and biohazards. Coordinate with VIC Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period. At the end of each operational period, provide a situation report to your direct supervisor related to the accomplishments/issues encountered during the operational period. Page 530 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Antemortem DNA Team Antemortem DNA Team Purpose/Mission To obtain and preserve DNA evidence to support disaster victim identification. ▪ Objectives Work with family members, friends and other agencies as needed to identify, collect, package, and store probative DNA reference samples for possible DNA testing Assigned Area Victim Information Center – Antemortem Records Management Area Supervisor Antemortem Records Management Group Supervisor Activation Checklist  Upon notification, arrive at the VIC location as directed by the Antemortem Records Management Group Supervisor.  Check in with the Antemortem Records Management Group Supervisor, and receive situation briefing and set up instructions.  Obtain information on the current VIC facility and operations: – Health and safety protocols and requirements – Security procedures and credential/access requirements  Coordinate with the Antemortem Records Group Supervisor to determine the scope of DNA sampling and analysis needs.  Evaluate the space assigned to the DNA Team and determine if it is adequate for DNA operations. – If additional space is needed, discuss with the Antemortem Records Management Group Supervisor  Coordinate with the VIC Support Group to ensure the proper equipment, supplies and IT applications are deployed to the appropriate areas to support DNA operations.  Determine DNA Team staffing requirements.  Assemble DNA Team personnel and provide them with an operational briefing to include: – Incident Characterization and Situational Awareness – Layout of the VIC Antemortem Records Management Area – DNA Team operations, staffing, and schedules – VIC Workflow – Health and Safety briefing – Security briefing – Equipment/supply request procedure – Direct personnel to use Job Action Sheets  Ensure that all DNA Team personnel have proper credentials to obtain access to the VIC area. Request that DNA Team personnel have credentials visible at all times.  Instruct DNA Team to set up equipment and supplies at the designated location in the VIC facility. – Request DNA Team personnel report resource needs for fulfillment by the VIC Support Group.  Coordinate with IT Team to ensure all necessary personnel have access to UVIS- Page 531 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths CMS and that all ancillary items are fully functional (computers, screens, printers, etc.).  Coordinate with Antemortem Records Management Group Supervisor and Interview Group Supervisor to determine the role for DNA Team personnel in the acquisition of DNA samples from family members and providing subject matter expertise regarding the DNA process. – Identify process by which the Interview Specialists and Team Leaders will request the presence of a DNA Team member to obtain a DNA Sample and/or provide information regarding the DNA sampling and analysis process.  Schedule Just-in-Time Training for DNA Team personnel. – Ensure they are comfortable with the data management system and all ancillary equipment. – Ensure staff understands the process of obtaining samples from families during the interview. – Ensure they understand the sensitivity of the operation and when working with families.  Notify Antemortem Records Group Supervisor when the DNA Team is ready for the commencement of operations. Operational Responsibilities The Antemortem DNA Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Antemortem DNA Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Sample collections from friends and family at the VIC: − Monitor status of antemortem interviews (coordinating with Interview Team) and prepare supplies and materials for DNA sample collections to prevent families from waiting. − At the appropriate time, and as requested by the Interview Team Leader, meet with families: o Introduce yourself and explain the process that will be followed including: ▪ How DNA testing will be used in the identification process. ▪ How long the testing might take. ▪ How the profiles will be used and any confidentiality/security policies. ▪ Addressing questions regarding the DNA collection and testing process. o Collect personal items: ▪ Complete direct reference collection form and have family provide authorization for testing. ▪ Identify other possible contributors to the personal item and collect elimination samples as needed. ▪ Label and seal the items according to standard protocols. o Collect kinship samples: ▪ Working with the family, draw/sketch a family pedigree and identify the available family references. Page 532 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths ▪ • • • Collect appropriate contact information for the family members who are not at the VIC so that arrangements can be made for later collections at the VIC or for off-site collections. ▪ Collect samples from individuals present at the VIC having them sign the authorization for testing. ▪ Label and seal the items according to standard protocols o Identify any direct references that might be helpful: ▪ Obtain name and contact information of the organization or agency at may have the sample. Perform collection of off-site DNA samples (if not available at the VIC): − Contact family members who need to provide a sample. − Make appropriate arrangements for sample collections (either at sample collection facilities or through self collections). o Note: for samples to be eligible for CODIS they must be collected by a law enforcement officer or approved personnel. − Investigate and locate family members with missing contact information to schedule collections. − Coordinate with Evidence Team to mail DNA collection kits to additional family members or to off-site collection locations. − Monitor kits sent out to make sure that collections take place and samples come back. − Contact agencies that may have direct references and coordinate the acquisition of the sample(s). Perform sample data management, accessioning, storage and transport: − Maintain chain of custody for all reference samples collected for DNA testing. − Document the sample collection in UVIS-CMS. − Coordinate transport of reference samples collected for DNA testing from the VIC to the Forensic Biology Laboratory for possible testing. − Monitor identifications and flag DNA cases that no longer need testing (if remains have been identified by other modalities). Provide support for families requesting information regarding the DNA collection and/or identification process: − Answer phone calls or other correspondence regarding questions about DNA. − Meet with families who come to the VIC with DNA questions. − Record all conversations regarding DNA samples associated with a case in UVIS-CMS. General: • Respond to requests and issues from the Antemortem Records Management Group Supervisor. • Attend all briefings/meetings as coordinated or requested by the Antemortem Records Management Group Supervisor. • Maintain communication with the Antemortem Records Management Group Supervisor regarding the Antemortem DNA Operations. − Report any issues that arise or process alterations needed to meet Antemortem DNA needs. • Develop and maintain the Antemortem DNA Team operational and staff schedule. • Ensure all Antemortem DNA Team personnel check-in and out at the beginning and end of shift. Page 533 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • Schedule and provide operational briefings with Antemortem DNA Team at the beginning and end of each operational period. − The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; scheduled AM interviews and anticipated walk-in AM interviews ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Identification of liaisons and points of contact for various resources (translators, mental health, etc.) ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Prepare and maintain Antemortem DNA Team records and reports as appropriate. Provide reports regularly to the Antemortem Records Management Group Supervisor, or as requested. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. − Follow all Universal Precautions against exposure to communicable disease and biohazards. Coordinate with VIC Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period At the end of each operational period, provide a situation report to your direct supervisor related to the accomplishments/issues encountered during the operational period. Considerations • • • DNA Team members will collect any information, samples or personal items presented by the family for DNA analysis. These items may not always be useful for DNA analysis, but should never be refused. The optimal relationships for kinship samples include: mother, father, siblings, and children (all biological) – The relationship of the family member to the missing person will be drawn in the pedigree. – The DNA Team member will take meticulous notes to document which family members have provided kinship samples to ensure that the relationship is known during analysis. – Although not all samples will be tested, all samples will be gathered, packaged and documented. In the case that family members are not available to come to the VIC for DNA Collection, the DNA Team Leader may coordinate with the OCME authority or law enforcement agencies in the other jurisdiction (where the family member is located) to ensure that DNA samples or personal items are collected, packaged and shipped according to standard protocols. Page 534 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Antemortem Dental Records Team Antemortem Dental Records Team Purpose/Mission To collect and evaluate antemortem dental records that will be compared to postmortem dental examinations in order to identify disaster victims ▪ ▪ Objectives ▪ Gather antemortem dental data from the family during antemortem interview and/or contact with the dental/medical provider of the missing person Conduct MFM tasks in accordance with established forensic standards to perform the accurate and efficient identification of victims Conduct the rapid return of decedents to their legal NOK Assigned Area Victim Information Center – Antemortem Records Management Area Supervisor Antemortem Records Management Group Supervisor Activation Checklist  Upon notification, arrive at the Victim Information Center (VIC) location as directed by the Antemortem Records Management Group Supervisor.  Check in with the Antemortem Records Management Group Supervisor, and receive situation briefing and Antemortem Dental Records Team operational requirements and set up instructions.  Obtain information on the current VIC facility and operations: − Health and safety protocols and requirements − Security procedures and credential/access requirements  Determine Dental Records Team staffing requirements and make necessary notifications.  Assemble Dental Records Team personnel and provide them with an operational briefing to include: − Situational brief − Health and safety protocols and requirements − VIC security protocols and procedures − Dental Records Team operations − Staffing and scheduling information  Ensure all Dental Records Team personnel have proper credentialing and request that identification be viable at all times.  Evaluate the space assigned to the Dental Records station and determine if adequate for team work flow and needs. − Ensure VIC Support Group and IT Team have deployed appropriate resource to set up the Dental Records Area. − If additional facility space is needed, discuss needs with the Antemortem Records Management Group Supervisor.  Identify method of scanning dental records/radiographs, and other antemortem data, for inclusion in UVIS-CMS.  Coordinate with the VIC Support Group and IT Team to set up Dental Records Team equipment and supplies at the designated location. Page 535 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Ensure all Dental Records Team personnel have access to UVIS-CMS.  Provide “Just-in-Time” Training to the Dental Records Team personnel, as needed.  Coordinate with VIC support Group and IT Team to ensure UVIS-CMS and all ancillary equipment (computers, scanners, screens, printers, etc.) are fully functional; request replacement and/or repair of malfunctioning equipment.  Coordinate with Interview Group Supervisor and Antemortem Records Management Group Supervisor to review the accessioning process and workflow for Dental Records Team to receive records submitted by the families during the antemortem interview.  Identify team resource needs and communicate all resource requests to the Antemortem Records Management Group Supervisor.  Notify the Antemortem Records Management Group Supervisor when the Dental Records Team is ready for the commencement of operations. Operational Responsibilities The Antemortem Dental Records Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Antemortem Dental Records Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: ▪ Collect all dental records from the families during antemortem interview process and appropriately load into UVIS-CMS according to the determined protocol. – Interview Team members will collect materials from family members during the antemortem interview. The Interview Team will properly document and package items to ensure chain-of-custody. – Following the conclusion of the interview, the Interview Team members will bring all items to the Evidence Team area. – All submitted materials will be documented in UVIS-CMS and/or an Evidence Tracking System. – The Evidence Team will transfer all antemortem records to the appropriate Antemortem Records Team for documentation and analysis. – Upon receipt of dental records, scan appropriate radiographs and documents into the data management system for current and future access. – Transfer dental records to the Records Management Team for appropriate storage or return records to the family, when possible. ▪ If dental records are not available directly from the family at the VIC, it will be necessary to obtain them from the dental provider. – Interview Team members will collect the contact information for the dental provider from the family during the antemortem interview. – Upon receipt of the dental provider’s information, contact the provider to obtain the dental records for the missing person. – Make appropriate arrangements for record collection. ▪ Upon request, provide families with information regarding questions about dental records and/or the identification process. – Record all conversations regarding dental records associated with a case in UVIS-CMS. • If applicable, compare antemortem and postmortem dental records within UVIS-CMS at the Dental Records Station. This comparison may also be performed by forensic odontologists assigned to a separate location to aid the DVI Team in antemortem Page 536 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • and postmortem comparison. Ensure consensus among the Forensic Odontology Team before submitting any potential dental identification for DVI review. General: • Respond to requests and issues from the Antemortem Records Management Group Supervisor. • Attend all briefings/meetings as coordinated or requested by the Antemortem Records Management Group Supervisor. • Maintain communication with the Antemortem Records Management Group Supervisor regarding the Antemortem Dental Operations. − Report any issues that arise or process alterations needed to meet Antemortem Dental needs. • Develop and maintain the Antemortem Dental Team operational and staff schedule. • Ensure all Antemortem Dental Team personnel check-in and out at the beginning and end of shift. • Schedule and provide operational briefings with Antemortem Dental Team at the beginning and end of each operational period. − The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; scheduled AM interviews and anticipated walk-in AM interviews ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Identification of liaisons and points of contact for various resources (translators, mental health, etc.) ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing • Prepare and maintain Antemortem Dental Team records and reports as appropriate. Provide reports regularly to the Antemortem Records Management Group Supervisor, or as requested. • Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. • Follow and adhere to all health and safety protocols. − Follow all Universal Precautions against exposure to communicable disease and biohazards. • Coordinate with VIC Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period. • At the end of each operational period, provide a situation report to your direct supervisor related to the accomplishments/issues encountered during the operational period. Considerations • It should be kept in mind that the Dental Records Team in the VIC represents just one function of the forensic odontologists who work in MFM operations. Forensic odontologists also work in the disaster morgue to gather postmortem dental radiographs and data for each recovered case as determined by the Pathologist and to compare antemortem and postmortem data to make victim identifications. This document focuses solely on the role of the forensic odontology staff within the Page 537 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • VIC. The comparison of postmortem and antemortem dental records within UVIS-CMS may occur at the Forensic Odontology Station, by the Antemortem Dental Records Team or by a separate DVI Reconciliation Team assigned to a separate location. All potential identifications by comparison of dental records will require confirmation by the Identification Review Committee. Page 538 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Medical Records Team Medical Records Team Purpose/Mission To collect and evaluate antemortem medical records that will be compared to postmortem examinations in order to identify disaster victims ▪ Objectives ▪ ▪ Gather antemortem medical data from the family during antemortem interview and/or contact with the medical provider of the missing person Conduct MFM tasks in accordance with established forensic standards to perform the accurate and efficient identification of victims Conduct the rapid return of decedents to their legal NOK Assigned Area Victim Information Center – Antemortem Records Management Area Supervisor Antemortem Records Management Group Supervisor Activation Checklist  Upon notification, arrive at the Victim Information Center (VIC) location as directed by the Antemortem Records Management Group Supervisor.  Check in with the Antemortem Records Management Group Supervisor, and receive situation briefing and Medical Records Team operational requirements and set up instructions.  Obtain information on the current VIC facility and operations: − Health and safety protocols and requirements − Security procedures and credential/access requirements  Determine Medical Records Team staffing requirements and make necessary notifications.  Assemble Medical Records Team personnel and provide them with an operational briefing to include: − Situational brief − Health and safety protocols and requirements − VIC security protocols and procedures − Medical Records Team operations − Staffing and scheduling information  Ensure all Medical Records Team personnel have proper credentialing and request that identification be viable at all times.  Evaluate the space assigned to the Medical Records station and determine if adequate for team work flow and needs. − Ensure VIC Support Group and IT Team have deployed appropriate resource to set up the Medical Records Area. Page 539 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths −         If additional facility space is needed, discuss needs with the Antemortem Records Management Group Supervisor. Identify method of scanning Medical records/radiographs, and other antemortem data, for inclusion in UVIS-CMS. Coordinate with the VIC Support Group and IT Team to set up Medical Records Team equipment and supplies at the designated location. Ensure all Medical Records Team personnel have access to UVIS-CMS. Provide “Just-in-Time” Training to the Medical Records Team personnel, as needed. Coordinate with VIC support Group and IT Team to ensure UVIS-CMS and all ancillary equipment (computers, scanners, screens, printers, etc.) are fully functional; request replacement and/or repair of malfunctioning equipment. Coordinate with Interview Group Supervisor and Antemortem Records Management Group Supervisor to review the accessioning process and workflow for Medical Records Team to receive records submitted by the families during the antemortem interview. Identify team resource needs and communicate all resource requests to the Antemortem Records Management Group Supervisor. Notify the Antemortem Records Management Group Supervisor when the Medical Records Team is ready for the commencement of operations. Operational Responsibilities The Medical Records Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Medical Records Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: ▪ Collect all Medical records from the families during antemortem interview process and appropriately load into UVIS-CMS according to the determined protocol. – Interview Team members will collect materials from family members during the antemortem interview. The Interview Team will properly document and package items to ensure chain-of-custody. – Following the conclusion of the interview, the Interview Team members will bring all items to the Evidence Team area. – All submitted materials will be documented in UVIS-CMS and/or an Evidence Tracking System. – The Evidence Team will transfer all antemortem records to the appropriate Antemortem Records Team for documentation and analysis. – Upon receipt of Medical records, scan appropriate radiographs and documents into UVIS-CMS for current and future access. – Transfer Medical records to the Records Management Team for appropriate storage or return records to the family, when possible. ▪ If Medical records are not available directly from the family at the VIC, it will be necessary to obtain them from the Medical provider. Page 540 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – ▪ • • Interview Team members will collect the contact information for the Medical provider from the family during the antemortem interview. – Upon receipt of the Medical provider’s information, contact the provider to obtain the Medical records for the missing person. – Make appropriate arrangements for record collection. Upon request, provide families with information regarding questions about Medical records and/or the identification process. – Record all conversations regarding Medical records associated with a case in the case management system. If applicable, compare antemortem and postmortem Medical records within UVISCMS at the Medical Records Station. This comparison may also be performed by forensic specialists assigned to a separate location to aid in antemortem and postmortem comparison. Ensure consensus among the Medical Records Team before submitting any potential identification for DVI review. General: • Respond to requests and issues from the Antemortem Records Management Group Supervisor. • Attend all briefings/meetings as coordinated or requested by the Antemortem Records Management Group Supervisor. • Maintain communication with the Antemortem Records Management Group Supervisor regarding the Antemortem Medical Records Operations. − Report any issues that arise or process alterations needed to meet Antemortem Medical Records needs. • Develop and maintain the Antemortem Medical Records Team operational and staff schedule. • Ensure all Antemortem Medical Records Team personnel check-in and out at the beginning and end of shift. • Schedule and provide operational briefings with Antemortem Medical Records Team at the beginning and end of each operational period. − The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule ▪ Scheduled AM interviews and anticipated walk-in AM interviews ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Identification of liaisons and points of contact for various resources (translators, mental health, etc.) ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing • Prepare and maintain Antemortem Medical Records Team records and reports as appropriate. Provide reports regularly to the Antemortem Records Management Page 541 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • Group Supervisor, or as requested. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. − Follow all Universal Precautions against exposure to communicable disease and biohazards. Coordinate with VIC Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period. At the end of each operational period, provide a situation report to your direct supervisor related to the accomplishments/issues encountered during the operational period. Considerations • • It should be kept in mind that the Medical Records Team in the VIC represents just one function of the forensic specialists who work in MFM operations. In the disaster morgue, forensic pathologists work to gather postmortem data for each recovered case as determined and to compare antemortem and postmortem data to make victim identifications. The comparison of postmortem and antemortem medical records within UVIS-CMS may occur at the Pathology Station, by the Antemortem Medical Records Team or by a separate DVI Reconciliation Team assigned to a separate location. All potential identifications by comparison of medical records will require confirmation by the Identification Review Committee. Page 542 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Records Management Team Records Management Team Purpose/Mission To manage all antemortem data provided by families and friends of victims ▪ Objectives Ensure that all antemortem materials and documents are properly documented, tracked and stored for current and future use Assigned Area Victim Information Center – Antemortem Records Management Area Supervisor Antemortem Records Management Group Supervisor Activation Checklist  Upon notification, arrive at the Victim Information Center (VIC) location as directed by the Antemortem Records Management Group Supervisor.  Check in with the Antemortem Records Management Group Supervisor, and receive situation briefing and Records Management Team operational requirements and set up instructions.  Obtain information on the current VIC facility and operations: – Health and safety protocols and requirements – Security procedures and credential/access requirements  Determine Records Management Team staffing requirements and make necessary notifications.  Assemble Records Management Team personnel and provide them with an operational briefing to include: − Situational brief − Health and safety protocols and requirements − VIC security protocols and procedures − Records Management Team operations − Staffing and scheduling information  Ensure all Records Management Team personnel have proper credentialing and request that identification be viable at all times.  Evaluate the space assigned to the Records Management station and determine if adequate for team work flow and needs. − Ensure VIC Support Group and IT Team have deployed appropriate resource to set up the Medical Records Area. − If additional facility space is needed, discuss needs with the Antemortem Records Management Group Supervisor.  Coordinate with the Evidence Team to establish Record Management Policy/System. − Coordinate with Evidence Team to determine chain-of-custody policy for records, samples and other materials. − Identify method of scanning records, and other antemortem data, for inclusion in UVIS-CMS. − Identify records tracking mechanism and/or log-in/out procedure to track the location of records.  Coordinate with the VIC Support Group and IT Team to set up Records Management Team equipment and supplies at the designated location. Page 543 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Ensure all Records Management Team personnel have access to UVIS-CMS.  Provide “Just-in-Time” Training to the Records Management Team personnel, as needed.  Coordinate with VIC support Group and IT Team to ensure UVIS-CMS and all ancillary equipment (computers, scanners, screens, printers, etc.) are fully functional; request replacement and/or repair of malfunctioning equipment.  Coordinate with Interview Group Supervisor and Antemortem Records Management Group Supervisor to review the accessioning process and workflow for Records Management Team to receive records submitted by the families during the antemortem interview.  Identify team resource needs and communicate all resource requests to the Antemortem Records Management Group Supervisor.  Notify the Antemortem Records Management Group Supervisor when the Records Management Team is ready for the commencement of operations. Operational Responsibilities The Records Management Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Records Management Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Collect and manage all case-files compiled by Evidence and the Antemortem Records Teams (Dental, Medical, DNA, Fingerprint, etc). – The Evidence Team will properly accession all samples, evidence and records received by the Interview Team, then will transfer all antemortem records to the appropriate Antemortem Records Team (Dental, Medical, DNA, Fingerprint, etc) for documentation and analysis. – Once the records are uploaded to the relative antemortem case-file for analysis, all original records will be transferred to the Records Management Team for appropriate storage and/or return original materials/records to the family, when possible. – Log and file materials as received and store in safe, secure location. – Manage the check-in and check-out of materials by personnel for analysis; maintain chain-of-custody. – Upon closure of case, transfer completed VIC files and accompanying materials to the agency records management department for retention. – Coordinate release of files systematically and with proper accounting for person receiving file in accordance with the procedures of the OCME. General: • Respond to requests and issues from the Antemortem Records Management Group Supervisor. • Attend all briefings/meetings as coordinated or requested by the Antemortem Records Management Group Supervisor. • Maintain communication with the Antemortem Records Management Group Supervisor regarding the Records Management Operations. − Report any issues that arise or process alterations needed to meet Records Management needs. • Develop and maintain the Records Management Team operational and staff Page 544 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • schedule. Ensure all Records Management Team personnel check-in and out at the beginning and end of shift. Schedule and provide operational briefings with Records Management Team at the beginning and end of each operational period. − The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; scheduled AM interviews and anticipated walk-in AM interviews ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Identification of liaisons and points of contact for various resources (translators, mental health, etc.) ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Prepare and maintain Records Management Team records and reports as appropriate. Provide reports regularly to the Antemortem Records Management Group Supervisor, or as requested. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. − Follow all Universal Precautions against exposure to communicable disease and biohazards. Coordinate with VIC Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period. At the end of each operational period, provide a situation report to your direct supervisor related to the accomplishments/issues encountered during the operational period. Page 545 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 546 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Antemortem Evidence Team Antemortem Evidence Team Purpose/Mission To collect antemortem reference materials/samples provided by families and friends of victims and maintain chain-of-custody throughout the VIC Operations ▪ Collect, document and package all antemortem reference materials/samples Collect label and package any relevant paperwork, photographs, x–rays, and personal effects Objectives ▪ Assigned Area Victim Information Center – Antemortem Records Management Area Supervisor Antemortem Records Management Group Supervisor Activation Checklist  Upon notification arrive at the VIC location as directed by the Antemortem Records Management Group Supervisor.  Check in with the Antemortem Records Management Group Supervisor, and receive situation briefing and Evidence Team operational requirements and set up instructions.  Obtain information on the current VIC facility and operations: − Health and safety protocols and requirements − Security procedures and credential/access requirements  Determine Evidence Team staffing requirements and make necessary notifications  Assemble Evidence Team personnel and provide them with an operational briefing to include: − Situational brief − Health and safety protocols and requirements − VIC security protocols and procedures − Evidence Team operations − Staffing and scheduling information  Ensure all Evidence Team personnel have proper credentialing and request that identification be viable at all times.  Evaluate the space assigned to the Evidence station and determine if adequate for team work flow and needs. − Ensure VIC Support Group and IT Team have deployed appropriate resource to set up the Evidence Area. − If additional facility space is needed, discuss needs with the Antemortem Records Management Group Supervisor.  Coordinate with the VIC Support Group and IT Team to set up Evidence Team equipment and supplies at the designated location.  Ensure all Evidence Team personnel have access to UVIS-CMS and/or any Evidence Tracking System to be utilized.  Provide “Just-in-Time” Training to Evidence Team personnel, as needed.  Coordinate with VIC support Group and IT Team to ensure UVIS-CMSand all ancillary equipment (computers, screens, printers, etc.) are fully functional; request replacement and/or repair of malfunctioning equipment. Page 547 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Coordinate with Interview Group Supervisor and Antemortem Records Management Group Supervisor to review the Evidence accessioning process and workflow for Evidence Team to receive materials submitted by the families during the antemortem interview.  Identify team resource needs and communicate all resource requests to the Antemortem Records Management Group Supervisor.  Notify the Antemortem Records Management Group Supervisor when the Evidence Team is ready for the commencement of operations. Operational Responsibilities The Evidence Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Evidence Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Collect and appropriately label and package all antemortem reference samples according to the determined protocol. – Interview Team members will collect materials from family members during the antemortem interview. The Interview Team will properly document and package items to ensure chain-of-custody. These materials include: ▪ Medical Records ▪ Dental Records ▪ Photographs ▪ DNA Samples (Direct or Family Reference Samples) – Following the conclusion of the interview, the Interview Team members will bring all items to the Evidence Team area. – All submitted materials will be documented in UVIS-CMS and/or the Evidence Tracking System. – If possible, the Evidence Team will scan/copy paper materials and return these items to the families immediately. – Transfer antemortem reference samples to the appropriate storage location or to the appropriate Antemortem Record Management Group (i.e. Medical Records, DNA, Dental, etc.) • Maintain chain-of-custody of all items collected and documented. • Coordinate with other Antemortem Records Management Teams to ship antemortem materials (DNA Samples, etc.) to appropriate laboratories for testing. • Coordinate with the AM DNA Team to mail out any DNA collection kits to family members unable to come to the VIC. Ensure all shipments are tracked and include a delivery confirmation. General: • Respond to requests and issues from the Antemortem Records Management Group Supervisor. • Attend all briefings/meetings as coordinated or requested by the Antemortem Records Management Group Supervisor. • Maintain communication with the Antemortem Records Management Group Supervisor regarding the Evidence Team Operations. − Report any issues that arise or process alterations needed to meet Evidence Team needs. Page 548 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • Develop and maintain the Evidence Team operational and staff schedule. Ensure all Evidence Team personnel check-in and out at the beginning and end of shift. Schedule and provide operational briefings with Evidence Team at the beginning and end of each operational period. − The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; scheduled AM interviews and anticipated walk-in AM interviews ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Identification of liaisons and points of contact for various resources (translators, mental health, etc.) ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Prepare and maintain Evidence Team records and reports as appropriate. Provide reports regularly to the Antemortem Records Management Group Supervisor, or as requested. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. − Follow all Universal Precautions against exposure to communicable disease and biohazards. Coordinate with VIC Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period. At the end of each operational period, provide a situation report to your direct supervisor related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • Activity Log Evidence – Log Sheet and Record Form Considerations • • • Any items found believed to have evidentiary purpose should be reported to the law enforcement and/or investigative authority. These materials will be photographed, documented and packaged prior to properly transferring the items to partner agencies. To release evidence to NOK: – Evidence staff will release submitted materials/samples to the NOK after a written request has been received and reviewed by the OCME legal department. – Evidence staff will release evidentiary items to the appropriate law enforcement agency. Law enforcement will be responsible for releasing any evidentiary items to NOK. Valid contact information must be obtained for all individuals, departments, and agencies involved with evidence collection. If multiple agencies are involved and evidence is released to multiple locations, it is imperative that all involved in the response be able to contact those having evidence or PE in their custody. Page 549 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 550 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Antemortem Fingerprint Team Antemortem Fingerprint Team Purpose/Mission To collect and evaluate antemortem fingerprint records that will be compared to postmortem examinations in order to identify disaster victims ▪ ▪ Objectives ▪ Gather antemortem fingerprint records from the family during antemortem interview and/or contact with the medical provider of the missing person Conduct MFM tasks in accordance with established forensic standards to perform the accurate and efficient identification of victims Conduct the rapid return of decedents to their legal NOK Assigned Area Victim Information Center – Antemortem Records Management Area Supervisor Antemortem Records Management Group Supervisor Activation Checklist  Upon notification, arrive at the Victim Information Center (VIC) location as directed by the Antemortem Records Management Group Supervisor.  Check in with the Antemortem Records Management Group Supervisor, and receive situation briefing and Antemortem Fingerprint Team operational requirements and set up instructions.  Obtain information on the current VIC facility and operations: − Health and safety protocols and requirements − Security procedures and credential/access requirements  Determine Antemortem Fingerprint Team staffing requirements and make necessary notifications.  Assemble Antemortem Fingerprint Team personnel and provide them with an operational briefing to include: − Situational brief − Health and safety protocols and requirements − VIC security protocols and procedures − Fingerprint Records Team operations − Staffing and scheduling information  Ensure all Antemortem Fingerprint Team personnel have proper credentialing and request that identification be viable at all times.  Evaluate the space assigned to the Medical Records station and determine if adequate for team work flow and needs. − Ensure VIC Support Group and IT Team have deployed appropriate resource to set up the Antemortem Fingerprint Area. − If additional facility space is needed, discuss needs with the Antemortem Records Management Group Supervisor.  Identify method of scanning Antemortem Fingerprint, and other antemortem data, for inclusion in UVIS-CMS.  Coordinate with the VIC Support Group and IT Team to set up Antemortem Fingerprint Team equipment and supplies at the designated location. Page 551 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Ensure all Antemortem Fingerprint Team personnel have access toUVIS-CMS.  Provide “Just-in-Time” Training to the Antemortem Fingerprint Team personnel, as needed.  Coordinate with VIC support Group and IT Team to ensure UVIS-CMS and all ancillary equipment (computers, scanners, screens, printers, etc.) are fully functional; request replacement and/or repair of malfunctioning equipment.  Coordinate with Interview Group Supervisor and Antemortem Records Management Group Supervisor to review the accessioning process and workflow for Fingerprint Records Team to receive records submitted by the families during the antemortem interview.  Identify team resource needs and communicate all resource requests to the Antemortem Records Management Group Supervisor.  Notify the Antemortem Records Management Group Supervisor when the Antemortem Fingerprint Team is ready for the commencement of operations. Operational Responsibilities The Antemortem Fingerprint Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The Antemortem Fingerprint Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: ▪ Collect all Antemortem Fingerprint records from the families during antemortem interview process and appropriately load into UVIS-CMS according to the determined protocol. – Interview Team members will collect information from family members during the antemortem interview regarding the potential source of antemortem fingerprint records. – Following the conclusion of the interview, the Interview Team members will notify the Antemortem Fingerprint Team of potential fingerprint sources. – Upon receipt of the information, contact the source to obtain the Antemortem Fingerprint records for the missing person. – Make appropriate arrangements for record collection. ▪ Upon request, provide families with information regarding questions about Antemortem Fingerprint records and/or the identification process. – Record all conversations regarding Antemortem Fingerprint records associated with a case in the case management system. • If applicable, compare antemortem and postmortem Antemortem Fingerprint within UVIS-CMS at the Antemortem Fingerprint Station. This comparison may also be performed by forensic specialists assigned to a separate location to aid in antemortem and postmortem comparison. • Ensure consensus among the Antemortem Fingerprint Team before submitting any potential identification for DVI review. General: • Respond to requests and issues from the Antemortem Records Management Group Supervisor. • Attend all briefings/meetings as coordinated or requested by the Antemortem Records Management Group Supervisor. • Maintain communication with the Antemortem Records Management Group Page 552 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • Supervisor regarding the Antemortem Fingerprint Team Operations. − Report any issues that arise or process alterations needed to meet Fingerprint Team needs. Develop and maintain the Antemortem Fingerprint Team operational and staff schedule. Ensure all Antemortem Fingerprint Team personnel check-in and out at the beginning and end of shift. Schedule and provide operational briefings with Antemortem Fingerprint Team at the beginning and end of each operational period. − The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; scheduled AM interviews and anticipated walk-in AM interviews ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Identification of liaisons and points of contact for various resources (translators, mental health, etc.) ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Prepare and maintain Antemortem Fingerprint Team records and reports as appropriate. Provide reports regularly to the Antemortem Records Management Group Supervisor, or as requested. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. − Follow all Universal Precautions against exposure to communicable disease and biohazards. Coordinate with VIC Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period At the end of each operational period, provide a situation report to your direct supervisor related to the accomplishments/issues encountered during the operational period. Considerations • • It should be kept in mind that the Antemortem Fingerprint Team in the VIC represents just one function of the fingerprint specialists who work in MFM operations. In the disaster morgue, fingerprint specialists work to gather friction ridge impressions from the victim, if possible, and to compare antemortem and postmortem data to make victim identifications. The comparison of postmortem and antemortem medical records within UVIS-CMS may occur at the Fingerprint Station, by the Antemortem Fingerprint Team or by a separate DVI Reconciliation Team assigned to a separate location. All potential identifications by comparison of medical records will require confirmation by the Identification Review Committee. Page 553 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 554 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Antemortem Quality Assurance/Quality Control Group Supervisor Antemortem Quality Assurance/Quality Control (AM QA/QC) Group Supervisor Purpose/Mission To manage all aspects of antemortem data quality assurance and quality control ▪ Establish and monitor quality control measures related to antemortem operations and data entry Ensure all antemortem documentation is complete and has been examined by the appropriate personnel Objectives ▪ Assigned Area Victim Information Center (VIC) Supervisor Deputy FM Branch Director – AM Activation Checklist  Upon notification, arrive at the VIC location as directed by the Deputy FM Branch Director – AM.  Check in with the Deputy FM Branch Director – AM and receive situation briefing and set up instructions.  Obtain information on the current VIC facility and operations: − Health and safety protocols and requirements − Security procedures and credential/access requirements  Participate in VIC walk-through with the Deputy FM Branch Director – AM and other Group Supervisors to identify the layout and flow of the VIC.  Meet with the Deputy FM Branch Director – AM to determine Quality Assurance / Quality Control policies and procedures based on incident characterization and VIC operations. – Determine chain-of-custody requirements to maintain integrity of evidence and records. – Determine records management policies.  Determine AM QA/QC Group staffing requirements.  Assign and notify AM QA/QC Group staff to report to the VIC.  Request Team Leaders to notify team members (specialists) and provide them with instructions to report to the VIC.  Conduct a walk-through of the VIC with AM QA/QC Group and brief them on the following items: − Incident Characterization and Situational Awareness − Layout of the VIC and workflow − AM QA/QC Group operations, staffing, and schedules − Health and Safety briefing − Security briefing − Equipment/supply request procedure − Direct personnel to use their position checklists  Ensure that all AM QA/QC Group personnel have proper credentials to obtain access to the VIC area. Request that AM QA/QC Group personnel have credentials visible at all times.  Evaluate VIC space assigned to the AM QA/QC Group; determine if adequate for group operations and needs. Page 555 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths −      If additional space is needed, discuss needs with the Deputy FM Branch Director – AM. Coordinate with the VIC Support Group to ensure the proper equipment, supplies and IT applications are deployed to the appropriate areas to support AM QA/QC Group operations. – Ensure that AM QA/QC Group personnel set up appropriate equipment at designated area. – Instruct AM QA/QC Group personnel test all equipment to be sure all is in working order. – Request AM QA/QC Group coordinates with IT Team to ensure all necessary personnel have access to UVIS-CMS. – Instruct personnel to identify any additional equipment / supplies required and make request to VIC Support Group. Determine communication needs (i.e., radios, phones) and make request to the VIC Support Group (Communication Team). Coordinate with the Interview Group Supervisor and the Antemortem Records Management Group Supervisor to brief VIC personnel regarding QA/QC procedures to prevent errors. – Review data entry instructions. – Review case/record management instructions. – Request VIC personnel identify any QA/QC questions or issues prior to or during operations. Advise the Deputy FM Branch Director – AM of any AM QA/QC Group issues, foreseeable or actual, and make corrective recommendations. Notify the Deputy FM Branch Director – AM that the AM QA/QC Group is ready for the commencement of operations. Operational Responsibilities The AM QA/QC Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The AM QA/QC Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Maintain robust quality assurance and quality control program. – Monitor Antemortem data collection and management to ensure proper review of each case for duplication, error and or missing casework. ▪ Ensure the case numbers documented on all casework are consistent. ▪ Review casework to determine if there are multiple files for any specific specialty (i.e. multiple dental radiographs). ▪ Review paperwork to ensure no data entry inconsistencies or errors exist. ▪ Upon identification of inconsistency in documentation, coordinate with appropriate personnel to complete proper data collection and/or decipher between duplicated casework. General: • Attend all briefings / meetings as coordinated or requested by the Deputy FM Branch Director – AM. Page 556 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • • Maintain communication with the Deputy FM Branch Director – AM regarding AM QA/QC. – Report any issues that arise or process alterations needed to meet AM QA/QC needs. Maintain communications with AM QA/QC Group personnel on issues related to changes to or deviations from established procedures. Develop and maintain the AM QA/QC Group operational and staff schedule. Ensure all AM QA/QC Group personnel check-in and out at the beginning and end of each shift. Schedule and provide operational briefings with the AM QA/QC Group at the beginning and end of each operational period. – Consider inviting Interview Group Supervisor and Antemortem Records Management Group Supervisor to ensure they are aware of the QA/QC briefing materials. – The operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational period schedule ▪ Scheduled antemortem interviews and anticipated walk-in antemortem interviews that will require records collection ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with families ▪ Identification of liaison and points-of-contact for various resources ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Prepare and maintain AM QA/QC records and reports, as appropriate. Provide reports regularly to the Deputy FM Branch Director – AM, or as requested. Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. Follow and adhere to all health and safety protocols. − Follow all Universal Precautions against exposure to communicable disease and biohazards. Be aware of AM QA/QC Group personnel well-being and ensure that assistance, medical or otherwise, is available to personnel. Coordinate with VIC Support Group to ensure that all work areas/stations are clean and supplies are replenished at end of every operational period. At the end of each operational period, provide a situation report to your direct supervisor related to the accomplishments/issues encountered during the operational period. Considerations • • The AM QA/QC Group Supervisor should review the proper data entry methods prior to the commencement of antemortem operations. This includes ensuring all personnel that will contribute to data entry participate in UVIS-CMS Just-in-Time Training opportunities as necessary. Any human or technical errors must be caught as early as possible (preferably before the remains are released from the morgue) in order to prevent potential misidentifications. Page 557 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 558 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Victim Information Center Support Group Supervisor Victim Information Center Support Group Supervisor Purpose/Mission To coordinate with other VIC Group Supervisors to provide logistical support of facilities, equipment, supplies, and Information Technology aspects of antemortem operations ▪ Objectives ▪ Coordinate with Deputy FM Branch Director – AM to ensure the appropriate equipment, vehicles, and supplies are available to support morgue operations Ensure that all operations are conducted in a safe and efficient manner Assigned Area Victim Information Center Supervisor Deputy FM Branch Director – AM Supporting Positions / Functions Facilities Team Supply Team Equipment Team Information Technology Team Activation Checklist  Upon notification, arrive at the VIC location as directed by the Deputy FM Branch Director – AM.  Check in with the Deputy FM Branch Director – AM and participate in an operational briefing to receive: – Incident Characterization and Situational Awareness – VIC Operations and VIC Support Group Expectations  Based on the VIC Location, Scale, and workflow determine set up and support needs – Identify whether the VIC will be collocated within a Family Assistance Center (FAC). If so, make contact with the FAC Logistics personnel to coordinate set up and maintenance operations. – Identify VIC Facilities, Supply, and Equipment Team Leaders and make necessary notifications. – Identify immediate needs to ensure VIC site is prepared for mobilization of equipment. ▪ Identify areas to be cleaned and cleared ▪ Identify staging areas for equipment and supplies  Determine the Information Technology support required for the mobilization and maintenance of UVIS-CMS. – Identify Information Technology Team Leader and make necessary notifications.  Assemble the VIC Support Group Team Leaders and staff and provide them: – All necessary information regarding the mass fatality incident (MFI) – Interview Group Operations, staffing, and schedules – Antemortem Records Management Group Operations, staffing, and schedules – VIC type and Workflow – PPE requirements and use – Health and Safety Protocol information Page 559 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths             – Equipment / supply request procedure – Direct personnel to use their position checklists Participate in VIC walk-through with the Deputy FM Branch Director – AM and Group Supervisors / Team Leaders. – Sketch a layout of VIC, including functional areas and flow. – Identify locations for staff check-in and check-out stations. – Identify location for primary and ancillary functions (VIC command center / administrative area, staff respite area, etc.). Establish contact with the Agency Operations Center through the Deputy FM Branch Director – AM to confirm process for requesting resources not available in the VIC cache. Establish timeline for the deployment and set up of equipment. Instruct VIC Support Group to perform initial set up operations: – Instruct the Facilities Team to clean, clear, and prepare the facility for the deployed equipment and supplies. − Instruct the Equipment and Supplies Teams to assess the equipment and supplies necessary to support operations. – Request the Information Technology Team conduct an assessment of the facility’s infrastructure and determine the need for augmentation to support UVIS-CMS. – Request the Information Technology Team to conduct an assessment of the communication capabilities within the VIC and determine the need for augmentation. Coordinate with the agency providing security to support efforts to secure the VIC. – Deploy resources for the immediate establishment of check-in and check-out stations. – Deploy resources to assist with the establishment of perimeters, roadblocks, etc. Coordinate with the Interview Group Supervisor to support the establishment of reception and interview stations. – Identify locations for reception stations at the entry to the VIC; account for waiting room space. – Identify private, quiet rooms for antemortem interviews. Coordinate with the Antemortem Records Management Group Supervisor to support the establishment of an antemortem records area. – Identify a location for the collection and management of antemortem data including areas for the necessary teams: Evidence, Dental Records, Medical Records, AM DNA, AM Fingerprint, and Records Management. Identify signage needs to appropriately label and provide direction and other messaging throughout the VIC. – Request the VIC Facilities Team to develop and hang required signage. Upon deployment of equipment and supplies to the various areas, instruct VIC support personnel to assist in the set up of each area. Determine VIC Support Group communication needs (i.e., radios, phones). Coordinate with VIC Group Supervisors to identify resource gaps and determine ability to fulfill requests. – If unable to fulfill requests, submit a request to the Agency Operations Center for sourcing. Instruct VIC Information Technology Team to provide Just-in-Time Training to personnel regarding the use of UVIS-CMS and/or the communications equipment Page 560 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths (radios, etc.).  Advise the Deputy FM Branch Director – AM of any VIC Support Group issues, foreseeable or actual, and make corrective recommendations.  Notify the Deputy FM Branch Director – AM that the VIC Support Group is ready for the commencement of operations. Operational Responsibilities The VIC Support Group Supervisor is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The VIC Support Group Supervisor should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • • • • • • Monitor equipment and supply usage throughout the VIC Operation. – Request VIC personnel report resource needs for fulfillment utilizing the indicated protocols. – Instruct VIC Support Group personnel to replenish supplies and equipment at the end of each operational period, or as needed. – Monitor levels of equipment and supplies in VIC cache, resupply as needed. – If unable to fulfill requests, submit a request to the Agency Operations Center for sourcing. Monitor the information technology infrastructure of the VIC operation. – Instruct the VIC IT Team to continue to provide Just-in-Time Training as needed. – Instruct the VIC IT Team to troubleshoot any problems that arise. – Brief the Deputy FM Branch Director – AM of any issues that may affect morgue operations. Participate in all VIC briefings and walk-throughs. – Determine the type and quantity of equipment sufficient to set up and continue the VIC operation for each operational period. If applicable, maintain contact with the FAC Logistics support to coordinate VIC support efforts. When possible, fulfill resource requests from VIC Group Supervisors. If the VIC Support Group cannot fulfill a request: – Coordinate with the Agency Operations Center to procure the requested resources through contract or resource request submitted to the NYCEM Emergency Operations Center (EOC). Brief Deputy FM Branch Director – AM on any logistics issues or changes in procedure. Prepare and maintain facility, supply, equipment records and reports as appropriate. Manage all VIC Support Group personnel: Assemble, brief, and assign work locations and preliminary work tasks to VIC Support Group Teams/personnel. Ensure all personnel observe established level of operational safety and adhere to all health and safety protocols. Maintain communications with VIC Support Group personnel on issues related to changes to or deviations from established disaster specific processing procedures. Be aware of VIC Support Group personnel well-being and maintain communication with the VIC Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. Ensure all Group personnel are using applicable portions of their position checklists. Page 561 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • At the end of each operational period, ensure the VIC is thoroughly cleaned and resupplied Considerations • • • If the VIC is located within a FAC operation, many logistics/support operations will be conducted jointly. The VIC Support Group Supervisor must maintain contact with the FAC Logistics Team to ensure proper maintenance of the facility and IT Infrastructure. In addition, the FAC Logistics Team may serve as an additional resource for needed equipment and supplies. The VIC Support Group Supervisor should, to the best ability, compile a deployable stockpile of equipment and supplies to establish and support VIC Operations. The stockpile should be stored in a single location prepared to deploy upon notice; regular maintenance and inventory of equipment and supplies will be required. When determining the communications method in coordination with the VIC IT Team, consider the sensitive nature of VIC Operations. Radio-use and use of phones in the presence of family members is considered insensitive and should be avoided. Instead, coordinate communication methods that will not be visible to family members. Page 562 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Victim Information Center Facilities Team Victim Information Center Facilities Team Purpose/Mission To maintain Victim Information Center facility to support antemortem operations ▪ Objectives Evaluate, prepare and maintain the Victim Information Center facility to support antemortem operations Assigned Area Victim Information Center Supervisor VIC Support Group Supervisor Activation Checklist  Upon notification, arrive at the Victim Information Center location as directed by the VIC Support Group Supervisor.  Check in with the VIC Support Group Supervisor, and receive situation briefing and VIC Facilities Team operational requirements and set up instructions.  Participate in VIC walk-through with the VIC Support Group Supervisor and receive operational briefing. – Obtain information on the current disaster morgue facility and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and Safety protocols and requirements ▪ VIC security protocols and credential/access requirements ▪ Staffing and scheduling information  If applicable, meet with the FAC Facilities Team to coordinate VIC facilities operations with the overall FAC facility.  Determine team staffing requirements and make necessary notifications.  Assemble VIC Facilities Team personnel and provide them with an operational briefing to include, but not limited to: – Situational Awareness/Incident Update – Health and safety protocols ad requirements – VIC Security protocols and procedures; including credential requirements – VIC Facilities Team Operations – Staffing and scheduling information  Based on the incident characterization, and whether the VIC is located within a FAC operation, evaluate the VIC facility/space: – Ensure the proper infrastructure is present to support VIC operations. – Ensure space includes private, secluded areas for interactions with family members. – Determine the ability to augment the facility to meet the needs of the VIC operations.  Per instruction from the VIC Support Group Supervisor, clean and prepare the facility for the deployment of VIC equipment and supplies.  Develop schedule for cleaning the morgue facility each operational period, including restrooms and ancillary areas.  Receive all resource requests from the VIC Support Group Supervisor and fulfill as possible.  Identify any facilities issues to the VIC Support Group Supervisor for resolution.  Notify VIC Support Group Supervisor when the VIC Facilities Team is ready for the Page 563 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths commencement of operations. Operational Responsibilities The VIC Facilities Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The VIC Facilities Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • Monitor and maintain facility at all VIC operations. – Monitor infrastructure, identify damages and notify VIC Support Group Supervisor of anticipated repair needs. – Respond to requests from the VIC Support Group Supervisor. – Maintain cleaning schedule. – Monitor temperature and airflow. – Provide regular reports to the VIC Support Group Supervisor regarding the condition of the morgue facility and the need for augmentation and/or repairs. Attend all briefings and walk-throughs as requested by the VIC Support Group Supervisor. Maintain staffing schedule for VIC Facilities Team personnel. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Ensure all team personnel are using applicable portions of their position checklists. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with appropriate personnel ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the Morgue Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Considerations • If the VIC is co-located with a FAC Operation, the facilities responsibilities may be assumed or combined with the FAC facilities personnel. Page 564 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Victim Information Center Supplies Team Victim Information Center Supplies Team Purpose/Mission To order, receive, distribute, and store supplies to support VIC Operations ▪ Objectives ▪ Receive and respond to supply orders from authorized VIC staff Maintain inventory of supplies Assigned Area Victim Information Center Supervisor VIC Support Group Supervisor Activation Checklist  Upon notification, arrive at the VIC location as directed by the VIC Support Group Supervisor.  Check in with the VIC Support Group Supervisor, and receive situation briefing and VIC Supply Team operational requirements and set up instructions.  Participate in VIC walk-through with the VIC Support Group Supervisor and receive operational briefing. – Obtain information on the VIC facility and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ VIC security protocols and credential/access requirements ▪ Staffing and scheduling information  Determine team staffing requirements and make necessary notifications.  Assemble VIC Supply Team personnel and provide them with an operational briefing to include, but not limited to: – Situational Awareness / Incident Update – Health and safety protocols and requirements – VIC security protocols and procedures; including credential requirements – VIC Supply Team operations – Staffing and scheduling information  Evaluate the space assigned to VIC Supply staging and determine if adequate for team work flow and needs. − If additional facility space is needed, discuss needs with VIC Support Group Supervisor.  Conduct an initial inventory of the supply stockpile and develop schedule for updating supply inventory.  Establish mechanism for the ordering and receiving of additional supplies.  Establish contact with the Agency Operations Center, through the VIC Support Group Supervisor, to source requested supplies unable to fulfill from stockpile and/or order.  Per the instruction of the VIC Support Group Supervisor, deploy required supplies to the necessary locations.  Receive all resource requests from the Morgue Support Group Supervisor and fulfill as possible.  Identify supply gaps or depletion to the Morgue Support Group Supervisor for replenishment. Page 565 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Notify VIC Support Group Supervisor when the VIC Supplies Team is ready for the commencement of operations. Operational Responsibilities The VIC Supplies Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The VIC Supplies Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • Monitor and maintain supplies levels at all VIC operations. – Monitor use of supplies and notify VIC Support Group Supervisor of anticipated replenishment needs. – Order and receive supplies as needed. – Respond to requests from the VIC Support Group Supervisor. – Maintain an inventory of the VIC supply cache. – Provide regular reports to the VIC Support Group Supervisor regarding the inventory levels of supplies and the need to receive/order additional supplies. Attend all briefings and walk-throughs as requested by the VIC Support Group Supervisor. Maintain staffing schedule for VIC Supplies Team personnel. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Ensure all team personnel are using applicable portions of their position checklists. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with appropriate personnel ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the VIC Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Page 566 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Victim Information Center Equipment Team Victim Information Center Equipment Team Purpose / Mission To order, receive, distribute, and store equipment to support VIC Operations ▪ Objectives ▪ Receive and respond to equipment orders from authorized VIC staff Maintain inventory of equipment. Assigned Area VIC Facility Supervisor VIC Support Group Supervisor Activation Checklist  Upon notification, arrive at the VIC location as directed by the VIC Support Group Supervisor.  Check in with the VIC Support Group Supervisor, and receive situation briefing and VIC Equipment Team operational requirements and set up instructions.  Participate in VIC walk-through with the VIC Support Group Supervisor and receive operational briefing. – Obtain information on the current VIC facility and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ VIC security protocols and credential/access requirements ▪ Staffing and scheduling information  Determine team staffing requirements and make necessary notifications.  Assemble VIC Equipment Team personnel and provide them with an operational briefing to include, but not limited to: – Situational Awareness / Incident Update – Health and safety protocols and requirements – VIC security protocols and procedures; including credential requirements – VIC Equipment Team operations – Staffing and scheduling information  Evaluate the space assigned to VIC Equipment staging and determine if adequate for team work flow and needs. – If additional facility space is needed, discuss needs with VIC Support Group Supervisor.  Conduct an initial inventory of the equipment cache prior to deployment to stations. – Determine type and amount of equipment available in VIC cache. – Develop schedule for updating equipment inventory.  Establish mechanism for the ordering and receiving of additional equipment.  Establish contact with the Agency Operations Center, through the VIC Support Group Supervisor, to source requested equipment unable to fulfill from stockpile and/or order.  Per the instruction of the VIC Support Group Supervisor, deploy required equipment to the necessary locations. – Coordinate with VIC personnel to set up stations at designated locations. – Coordinate with the VIC personnel to test all equipment to be sure all is in working order. Page 567 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Provide “Just-in-Time” Training on equipment for VIC personnel, if needed.  Develop and implement safety and security measures for VIC equipment.  Receive all resource requests from the VIC Support Group Supervisor and fulfill as possible.  Identify equipment gaps or depletion to the VIC Support Group Supervisor for replenishment.  Notify VIC Support Group Supervisor when VIC Equipment Team is ready for the commencement of operations. Operational Responsibilities The VIC Equipment Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The VIC Equipment Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • • • • Monitor and maintain equipment at all VIC operations. – Monitor use of equipment and notify VIC Support Group Supervisor of anticipated replenishment needs. – Order and receive equipment as needed. – Respond to requests from the VIC Support Group Supervisor. – Maintain an inventory of the VIC equipment cache. – Provide regular reports to the Morgue Support Group Supervisor regarding the inventory levels of equipment and the need to receive/order additional equipment. Attend all briefings and walk-throughs as requested by the VIC Support Group Supervisor. Maintain staffing schedule for VIC Equipment Team personnel. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Ensure all team personnel are using applicable portions of their position checklists. Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with appropriate personnel ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the VIC Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Page 568 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Victim Information Center Information Technology Team Victim Information Center Information Technology Team Purpose/Mission To provide Information Technology and Telecommunications support to the VIC operation ▪ Objectives ▪ Establish and maintain Information Technology and Telecommunications support of VIC operations, including the operation of UVIS-CMS to manage the antemortem data Provide Just-in-Time training to VIC personnel regarding the proper use of UVIS-CMS and other technologies Assigned Area Victim Information Center Supervisor VIC Support Group Supervisor Activation Checklist  Upon notification, arrive at the VIC location as directed by the VIC Support Group Supervisor.  Check in with the VIC Support Group Supervisor, and receive situation briefing and VIC Information Technology Team operational requirements and set up instructions.  Participate in VIC walk-through with the VIC Support Group Supervisor and receive operational briefing. – Obtain information on the current disaster morgue facility and operations: ▪ Incident Characterization and Situational Awareness ▪ Health and safety protocols and requirements ▪ VIC security protocols and credential/access requirements ▪ Staffing and scheduling information  Perform assessment of VIC facility infrastructure to determine the ability to support UVIS-CMS. – Identify necessary augmentation of the facility infrastructure to support UVISCMS.  Determine team staffing requirements and make necessary notifications. Consider creating units responsible for the following areas: – Desktop: Responsible for managing all desktop equipment needs. – Server: Responsible for managing all server and telephony needs. – Network: Responsible for managing all network needs. – Applications: Responsible for managing all application needs. – Communications: Responsible for managing all communications needs (Radios, etc.).  Assemble VIC IT Team personnel and provide them with an operational briefing to include, but not limited to: − Situational Awareness / Incident Update − Health and safety protocols and requirements − VIC security protocols and procedures; including credential requirements − VIC IT Team operations to establish and maintain UVIS-CMS and/or communications capabilities − Staffing and scheduling information  Provide instruction to the VIC IT Team to set up equipment necessary to establish the IT infrastructure. Page 569 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths –      Coordinate with the VIC Support Group to deploy all equipment and supplies necessary to establish the necessary IT infrastructure. – Instruct VIC IT Team to assist forensic personnel to set up UVIS-CMS equipment at each station. – Instruct VIC IT Team to test UVIS-CMS and ancillary equipment to ensure all is functional. – Ensure all VIC personnel receive “Just-in-Time” Training on UVIS-CMS to ensure that they are able to properly enter all antemortem data. Instruct VIC IT Team to establish necessary communications methods. – Coordinate with VIC Group Supervisors to determine communications needs. – Coordinate with the VIC Support Group to deploy all equipment and supplies necessary to establish the necessary communications infrastructure. – Instruct VIC IT Team to test all radios and/or other communications tools to ensure all are functional. – Instruct VIC IT Team to distribute radios and/or other communications tools – Ensure all morgue personnel receive “Just-in-Time” Training on radio-use to ensure that they are able to properly communicate with other VIC personnel. Implement safeguards and regulate access to information to ensure integrity of sensitive victim and victim family data. Receive all resource requests from the VIC Support Group Supervisor and fulfill as possible. Report any VIC IT issues to the VIC Support Group Supervisor for resolution. Notify VIC Support Group Supervisor when VIC IT Team is ready for the commencement of operations. Operational Responsibilities The VIC Information Technology Team is responsible for the following items throughout the VIC operations. Several of these items will be ongoing or repeated through the course of the response. The VIC Information Technology Team should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • • • Monitor and maintain Information Technology and Telecommunications to support VIC operations. – Monitor infrastructure, identify damages and notify VIC Support Group Supervisor of anticipated repair needs. – Order and receive IT equipment and supplies as needed; coordinate with the VIC Equipment and Supplies Teams as needed. – Respond to requests from the VIC Support Group Supervisor. – Maintain personnel to assist VIC personnel with data entry and/or record keeping issues. – Provide regular reports to the VIC Support Group Supervisor regarding Information Technology and Telecommunications; identify the need for augmentation and/or repairs. Consider staffing an IT Help Desk to serve as a central point-of-contact for any ITrelated issues. Attend all briefings and walk-throughs as requested by the VIC Support Group Supervisor. Maintain staffing schedule for VIC IT Team personnel. Maintain communications with team personnel on issues related to changes to or deviations from established disaster specific processing procedures. Page 570 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • Ensure all team personnel are using applicable portions of their position checklists Follow and adhere to all health and safety protocols. Be aware of team personnel well-being and maintain communication with appropriate personnel ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the VIC Support Group Supervisor related to the accomplishments/issues encountered during the operational period. Considerations • When determining the communications method in coordination with the VIC Support Group Supervisor, consider the sensitive nature of VIC Operations. Radio-use and use of phones in the presence of family members is considered insensitive and should be avoided. Instead, coordinate communication methods that will not be visible to family members. Consider: • The VIC Support Group Supervisor should be present for the decision to activate the VIC operation. The number of interview stations will be partly dependent on the IT infrastructure available to handle the interview needs. • If the infrastructure is not available to efficiently and effectively operate UVIS-CMS, consider the use of paper AM interview forms. The data can carefully be entered into UVIS-CMS separately. • Lessons learned from past event show that in order to prevent errors in data entry; it is beneficial to have a dual screen station set up. At least one screen should be facing the interviewer for data entry; the other screen(s) should be facing the family/friends. This allows the family/friends to view and identify errors during the interview process (i.e. misspelling names, errors in number order, etc.). Page 571 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 572 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths G. Pre-Scripted Mission Requests Page 573 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 574 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Request: Fatality Search and Recovery Team Request Information Incident Name E-Team Tracking Number D-Lan Ticket Number Date/Time Request Needed Person Submitting Request Requesting Individual Requesting Agency Requesting County Is this request (check all that apply): □ Life Safety □ Priority □ Routine Request Details Brief description of problem encountered Due to a disaster in New York City, the City requires assistance to support ongoing Mass Fatality Management (MFM) recovery and mortuary affairs operations. Resources Requested Requesting operations support from National Guard Bureau Fatality Search and Recovery Team (FSRT) or similar resource. Task & Purpose To recover decedents from a chemically, biologically, or radiologically contaminated area. Related ESFs Public Health and Medical Services (ESF 8) Mission Resource should have an ability to perform search and recovery of decedents in a field location, be capable to enter chemical, biological or radiologically contaminated areas, and support radiological monitoring of the area and decedents Notes 1. Potential Dependencies to Consider – Transportation Support, Credentialing Support for Staff, Facility Support, Equipment Support, and Base Camp Support for Staff. Quantity of Resources Requested Page 575 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Current Resources Committed to Identified Tasks/Functions Have all local capabilities associated with this resource been exhausted? □ Yes □ No What Sources/Vendors Have Been Contacted? Potential Substitutes Personnel Required To Operate, Support, And Maintain Support Equipment Needed Approximate Length Of Time Resource Is Needed Delivery Information Delivery Location Delivery Contact Name Delivery Phone Number Delivery Notes Safety Considerations 1. Ensure information provided on this form as well as all actions taken in relations to this request is performed by qualified professionals. 2. Requesting agency assumes all costs unless otherwise noted. 3. It is the requestor’s responsibility to notify the SEOC Logistics of the resource status. (Arrival time, idle time, time used, demobilization time before the actual demobilization, and time released). Page 576 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Request: Mortuary Affairs Request Information Incident Name E-Team Tracking Number D-Lan Ticket Number Date/Time Request Needed Person Submitting Request Requesting Individual Requesting Agency Requesting County Is this request (check all that apply): □ Life Safety □ Priority □ Routine Request Details Brief description of problem encountered Due to a disaster in New York City, the City requires assistance to support ongoing Mass Fatality Management (MFM) recovery and mortuary affairs operations. Resources Requested Requesting operations support from Department of Defense (DOD) –Title 10 Mortuary Affairs (MA) Unit or similar resource. Task & Purpose To provide mortuary affairs assistance in support of disaster operations following the occurrence of a large-scale incident. Related ESFs Public Health and Medical Services (ESF 8) Mission Resource will recover and transport remains to collection point/mortuary affairs facility, and prepare and coordinate shipments of remains to the place designated by authorized person. Notes 1. As requested by and in coordination with FEMA the Department of Defense (DOD) will provide personnel in support of the recovery of remains. One DOD MA six-person team can recover approx 20 remains per day. 2. Potential Dependencies to Consider – Transportation Support, Credentialing Support for Staff, Facility Support, Equipment Support, and Base Camp Support for Staff. Page 577 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Quantity of Resources Requested Current Resources Committed to Identified Tasks/Functions Have all local capabilities associated with this resource been exhausted? □ Yes □ No What Sources/Vendors Have Been Contacted? Potential Substitutes Personnel Required To Operate, Support, And Maintain Support Equipment Needed Approximate Length Of Time Resource Is Needed Delivery Information Delivery Location Delivery Contact Name Delivery Phone Number Delivery Notes Safety Considerations 1. Ensure information provided on this form as well as all actions taken in relations to this request is performed by qualified professionals. 2. Requesting agency assumes all costs unless otherwise noted. 3. It is the requestor’s responsibility to notify the SEOC Logistics of the resource status. (Arrival time, idle time, time used, demobilization time before the actual demobilization, and time released). Page 578 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Request: Refrigerated Storage Units Request Information Incident Name E-Team Tracking Number D-Lan Ticket Number Date/Time Request Needed Person Submitting Request Requesting Individual Requesting Agency Requesting County Is this request (check all that apply): □ Life Safety □ Priority □ Routine Request Details Brief description of problem encountered Due to a disaster in New York City, the City requires assistance to support ongoing Mass Fatality Management (MFM) recovery and mortuary affairs operations. Resources Requested Requesting a refrigerated trailer (with delivery). Task & Purpose To provide immediate and intermediate cold storage solution for human remains recovered as a result of disaster/MFM operations in New York City. Related ESFs Public Health and Medical Services (ESF 8) Mission Notes 1. See attached equipment specifications Quantity of Resources Requested Page 579 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Current Resources Committed to Identified Tasks/Functions Have all local capabilities associated with this resource been exhausted? □ Yes □ No What Sources/Vendors Have Been Contacted? Potential Substitutes Personnel Required To Operate, Support, And Maintain Support Equipment Needed Approximate Length Of Time Resource Is Needed Delivery Information Delivery Location Delivery Contact Name Delivery Phone Number Delivery Notes Safety Considerations 1. Ensure information provided on this form as well as all actions taken in relations to this request is performed by qualified professionals. 2. Requesting agency assumes all costs unless otherwise noted. 3. It is the requestor’s responsibility to notify the SEOC Logistics of the resource status. (Arrival time, idle time, time used, demobilization time before the actual demobilization, and time released). Page 580 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Request: Mass Fatality Management IMT Team Request Information Incident Name E-Team Tracking Number D-Lan Ticket Number Date/Time Request Needed Person Submitting Request Requesting Individual Requesting Agency Requesting County Is this request (check all that apply): □ Life Safety □ Priority □ Routine Request Details Brief description of problem encountered Due to a disaster in New York City, the City requires assistance to support ongoing Mass Fatality Management (MFM) recovery and mortuary affairs operations. Resources Requested Request dedicated MFM Incident Management Teams (IMT). Task & Purpose To provide a planning cell or team capable of conducting and producing plans for near term or midterm response efforts. The second planning cell is for future or long- term planning, which is defined as beyond the two upcoming operational periods and out to demobilization. Related ESFs Public Health and Medical Services (ESF 8) Mission Notes 1. This function is very heavily logistically oriented and may require strategic assets to accomplish mass fatality demobilization. Planning cells should assist in development of detailed, risk-based, unified plans. The two cells should assist in maintaining situational awareness for the appropriate operations period(s) and assist with publication of the Situation Report for respective operational period. Page 581 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Quantity of Resources Requested Current Resources Committed to Identified Tasks/Functions Have all local capabilities associated with this resource been exhausted? □ Yes □ No What Sources/Vendors Have Been Contacted? Potential Substitutes Personnel Required To Operate, Support, And Maintain Support Equipment Needed Approximate Length Of Time Resource Is Needed Delivery Information Delivery Location Delivery Contact Name Delivery Phone Number Delivery Notes Safety Considerations 1. Ensure information provided on this form as well as all actions taken in relations to this request is performed by qualified professionals. 2. Requesting agency assumes all costs unless otherwise noted. 3. It is the requestor’s responsibility to notify the SEOC Logistics of the resource status. (Arrival time, idle time, time used, demobilization time before the actual demobilization, and time released). Page 582 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Request: Disaster Mortuary Operational Response Team (DMORT) Request Information Incident Name E-Team Tracking Number D-Lan Ticket Number Date/Time Request Needed Person Submitting Request Requesting Individual Requesting Agency Requesting County Is this request (check all that apply): □ Life Safety □ Priority □ Routine Request Details Brief description of problem encountered Due to a disaster in New York City, the City requires assistance to support ongoing Mass Fatality Management (MFM) efforts. Resources Requested OCME requests DMORT support in the following quantities and specialities to support MFM operations: Forensic Pathologists Forensic Odontologists Forensic Anthropologists Fingerprint Specialists Forensic Photographers Forensic Radiographers Mortuary Support Personnel Scribes Victim Information Center Team DMORT All-Hazards Team Logistics Support Security Support IT Support Task & Purpose To assist in postmortem and antemortem processing of disaster victims; to provide general MFM support in logistics, security, and/or information technology. Related ESFs Page 583 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Public Health and Medical Services (ESF 8) Mission Notes Quantity of Resources Requested See above detailed request. Current Resources Committed to Identified Tasks/Functions Have all local capabilities associated with this resource been exhausted? □ Yes □ No What Sources/Vendors Have Been Contacted? Potential Substitutes Personnel Required To Operate, Support, And Maintain Support Equipment Needed Approximate Length Of Time Resource Is Needed Page 584 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Delivery Information Delivery Location Delivery Contact Name Delivery Phone Number Delivery Notes Safety Considerations 1. Ensure information provided on this form as well as all actions taken in relations to this request is performed by qualified professionals. 2. Requesting agency assumes all costs unless otherwise noted. 3. It is the requestor’s responsibility to notify the SEOC Logistics of the resource status. (Arrival time, idle time, time used, demobilization time before the actual demobilization, and time released). Page 585 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 586 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Request: Disaster Victim Identification Team (Interpol) Request Information Incident Name E-Team Tracking Number D-Lan Ticket Number Date/Time Request Needed Person Submitting Request Requesting Individual Requesting Agency Requesting County Is this request (check all that apply): □ Life Safety □ Priority □ Routine Request Details Brief description of problem encountered Due to an international disaster in New York City, the City requires assistance to support ongoing Mass Fatality Management (MFM) disaster victim identification (DVI) efforts. Resources Requested Request Disaster Victim Identification coordination support from Interpol National Central Bureau (NCB) housed at the Federal Bureau of Investigation (FBI) and Interpol Incident Response Teams. Task & Purpose To assist in the coordination and collection of antemortem data when foreign decedents are involved in the incident. DVI personnel onsite in NYC will liaise with Interpol DVI personnel in foreign field offices to assist with coordination efforts in NYC. Related ESFs Public Health and Medical Services (ESF 8) Mission Notes 1. Requested Interpol personnel will support disaster victim identifixation and antemortem data collection only. Interpol personnel are not requested to fulfill law enforcement functions. Quantity of Resources Requested Page 587 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Current Resources Committed to Identified Tasks/Functions Have all local capabilities associated with this resource been exhausted? □ Yes □ No What Sources/Vendors Have Been Contacted? Potential Substitutes Personnel Required To Operate, Support, And Maintain Support Equipment Needed Approximate Length Of Time Resource Is Needed Delivery Information Delivery Location Delivery Contact Name Delivery Phone Number Delivery Notes Safety Considerations 1. Ensure information provided on this form as well as all actions taken in relations to this request is performed by qualified professionals. 2. Requesting agency assumes all costs unless otherwise noted. 3. It is the requestor’s responsibility to notify the SEOC Logistics of the resource status. (Arrival time, idle time, time used, demobilization time before the actual demobilization, and time released). Page 588 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Request: National Guard Civil Support Team Request Information Incident Name E-Team Tracking Number D-Lan Ticket Number Date/Time Request Needed Person Submitting Request Requesting Individual Requesting Agency Requesting County Is this request (check all that apply): □ Life Safety □ Priority □ Routine Request Details Brief description of problem encountered Due to a disaster in New York City, the City requires assistance to support ongoing Mass Fatality Management (MFM) efforts. Resources Requested OCME requests National Guard Civil Support Team personnel to assist in contaminated support MFM operations. Task & Purpose To assist in postmortem and antemortem processing of CBRNE contaminated disaster victims. Related ESFs Public Health and Medical Services (ESF 8) Mission Notes Quantity of Resources Requested See above detailed request. Page 589 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Current Resources Committed to Identified Tasks/Functions Have all local capabilities associated with this resource been exhausted? □ Yes □ No What Sources/Vendors Have Been Contacted? Potential Substitutes Personnel Required To Operate, Support, And Maintain Support Equipment Needed Approximate Length Of Time Resource Is Needed Delivery Information Delivery Location Delivery Contact Name Delivery Phone Number Delivery Notes Safety Considerations 1. Ensure information provided on this form as well as all actions taken in relations to this request is performed by qualified professionals. 2. Requesting agency assumes all costs unless otherwise noted. 3. It is the requestor’s responsibility to notify the SEOC Logistics of the resource status. (Arrival time, idle time, time used, demobilization time before the actual demobilization, and time released). Page 590 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths H. Core and Target Capabilities Page 591 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 592 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Core Capability: Fatality Management Services The Federal Emergency Management Agency under the National Preparedness Goal developed 31 core capabilities related to disaster management. The New York City Office of Chief Medical Examiner’s disaster response activities fall under Fatality Management Services. Mission Area: Response • Response Core Capabilities comprise “the capabilities necessary to save lives, protect property and the environment, and meet basic needs after an incident has occurred.”17 Description: Provide fatality management services, including body recovery and victim identification, working with state and local authorities to provide temporary mortuary solutions, sharing information with mass care services for the purpose of reunifying family members and caregivers with missing persons/remains, and providing counseling to the bereaved.57 Target Capabilities: Fatality Management Services “To effectively perform scene documentation; the complete collection and recovery of the dead, victim’s personal effects, and items of evidence; decontamination of remains and personal effects (if required); transportation, storage, documentation, and recovery of forensic and physical evidence; determination of the nature and extent of injury; identification of the fatalities using scientific means; certification of the cause and manner of death; processing and returning of human remains and personal effects of the victims to the legally authorized person(s) (if possible); and interaction with and provision of legal, customary, compassionate, and culturally competent required services to the families of deceased within the context of the family assistance center.”58 57 58 FEMA National Preparedness Goal Core Capabilities FEMA Crosswalk of Target Capabilities to Core Capabilities, 2007 Page 593 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 594 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths I. Forms For operational forms for scene, postmortem, and antemortem operations, please reference the Regional Mass Fatality Management Response System Field Operations Guides for Scene, Disaster Morgue, and Victim Information Center. Page 595 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 596 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths OCME Incident Characterization Form Purpose: The Incident Characterization Form provides an initial assessment of the incident, allowing command staff to make appropriate decisions regarding operational decisions. Preparation: The Incident Characterization is completed by field personnel responding to the scene. Distribution: The Incident Characterization will be part of the Situation Report and given to all supervisory personnel at the Section, Branch, Group, and Unit levels. All completed original forms must be given to the Documentation Unit. Notes: • The Incident Characterization is part of the Situation Report. • Updated Incident Characterization forms may be included as the situation progresses. # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. Indicate which borough. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. 3 Criteria Select the most fitting option describing the incident for each category. 4 Notes Include any quantifying or relevant information specific to the category. 5 Immediate Resources List preliminary additional resources that may be necessary Required for the incident response and indicate the resource type. Page 597 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 598 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 599 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 600 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Incident Objectives59 Purpose: The Incident Objectives (equivalent to ICS 202) describes the basic incident strategy, incident objectives, command emphasis/priorities, and safety considerations for use during the next operational period. Preparation: This form is completed by the Documentation Unit following each Command and General Staff meeting conducted to prepare the Situation Report. Distribution: This form may be reproduced with the Situation Report and may be part of the Situation Report and given to all supervisory personnel at all levels. All completed original forms must be given to the Documentation Unit. Notes: • This form is part of the Situation Report and can be used as the opening or cover page. • If additional pages are needed, use a blank form and repaginate as needed. # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. Indicate which borough. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. Enter clear, concise statements of the objectives for managing the current operational period in priority order. Objectives should follow the SMART model: Specific: Is the wording precise and unambiguous? Measureable: How will achievements be measured? Action-Oriented: Is an action verb used? Realistic: Is the outcome achievable? Time-Sensitive: What is the timeframe? 3 Objective(s) 4 Command Emphasis and Situational Awareness Enter information regarding the prioritization of incident objectives and general information regarding the situation (i.e. weather, scene hazards, etc.) 5 Site Safety Plan Indicate whether a safety plan is required and where it is located. 6 Situation Report List which items are included in the complete Situation Report. 7 Preparation Enter the name of the person preparing the form. 8 Approval Enter the name of the person approving the content. 59 Adapted from FEMA ICS 202 form (https://training.fema.gov/emiweb/is/icsresource/icsforms.htm) Page 601 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 602 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Organizational Assignment List60 Purpose: The Organization Assignment List (equivalent to ICS 203) provides personnel with information on the units that are currently activated and the names of personnel staffing each position/unit. It is used to complete the Incident Organization Chart which is posted on the Incident Command Post display. An actual organization will be incident or event-specific. Not all positions need to be filled. Some blocks may contain more than one name. The size of the organization is dependent on the magnitude of the incident and can be expanded or contracted as necessary. Preparation: The Resources Unit prepares and maintains the list under the direction of the Operations Center Coordinator. Only positions that are being utilized should be completed. Distribution: This form is duplicated and attached to the Incident Objectives and given to all recipients as part of the Situation Report. All completed original forms must be given to the Documentation Unit. Notes: • This form serves as part of the Situation Report • If needed, more than one name can be put in each block by inserting a slash • If additional pages are needed, use a blank forms and repaginate as needed • All names should be recorded with first initial and full last name # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. Indicate which borough. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. 3 Agency Command Staff Enter the names of the Disaster Response Coordinator and Command Staff. 4 Agency Operations Center Enter the names of the Agency Operations Center Staff. 5 Agency Logistics Enter the names of the Agency Logistics Command Staff. 6 Fatality Management Branch Staff Enter the names of the Fatality Management Branch Director and their Command Staff. 7 Agency Finance/ Administration Enter the names of the Agency Finance/Administration Command Staff. 8 Preparation Enter the name of the person preparing the form. 60 Adapted from FEMA ICS 203 form (https://training.fema.gov/emiweb/is/icsresource/icsforms.htm) Page 603 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 604 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Assignment List61 Purpose: The Assignment List informs staff of incident assignments. Once the assignments are determined by Command Staff, the assignment information is distributed among responding personnel. Preparation: The Assignment List is prepared by the Documentation Unit with input from Deputy Fatality Management Branch Directors and the Agency Command Staff as needed. The Disaster Response Coordinator must approve before distribution. Distribution: This form is duplicated and included in the Situation Report. All original forms must be given to the Documentation Unit. Notes: • Multiple pages may be used as necessary # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. Indicate which borough. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. 3 Operations Personnel Enter the names and contact information of the relevant Command Staff. 4 Resources Assigned Enter basic information about resources ordered, including name/type of resource, unique identifier, time ordered and estimated arrival time, and any notes (i.e. staging location, etc.) 5 Tactical Objectives Describe the tactical objectives to be completed within the operational period for the resources assigned. 6 Special Instructions Note any safety concerns, operational locations, or other important information not included elsewhere. 7 Preparation Enter the name of the person preparing the form. 61 Adapted from FEMA ICS 204 form (https://training.fema.gov/emiweb/is/icsresource/icsforms.htm) Page 605 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 606 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Incident Radio Communications Plan62 Purpose: The Incident Radio Communications Plan provides information regarding assigned radio frequencies in use for incident operations. Preparation: This form is prepared by the Documentation Unit and given to the Operations Center Coordinator for addition in the Situation Report. Distribution: This form is included in the Situation Report that is distributed to all personnel involved in the incident. All completed original forms must be given to the Documentation Unit. Notes: • Multiple pages may be used as necessary # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. Indicate te which borough. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. 3 Basic Radio Channel Use List the radio channels in use and assigned function. 4 Special Instructions Note any safety concerns, operational locations, or other important information not included elsewhere. 5 Preparation Enter the name of the person preparing the form. 62 Adapted from FEMA ICS 205 form (https://training.fema.gov/emiweb/is/icsresource/icsforms.htm) Page 607 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 608 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Medical Plan63 Purpose: The Medical Plan (equivalent to ICS 206) provides information on incident medical aid stations, transportation services, and medical emergency procedures. Preparation: This form is prepared by the Safety Officer and reviewed by the Disaster Response Coordinator. Distribution: This form is included in the Situation Report and given to all responders. All completed original forms must be given to the Documentation Unit. Notes: • Multiple pages may be used as necessary # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. Indicate which borough. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. 3 Medical Aid Stations Complete the name, location, contact information, and availability of paramedics for designated medical aid stations. 4 Transportation Complete the information for available emergency transportation for responders. 5 Hospitals Complete the information for nearby hospitals. 6 Special Medical Emergency Procedures Detail procedures for reporting medical emergencies, including who should be contacted and how an incident within the incident will be handled. 7 Preparation Enter the name of the person preparing the form. 8 Approval Enter the name of the person approving the form. 63 Adapted from FEMA ICS 206 form (https://training.fema.gov/emiweb/is/icsresource/icsforms.htm) Page 609 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 610 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Organizational Chart64 Purpose: The Organizational Chart (equivalent to ICS 207) provides a fillable organization chart for the incident response. Preparation: This form is prepared by the Documentation Unit and reviewed by the Operations Center Coordinator. Distribution: This form is included in the Situation Report and given to all responders. All completed original forms must be given to the Documentation Unit. # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. 3 Agency Organizational Chart Enter the names of the individuals in the Command roles. 4 Preparation Enter the name of the person preparing the form. 64 Adapted from FEMA ICS 207 form (https://training.fema.gov/emiweb/is/icsresource/icsforms.htm) Page 611 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 612 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Incident Check In List 65 Purpose: The Incident Check-In List (equivalent to ICS 211) allows for documentation of personnel and accountability for time and assignments. Preparation: This form is prepared by the Documentation Unit and reviewed by the Operations Center Coordinator. Distribution: This form is included in the Situation Report and given to all responders. All completed original forms must be given to the Documentation Unit. Notes: • Multiple pages may be used as necessary # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. 3 Check In Location Check off the box corresponding to check-in location. If other, please write in location name. 4 Personnel Fill in personnel details including: • Name • Agency • Assignment • Supervisor • Location • Time In • Time Out • Phone Number 5 Preparation Enter the name of the person preparing the form. 65 Adapted from FEMA ICS 211 form (https://training.fema.gov/emiweb/is/icsresource/icsforms.htm) Page 613 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 614 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Activity Log66 Purpose: The Activity Log (equivalent to ICS 214) documents major events that occur during an operational period. Preparation: This form is prepared by the Documentation Unit and reviewed by the Operations Center Coordinator. Distribution: This form is included in the Situation Report and given to all responders. All completed original forms must be given to the Documentation Unit. Notes: Multiple pages may be used as necessary # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. Indicate which borough. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. 3 Unit Roster Enter the names of the individuals in the unit, including name, position, and assigned area. 4 Activity Document notable occurrences, including the time. 5 Preparation Enter the name of the person preparing the form. 6 Approval Enter the name of the person approving the form. 66 Adapted from FEMA ICS 214 form (https://training.fema.gov/emiweb/is/icsresource/icsforms.htm) Page 615 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 616 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Vehicle/Equipment Log67 Purpose: The Vehicle/Equipment Log (equivalent to ICS 218) documents the usage of vehicles and equipment during an operational period. Preparation: This form is prepared by Logistics personnel and reviewed by the Logistics Chief. Distribution: The ICS 218 is included in the Situation Report and given to all responders. All completed original forms must be given to the Documentation Unit. Notes: Multiple pages may be used as necessary # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. Indicate which borough. 2 Operational Period Enter the start date (xx/xx/xxxx) and time (using 24-hour clock) and end date and time for the operational period to which the form applies. 3 Vehicle/Equipment Category Provide a broad category for the items being documented (i.e. Generators, Investigator Vehicles, etc). 4 Vehicle/Equipment Information Document vehicle/equipment information and usage, including: Make Model Operator Name Assignment License Plate/VIN (or equivalent) Time Out Time In 5 Preparation Enter the name of the person preparing the form. 67 Adapted from FEMA ICS 218 form (https://training.fema.gov/emiweb/is/icsresource/icsforms.htm) Page 617 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 618 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths J. Pre-Established Body Collection Points Page 619 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 620 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Pending responses from health care facilities Page 621 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 622 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Annexes Page 623 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 624 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths 1: Biological Incident Decedent Recovery Strategy for Health Care Facilities Page 625 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 626 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Biological Incident Surge Response Triggers The majority of biological outbreaks that occur in NYC will not cause sufficient strain or fatalities to activate this Surge plan. Minor foodborne outbreaks, seasonal influenza, and isolated airborne outbreaks will not result in a surge of fatalities that would cause undue stress to the fatality management system in the city. The decision to activate the Surge plan will be made by senior leadership from the OCME, HCFs, and other city agencies and officials. Since a biological incident can occur before authorities know about the outbreak, the OCME has established caseload hazard trigger points. These will help professionals determine whether a situation that might signal a biological incident has occurred. In addition to identifying an unusual incident, these trigger points are associated with specific response activities. Based on the trigger points, the OCME can modularly increase its capability in relation to the magnitude of the event. Surveillance indicators will depend on the specific pathogen, but can be generally defined as an unexplained uptick in similar symptoms/illnesses that is identified during routine analysis. • • • • • • Less than 60 deaths per day – with no surveillance indicators reported 60 - 200 deaths per day – with or without surveillance indicators reported 200 - 500 cumulative deaths – additional surveillance indicators present 500 - 2,000 cumulative deaths – additional surveillance indicators present 2,000 - 5,000 cumulative deaths – additional surveillance indicators present Above 5,000 cumulative deaths – additional surveillance indicators present Early increased numbers of daily fatalities will manifest at all stages of decedent processing: • • • • An increase in the number of requests by health care facilities for OCME to hold decedents An increase in funeral directors being unable to pick up decedents from HCFs or OCME in a timely manner An increase in cases that exceeds OCME’s standard storage capacity Inability of cemeteries and City Burial to keep up the number of requested burials Assignment of Responsibilities It is essential that health care facilities include fatality management in their emergency planning efforts. While NYCEM and OCME will provide significant assistance with BCP operations at health care facilities, a large portion of responsibility will fall on HCF staff. Employees should be familiar with the overall process and be assigned positions prior to an incident occurring. Biological incidents are unique in that resulting deaths may be classified as “natural”. In daily operations, OCME does not have jurisdiction over natural deaths and only takes custody of these decedents should they not be claimed by family members or should the HCF face storage issues. The physicians at the HCF have the authority and Page 627 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths responsibility to sign and issues death certificates and the HCF must maintain decedent personal effects until they are released to the family. Mass numbers of fatalities caused by naturally occurring biological incidents, such as pandemic influenza, will still fall under the jurisdiction of the HCFs for the issuance of death certificates and authority will stay with the HCF to release remains to funeral directors. However, due to the anticipated large numbers of decedents, OCME will assist HCFs with long-term storage, as presented in this document. During a natural biological incident, HCFs must continue to follow standard operating procedures for reporting ME cases (including homicides, suicides, therapeutic complications, and accidents). Suspected intentional or criminal biological incidents will result in manner of death being listed as “homicide”. OCME will rely on HCFs to manage to manage storage operations at BCPs located at HCFs during biological incidents suspected of being criminal or intentional in nature, but will be responsible for postmortem operations and death certificate registration. During a natural biological incident, HCFs must separate nonbiological incident ME cases. Non-disaster ME cases should be handled according to standard operating procedures. Essential Support Processes Decedent Tracking Proper tracking of decedents is paramount during all phases of processing. Health care facilities must ensure 100% accuracy in managing decedents while they are in the custody of the HCF. Chain of custody should be enforced from the time a decedent is declared dead to when OCME takes custody of the BCP. As the surge escalates, the HCF Morgue Manager may consider designating one or more Body Handlers as quality assurance/quality control officers to ensure chain of custody is being maintained and decedents are being properly tracked. Copies of all BCP documentation and decedent manifests should be provided to OCME personnel upon pick up of the BCP. OCME personnel will reconcile the BCP manifest with the presence of physical decedents prior to accepting a BCP for transport to an OCME facility. Digital systems for data management are always preferred to paper systems. Death certificates for natural biological incidents (i.e. pandemic influenza) should be registered according to normal HCF protocol through the Electronic Death Registration System (EDRS). Deaths may be recorded through the Health Care Self-Reporting Module available in UVIS-CMS (preferred) or may be called into OCME Communications. During an intentional or criminal biological incident, death certificates should not be registered by HCF physicians. Deaths should be entered into UVIS-CMS via the SelfReporting Module or reported to OCME Communications. HCFs should record all pertinent information relating to a decedent including but not limited to: • Full name (first, last, and middle) • Date of birth • Date of death • Sex • Age • BCP intake date Page 628 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • HCF admission date Case history BCP/HCF identification number Presence of personal effects (if applicable) OCME case number (if available) OCME case type (i.e. claim only or ME) Contact information for NOK (if known) Contact information for funeral home (if known) Religious affiliation (if known) Personal Effects Management Health care facilities initially manage decedent personal effects on a daily basis. This function will continue during a biological incident, but will need to surge in capacity as with decedent storage. As with tracking of decedents, tracking personal effects must be performed with 100% accuracy due to the importance of these items to family members. Chain of custody must be documented from when items are collected after to death to their release to the appropriate entity (i.e. next of kin, law enforcement, etc.). HCFs should prepare for storing personal effects for an extended period of time and in an increased amount. A secure facility should be chosen that will be large enough to handle a large amount of personal effects. Decedent personal effects can be packaged per hospital protocol, but during a surge, personnel should ensure items are sealed well prior to labeling. Plastic bins may be useful in organizing large amounts of PE. HCFs should avoid utilizing several smaller facilities. All PE should be tagged with a unique identifier as well as the unique identifier of the decedent to allow for reassociation. It is unlikely decedent personal effects will have evidentiary value in a biological incident, even criminal, due to the incubation period required for all concerning pathogens. However, during a criminal incident, law enforcement may request personal effects be released to them for further analysis. Interagency Communication Managing BCP operations following a surge in decedents will be an intensive operation – effective and efficient communication will be a necessity for success. Many individuals and agencies will be involved and HCFs should, in their pre-planning efforts, familiarize staff members with the general communication flow. The NYCEM Citywide Operations Center serves a hub of communication for multiple agencies and will allow for the coordination of BCP exchanges between the HCFs and OCME to occur. Page 629 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Figure 3: During a biological incident, effective communication between relevant agencies is paramount. Interagency coordination occurs primarily in the NYCEM EOC, where representatives from all relevant agencies can discuss matters directly. In addition, the private company that will be contracted by the city to supply and deliver the BCPs will be asked to provide a representative to the EOC. Page 630 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths BCP Operations Staffing HCFs should identify individuals to fill ancillary roles related to BCP operations during a surge in fatalities following a biological incident. Administrators should keep in mind that BCP operations will need to run 24 hours per day for an extended period of time and appropriately train an adequate number of personnel to fill each position. Morgue Manager The Morgue Manager is responsible for overseeing all decedent affairs for a HCF’s BCP operation. Individuals assigned to this position should have experience managing complex operations, developing staffing schedules, and be able to communicate clearly and effectively. The Morgue Manager will oversee the Personal Effects Manager, Security Manager, Logistics Manager, Body Handlers, and Operations Center Representative(s). The Morgue Manager will be responsible for managing the schedules for all support personnel for their assigned shift. Schedules should be distributed at minimum 24 hours in advance. Because of the managerial nature of this position, HCF administrators should seek to assign as few individuals as possible to reduce confusion and turnover (consider two daytime managers, two overnight managers, and backups for each shift). These Page 631 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths individuals should be temporarily reassigned from their day-to-day responsibilities for the course of BCP operations for a HCF. HCF Administration may alternatively consider adding Assistant Morgue Managers to reduce the workload of the Morgue Manager, one overseeing Operations (Operations Center Representatives, Body Handlers, and Personal Effects Manager) and one overseeing Support (Logistics and Security Managers). Assistant Morgue Managers may be necessary if the rate of recovery exceeds a certain level. Operations Center Representatives The Morgue Manager may assign representatives to various operations centers around the city during a biological incident. Primary operations centers may include the internal HCF Operations Center, the NYCEM Operations Center, and the OCME Operations Center. Operations Center Representatives should be knowledgeable of HCF daily and disaster operations, including specific BCP operations. Operations Center Representatives function to provide communication and coordination between on-site operational personnel and partner agencies regarding operations. Assistant Morgue Manager – Operations The Assistant Morgue Manager – Operations will oversee the intake of decedents into the BCP, the management of decedent personal effects, and developing employee schedules. HCF Body Handlers and the Personal Effects Manager will report to the Assistant Morgue Manager – Operations. The Assistant Morgue Manager – Operations may not be activated, as the Morgue Manager may be capable of managing both operational and support requirements for a HCF. Body Handlers HCF Body Handlers are responsible for transporting decedents from HCF beds to the BCP. Duties include transferring decedents into human remains pouches, placing all decedent tags per HCF protocol, and intaking decedents into the BCP via the HCF tracking program. Body handlers will maximize space in BCPs using shelving and a fishtail storage pattern and communicate with the Morgue Manager with regards to capacity and scheduling BCP collection and replacement. A minimum of two body handlers should escort each body from the HCF into the BCP to reduce the risk of strain caused by lifting decedents. Personal Effects Manager The Personal Effects Manager is responsible for overseeing Personal Effects Specialists in the tracking all personal effects from biological incident decedents. Tasks to manage include proper accessioning of all effects, proper tagging of all effects with unique identifiers, managing the release of effects to family members, and maintaining proper quality assurance and quality control over the process. The Personal Effects Manager Page 632 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths should work with the Morgue Manager and the Logistics Manager to identify appropriate space for storing personal effects long-term. The Personal Effects Manager should anticipate the demand and request appropriate staffing of Specialists to manage all decedent personal effects. In certain cases, particularly if the incident is criminal in nature, NYPD or other law enforcement may take custody of decedent personal effects prior to them being released to the next of kin. Personal Effects Specialists Personal Effects Specialists will work under the Personal Effects Manager to assist in conducting personal effects operations, as they are likely to run 24 hours per day. Responsibilities include tracking all personal effects from biological incident decedents. Tasks to manage include proper accessioning of all effects, proper tagging of all effects with unique identifiers, managing the release of effects to family members, and maintaining proper quality assurance and quality control over the process. Assistant Morgue Manager – Support The Assistant Morgue Manager – Support will oversee BCP security, infrastructure, and logistics needs, as well as and developing employee schedules. HCF Logistics and Security personnel will report to the Assistant Morgue Manager – Support. The Assistant Morgue Manager – Support may not be activated, as the Morgue Manager may be capable of managing both operational and support requirements for a HCF. Logistics Manager The HCF Morgue Logistics Manager is responsible for overseeing and managing the facility infrastructure, support, and supply coordination for BCP operations. The Morgue Manager must be familiar with the facilities and infrastructure of the HCF and will likely be staffed from the Maintenance or Facilities department. The Logistics Manager will coordinate with the BCP delivery vendor and OCME Logistics personnel to determine appropriate types and locations of BCPs for the HCF. In addition, the Logistics Manager will coordinate and troubleshoot utilities for the BCP (including fueling), monitoring and maintaining temperature of the BCP, and coordinating the delivery of additional supplies and equipment necessary for operations. The Logistics Manager may need support staff to assist in coordinating the above depending on the scale of operations. Schedules should be coordinated by the Logistics Manager. These Logistics Support Personnel will report to the Logistics Manager Security Manager The Security Manager is responsible for providing security and proper credentials for all locations and individuals involving BCP operations, including any storage areas used for supplies and equipment and personal effects. Page 633 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths The Security Manager may need support staff to assist in coordinating the above depending on the scale of operations. Schedules should be coordinated by the Security Manager. These Security Personnel will report to the Security Manager. The Security Manager should prepare staff who do not routinely work with decedents and remind them for the need for sensitivity and monitor staff for emotional well-being. Page 634 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths BCP Logistics Requirements As most health care facilities in New York City have limited on-site storage available for decedents, the addition of external refrigerated storage (body collection point) is essential. One of the primary components of the surge plan is the temporary placement of large-scale mobile refrigerated storage outside of health care facilities. Placement can be determined as the incident progresses or the decision can be made proactively to place storage at all major health care facilities. Planning efforts prior to a biological incident should identify appropriate facility infrastructure and predetermined locations for accommodating BCPs. Area Requirement The area chosen for the remains storage should be large enough to accommodate two identical units. This allows for a simultaneous removal of a full BCP to a morgue facility and replacement with an empty BCP for continued storage. Accessibility In addition to having adequate space, chosen sites should be accessible by tractor trailer. Special attention should be paid to ensuring there is a truck accessible route (including any height restrictions and required turns). In New York City, tractor trailers are not allowed on parkways and certain other major thoroughfares. HCFs and NYCEM may need to arrange for special permission and/or escorts in order to facilitate the exchange of BCPs. Many HCFs have loading docks, but if a loading dock is not present or available, the Logistics Manager should request either a CONNEX unit or a trailer equipped with a lift gate to facilitate loading. Utilities and Fueling Adequate utilities must be available, ensuring any electrical requirements for the unit are met. Refueling will need to occur on a regular basis on site, either with a fuel truck or onsite fuel tanks. If fuel trucks will be utilized, the HCF Logistics Manager should ensure there are no restrictions on the route to the HCF on hazardous materials. It may be necessary to acquire special permissions and/or to provide escorts for the trucks delivering Security The area chosen for BCPs should be private and securable. Consider temporary fencing, tent structures to block the area from public view. Security personnel should be present at all times to credential personnel, Page 635 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Equipment The two main options for on-site storage of remains at a health care facility are refrigerated trailers and refrigerated CONEX units. Refrigerated trailers are preferred over refrigerated CONEX units due to their increased mobility. Refrigerated trailers are no more than 53’ in length and 8.5’ in width. These units will be delivered using a tractor (semi-truck). As mentioned previously, if the HCF does not have access to a loading dock, the requested trailer must be equipped with a lift gate. The rear door of the trailer should be secured with a high-secure hardened steel lock. A kingpin lock should be used to secure the trailer from unauthorized pickups. The interior floor of the refrigerated trailer should preferably be extruded metal or flat polymer (referred to as “grocery floor”) as they are easiest to clean and disinfect. Duct metal floors are available, but are more difficult to clean. Shelving will not be immediately available, but can be requested and supplied as operations continue if the rate of recovery necessitates. Most refrigerated trailers are powered with diesel fuel. Refueling requirements will vary, but generally trailers will need to be refueled every two to three days. Some refrigerated trailers may come with an electric standby mode on the refrigeration unit which will allow it to run solely on electrical power. Refrigeration units can also be plugged into the main facility’s electrical grid without significant alterations. Internal temperatures should be strictly monitored to ensure a constant 37º F temperature. Maintenance needs and requirements should be noted and communicated to the HCF Morgue Manager. Figure 4: Refrigerated trailers may be used as a body collection point. Page 636 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Refrigerated CONEX units may be requested in 20’ or 40’ lengths. Both are 8’ in width. CONEX units come in three heights, which may need to be considered if there are height restrictions on the delivery route. CONEX units will be delivered using a flatbed tractor-trailer or tow truck. Unlike refrigerated trailers, CONEX units are at ground level, eliminating the need for either a loading dock or lift gate. The rear door of the CONEX unit should be secured with a high-secure hardened steel lock. Refrigerated CONEX units come standard with duct metal flooring. Shelving will not be immediately available, but can be requested and supplied as operations continue if the rate of recovery necessitates. CONEX units are powered with electric only through a “clip on” generator. The generator must be specifically requested, as it does not come standard. CONEX refrigeration units can also be powered by an external generator with proper connections. Refueling requirements for the generator will vary, but generally will need to be refueled every two to three days. It is possible to power the CONEX using the main facility’s electrical grid, must it is likely that alterations would need to be made (including installing a transformer). Therefore, a “clip on” generator is the preferred power source. Internal temperatures should be strictly monitored to ensure a constant 37º F temperature. Maintenance needs and requirements should be noted and communicated to the HCF Morgue Manager. Figure 5: Refrigerated CONEX units may be used as a body collection point. Refrigeration units do not come standard on CONEX units and compatible units must be requested separately. Some HCFs do have limited internal refrigerated storage. Depending on the specifics of the incident, additional shelving and removal of non-essential supplies and equipment may allow for adequate storage within existing facilities. However, a separate storage facility will increase the overall recovery time, as decedents will need to be transported from the storage facility into a trailer or CONEX. Decedent tracking may also be more complicated and prone to errors with this configuration, as additional steps are introduced. It should be noted that any refrigerated storage that is augmented for BCP operations should be refrigerated storage that was already utilized for decedent storage – food refrigerated storage should not be used for decedent storage. Page 637 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Semi-permanent refrigerated structures are available but are not recommended for BCP operations. These structures require significant set-up time and present the same issues as augmenting existing refrigerated storage. OCME has two semi-permanent refrigerated systems that would likely be set up as remains storage facilities (RSF) directly outside of disaster morgues. RSFs are meant to be semi-permanent storage adjacent to the disaster morgue as a means of controlling the flow of decedents through the morgue and allowing for long-term storage prior to releasing remains to a funeral director. Supplies There will be few substitutions for regular supplies required for fatality management operations during a biological incident. Adequately increasing the inventory of necessary supplies as the incident progresses will be the primary concern. The main departure from standard protocols will include they type of human remains pouches (HRP). Since long-term storage is expected during a surge incident, daily use HRPs will not be durable enough. Disaster HRPs are constructed from thicker material and will hold up against repeated transfers, natural decomposition, and temporary interment if necessary. All HCFs should maintain a store of 100 – 200 disaster HRPs for their BCP operations. OCME and DOHMH will coordinate the delivery of additional disaster HRPs with delivery or replacement of BCPs to ensure adequate supplies at each HCF. HCFs should contact OCME or DOHMH if their internal supply is low. PPE and disinfection procedures will be variable depending on the pathogen, although standard precautions will likely be satisfactory. Many biological agents capable of causing a significant surge in fatalities are either not transmissible (i.e. anthrax) or have a negligible risk of postmortem transmission (i.e. influenza). It should be noted that staff and public fear may dictate higher levels of PPE and more aggressive disinfection protocols. Agency leads should make the final determination; ensuring recommendations are not less than those presented by subject matter experts. Thorough and repeated PPE training should occur to reduce the risk of contamination and increase staff confidence in working in hazardous environments. HCFs should note that the PPE requirements in use for patients may not be the same for decedents, as the threat of transmission may be reduced after death. As such, requirements should be determined separately. All personnel and equipment in direct contact with decedents or decedent personal effects should adhere to PPE and disinfection protocols. Personnel working in BCP support roles with no direct contact to decedents do not need to adhere to PPE requirements, unless specifically directed by Health and Safety personnel. HCFs should also stock additional supplies necessary for tagging decedents and associated personal effects with a unique identifier. The system used for daily operations will likely be sufficient for tracking decedents during a surge incident, but HCFs may also look into stockpiling dedicated tags for this purpose. Page 638 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Special Considerations Direct Drop-Offs During a large scale biological incident, it is likely that decedents will be dropped off directly to HCFs (and OCME facilities) by family members. While public messaging will seek to combat this, the inevitable delay in residential pickups, uncertainty by family members, and an overwhelmed health care system will lend itself to direct drop-offs occurring. In this situation, HCFs should initially treat the decedent as a patient and pronounce death according to protocol. NYPD should be contacted to interview the family member – a scene investigation of the place of death may be deemed necessary. NYPD and HCFs should obtain basic information from the individual dropping off the decedent, as well as the decedent. More in depth information can be collected at the Victim Information Center. After all information is collected and a reasonable determination is made that the decedent is likely to be connected to the incident, the HCF should intake the decedent into the BCP according to their protocol. It should be documented which cases were dropped off directly to the BCP. Interaction with Funeral Directors For instances of natural death with a physician-signed death certificate, HCFs should release decedents to licensed funeral directors per protocol as long as a BCP is under HCF authority. Once the BCP has been transferred to OCME authority, funeral directors will need to wait until cases are ready for pick up from. For natural deaths at OCME disaster morgues during a surge incident, it is likely that processing through the morgue will be limited to the collection of identification information. Decedents will be released directly to funeral directors from OCME Remains Storage Facilities as soon as all required information is collected. During biological incidents of a criminal or intentional nature, no decedents should be released from HCF BCPs, as they are considered homicides (ME Cases). Public fear during a biological incident may result in funeral directors refusing some or all typical responsibilities. HCFs should be aware it is the family’s responsibility to select funeral directors who are willing to take custody of decedents – there are no additional responsibilities on the HCF outside of properly pack Staff Attrition Because of the potential widespread effect and extended timeframe, biological incidents will be accompanied by significant staff attrition due to a number of issues. During incidents involving a transmissible pathogen, including pandemic influenza, HCFs should anticipate staff absences from work due illness and family illness. Isolated releases of non-transmissible pathogens may also affect staff, but are less likely to do so. Public fear during an incident will affect staff members, and may reduce the number of individuals willing to participate in disaster operations. Clear communication, frequent Page 639 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths and detailed training, staff prophylaxis, and robust personal protective equipment protocols will help alleviate staff concerns (but will not remove them). Mitigating staff fears may involve using a higher level of PPE for dealing with cases than is scientifically and medically necessary. Staff fatigue will be a primary concern, as operations during a surge incident will likely run for weeks or months. HCF administrators should ensure proper staffing schedules are maintained with adequate recovery periods. Staff mental health should be a priority, especially for staff not accustomed to working with or around decedents. HCF administrators may reach out through the NYCEM EOC to the American Red Cross for mental or spiritual counselor assistance for staff during these incidents. Religious Traditions Religious traditions surrounding death should be accommodated as much as feasibly possible during biological incidents without impacting BCP operations or placing individuals at increased risk of contracting an illness. All major religions have some precedent (although in many cases it is not unanimous among leadership) and considerations for suspending traditional practices when decedents fall under medical examiner jurisdiction. The delayed release of remains in a biological incident will be the primary conflict with most religious traditions, as decedents will not be fragmented, full autopsies will not likely be conducted, and mandatory cremation would be extremely rare. HCF Administration should maintain close contact with religious leaders to ensure effective communication is occurring. In turn, HCF personnel should ensure that any religious considerations that are not undue burden on BCP operations are met, if they are requested. For instance, Judaism and Hinduism require decedents to be accompanied prior to burial. HCFs may consider having a religious leader from these faiths allowed near the BCP to fulfill this requirement. Page 640 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Job Action Sheets HCF Morgue Manager HCF Morgue Manager Purpose / Mission To oversee the operations and logistical support for HCF Body Collection Point; To coordinate operational needs with NYC agencies and private contractors ▪ ▪ Objectives ▪ ▪ Identify appropriate Body Collection Point type based on incident characteristics and HCF infrastructure Coordinate with OCME Logistics personnel and the HCF Logistics Manager to determine optimal staging locations for BCP Coordinate remains storage and transportation between HCF and BCP Coordinate BCP pickup and drop off with private contractor/vendor Suggested Qualifications ▪ ▪ ▪ ▪ ▪ Assigned Area HCF Body Collection Point Supervisor To be determined by HCF Administrators Supporting Positions / Functions Assistant Morgue Manager – Operations Assistant Morgue Manager – Support Operations Center Representative(s) HCF Senior Leadership Experienced Mortuary Supervisor Knowledge of remains storage requirements Ability to delegate and communicate effectively Familiarity with disaster response procedures Activation Checklist  Upon notification and deployment, receive incident characterization and initial information concerning the type and scope of remains storage needs.  Report to the HCF Administrators to receive instructions.  Notify supervisor of disaster role.  Receive instruction from the HCF Administrators to determine goals and objectives for decedent storage.  Formerly request OCME support through NYCEM in managing in-hospital surge deaths through body collection points.  Attend any briefings or conference calls related to the operation.  Determine staffing needs based on rate of recovery from the HCF and operational periods consistent with citywide operations.  Staff support positions, including:  HCF Assistant Morgue Manager – Operations  HCF Assistant Morgue Manager – Support  Operations Center Representative(s)  Ensure support positions fully staff respective functions.  Conduct staff briefing on current situation and incident objectives; develop response Page 641 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths strategy and tactics; outline action plan; and schedule next briefing.  Coordinate with the Assistant Morgue Manager – Support to determine initial storage deployment.  Identify initial staging location for storage.  Confirm status of necessary supplies, including disaster human remains pouches, and make the request for additional supplies, as necessary.  Coordinate with private contractor/vendor to determine optimal route to the staging location.  Ensure BCP is properly staffed and all staff is adequately trained on all protocols.  Ensure remains storage and transport equipment and supplies are complete.  Ensure personnel are equipped with appropriate PPE to comply with health and safety requirements.  Ensure all equipment has been tested to ensure functionality prior to the commencement of operations.  Ensure that all necessary equipment is staged in easily accessed location and security is aware of its presence.  Notify the HCF Administrators and OCME Agency Operations Center when the storage facility is ready for the commencement of operations and ensure the BCP is prepared to receive remains. Operational Responsibilities The HCF Morgue Manager is responsible for the following items throughout the course of the operation. Several of these items will be ongoing or repeated through the course of the operation. The HCF Morgue Manager should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • • Monitor the systematic accessioning of remains into the BCP. − Maintain awareness of the inventory of the remains in the BCP and determine the need to augment with shelving. ▪ Ensure that all remains stored in the BCP are documented and tracked. ▪ Ensure that all remains are tracked and stored in a manner that minimizes further damage or alteration. Ensure complete accuracy and completeness of all BCP records. At the appropriate time, coordinate delivery of the BCP to the designated disaster morgue and transfer remains to the designated Remains Storage Facility. – Coordinate with the Remains Storage Group Supervisor in the OCME Morgue to determine readiness of the Remains Storage Facility to receive disaster-related remains. – Maintain communication with the private contractor and Remains Storage Group Supervisor during the transport process. Document the departure from the scene and arrival at the morgue site. General: • Attend all briefings/meetings as coordinated or requested by the HCF Administrators or other agency partners. • Maintain communication with the OCME Operations Center regarding BCP operations. – Regularly report storage metrics to allow for optimal transport coordination – Report any issues that arise or process alterations needed to meet needs. Page 642 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • • • Maintain communication with the vendor conducting BCP pickup and deliveries. Maintain communications with HCF BCP personnel on issues related to changes to or deviations from established procedures. Coordinate with Security Manager and NYPD to ensure protocol is followed should decedents be brought directly to the BCP Develop and maintain the HCF BCP operational and staff schedule Ensure all HCF BCP personnel check-in and out at the beginning and end of each shift Ensure all HCF BCP personnel are using applicable portions of their position checklists. Prepare and maintain HCF BCP records and reports, as appropriate. Provide reports regularly to the HCF Administrators, or as requested. Monitor use of supplies and notify HCF Logistics Manager or NYCEM Operations Center of anticipated replenishment needs. Be aware of personnel well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the HCF Administrators and OCME Operations Center related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • • Decedent tracking forms/system Situation Reports Health and Safety Plan Equipment and Supplies • • • • • • • Decedent tracking equipment (i.e. barcode scanner, printer) General office equipment Human remains pouches PPE Decedent tags Equipment to augment storage capacity (i.e. shelving) Lifting equipment Best Practices and Considerations • • • • • • It is optimal to store remains at a maximum temperature of 37 degrees Fahrenheit; ensure all equipment is functioning properly prior to operations. Consider which storage facility option is the most appropriate depending on the scene, number of remains, and the response capacity. Identify secondary and tertiary options. Consider additional equipment needed to support the proper functioning of the storage facility (generators, lights, etc.). Consider the use of augmentation equipment (i.e. shelving) to increase the capacity of the storage facility. Be aware of the fueling requirements for the storage facility and ensure that a regular refueling regiment is scheduled with the fueling vendor. Following the incident, clean all vehicles and equipment with the appropriate disinfecting agents as recommended by Health and Safety personnel. Page 643 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 644 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Operations Center Representative HCF Operations Center Representative Purpose / Mission Represent the HCF at the required location during a biological incident to coordinate decedent management needs between appropriate NYC agencies. ▪ ▪ Objectives ▪ Communicate BCP status information and needs with OCME and NYCEM Coordinate agency needs/requests with relevant agencies at the operations center Facilitate the flow of information between HCF Morgue Manager and external agencies and entities as necessary and related to the biological incident Suggested Qualifications ▪ ▪ ▪ Assigned Area Emergency Operations Center (NYCEM or OCME) Supervisor HCF Morgue Manager Knowledge of facility capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Activation Checklist □ □ □ □ □ □ Receive appointment and briefing from the HCF Morgue Manager. Notify your usual supervisor of your disaster collateral assignment. Report to requested Emergency Operations Center. Coordinate with local governmental and non-governmental entities at the EOC to obtain resources that cannot be obtained locally, regionally or within the private sector. – Note: Obtaining these resources, just like when obtaining local assets, requires official coordination within the EOC. – Local NYC government, including NYC OCME – Metropolitan Funeral Directors Association and all other funeral directors – Private Sector Cemetery Owners – Private Sector Crematorium Owners – State Funeral Director Association – American Red Cross – The Salvation Army – New York Disaster Interfaith Services (NYDIS) – Other Private and Commercial Entities Coordinate with State and Federal entities represented at the EOC to obtain resources that cannot be obtained locally, regionally, or within the private sector. – Note: Obtaining these resources, just like when obtaining local assets, requires official coordination within the EOC. – New York State Department of Health (DOH) – New York State Department of Homeland Security and Emergency Services (DHSES) – Division of Cemeteries in the New York Department of State – US Department of Health and Human Services (HHS) Document all key activities, actions, and communications. Page 645 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths □ Participate in EOC briefings and report information between the HCF Morgue Manager and entities within the EOC. Operational Responsibilities The HCF Operations Center Representative is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The HCF Operations Center Representative should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Attend all EOC briefings and Citywide Incident Action Planning meetings to gather and share incident and HCF operational information. Contribute to the briefing by identifying HCF goals for incorporation into the Citywide Incident Action Plan (IAP). • Request assistance and information as needed through the agency representatives. • Respond to requests and issues from other EOC entities. • Report pertinent information to appropriate HCF positions. • Prepare and maintain records and reports as appropriate. General: • Attend all briefings/meetings as coordinated or requested by the HCF Morgue Manager. • Maintain communication with the HCF Morgue Manager regarding interagency liaison requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with HCF Morgue Manager on issues related to changes to or deviations from established procedures. • Develop and maintain the operational and staff schedule. • Check-in and out at the beginning and end of each shift. • Use applicable portions of position checklists. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the HCF Morgue Manager, or as requested. • Monitor use of supplies and notify HCF Morgue Logistics Manager of anticipated replenishment needs. • Be aware of personnel well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the HCF Morgue Manager related to the accomplishments encountered during the operational period. Equipment • • • • Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • • Ensure information is being released through appropriate channels. All information coming from any HCF representative should be consistent and approved by the HCF Morgue Manager or HCF Administrators. Press and media inquiries should be directed to the HCF Public Information Officer. Page 646 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Assistant Morgue Manager – Operations HCF Assistant Morgue Manager – Operations Purpose / Mission To oversee the storage, tracking, and transportation of remains removed from HCFs prior to transfer to the disaster morgue ▪ ▪ Objectives ▪ ▪ Identify appropriate Body Collection Point type based on incident characteristics and HCF infrastructure Coordinate with OCME Logistics personnel and the HCF Logistics Manager to determine optimal staging locations for BCP Coordinate remains storage and transportation between HCF and BCP Coordinate BCP pickup and drop off with private contractor/vendor Suggested Qualifications ▪ ▪ ▪ ▪ Assigned Area HCF Body Collection Point Supervisor HCF Morgue Manager Supporting Positions / Functions Body Handlers Personal Effects Manager Experienced Mortuary Supervisor Knowledge of remains storage requirements Ability to delegate and communicate effectively Familiarity with disaster response procedures Activation Checklist  Upon notification and deployment, receive incident characterization and initial information concerning the type and scope of remains storage needs.  Report to the HCF Morgue Manager to receive instructions.  Receive instruction from the HCF Morgue Manager to determine goals and objectives for decedent storage.  Determine staffing needs based on rate of recovery from the HCF and operational periods consistent with citywide operations.  Staff support positions, including:  Body Handlers  Personal Effects Manager  Coordinate with the Morgue Manager to determine initial storage deployment.  Identify initial staging location for storage.  Coordinate with private contractor/vendor to determine optimal route to the staging location.  Ensure BCP is properly staffed and all staff is adequately trained on all protocols.  Ensure Body Handlers are briefed on protocols/methods to systematically accession remains into the BCP, track the unique identifiers, and store remains.  Ensure Personal Effects staff is briefed on protocols/methods to systematically accession decedent personal effects into storage, track the unique identifiers, and release protocols. Page 647 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Ensure remains storage and transport equipment and supplies are complete.  Ensure BCP personnel are equipped with appropriate PPE to comply with health and safety requirements.  Test all equipment to ensure functionality prior to the commencement of operations.  Ensure that all necessary equipment is staged in easily accessed location and security is aware of its presence.  Distribute radios to appropriate personnel to ensure communication among the BCP personnel.  Notify the HCF Administrators and OCME Agency Operations Center when the storage facility is ready for the commencement of operations and ensure the BCP is prepared to receive remains. Operational Responsibilities The HCF Assistant Morgue Manager – Operations is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the operation. The HCF Assistant Morgue Manager – Operations should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • • Monitor the systematic accessioning of remains into the BCP. − Maintain awareness of the inventory of the remains in the BCP and determine the need to augment with shelving. ▪ Ensure that all remains stored in the BCP are documented and tracked. ▪ Ensure that all remains are tracked and stored in a manner that minimizes further damage or alteration. At the appropriate time, coordinate delivery of the BCP to the designated disaster morgue and transfer remains to the designated Remains Storage Facility. – Coordinate with the Remains Storage Group Supervisor in the Morgue to determine readiness of the Remains Storage Facility to receive disasterrelated remains. – Maintain communication with the private contractor and Remains Storage Group Supervisor during the transport process. Document the departure from the scene and arrival at the morgue site. General: • Attend all briefings/meetings as coordinated or requested by the HCF Morgue Manager. • Maintain communication with the OCME Operations Center regarding BCP operations. – Report any issues that arise or process alterations needed to meet needs. • Maintain communications with HCF BCP personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the HCF BCP operational and staff schedule • Ensure all HCF BCP personnel check-in and out at the beginning and end of each shift • Ensure all HCF BCP personnel are using applicable portions of their position checklists. Page 648 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • Prepare and maintain HCF BCP records and reports, as appropriate. Provide reports regularly to the HCF Morgue Manager, or as requested. Monitor use of supplies and notify HCF Logistics Manager or NYCEM Operations Center of anticipated replenishment needs. Be aware of personnel well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. At the end of each operational period, provide a situation report to the HCF Morgue Manager and OCME Operations Center related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • Decedent tracking forms Personal effect tracking forms Equipment and Supplies • • • • • Human remains pouches PPE Decedent tags Equipment to augment storage capacity (i.e. shelving) Lifting equipment Best Practices and Considerations • • • • • • • It is optimal to store remains at a maximum temperature of 37 degrees Fahrenheit; ensure all equipment is functioning properly prior to operations. Personal effects likely will not need to be stored at a specific temperature, but must be secured. Consider which storage facility option is the most appropriate depending on the facility, number of remains, and the response capacity. Consider additional equipment needed to support the proper functioning of the storage facility (generators, lights, etc.). Consider the use of augmentation equipment (i.e. shelving) to increase the capacity of the storage facility. Be aware of the fueling requirements for the storage facility and ensure that a regular refueling regiment is scheduled with the fueling vendor. Following the incident, clean all vehicles and equipment with the appropriate disinfecting agents as recommended by Health and Safety personnel. Page 649 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 650 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Body Handlers HCF Body Handlers Purpose / Mission To place remains in the human remains pouch, ensuring proper tagging and documentation and deliver remains to the HCF BCP ▪ ▪ Objectives ▪ Coordinate with physicians and nurses to properly place remains and any associated evidence in a human remains pouch (HRP) Ensure remains and HRP are properly marked and documented Remove HRP from HCF room/bed in a timely and efficient manner Suggested Qualifications ▪ Assigned Area HCF BCP Supervisor HCF BCP Assistant Manager – Operations Physical ability to lift decedents no higher than waist height Activation Checklist  Upon notification and deployment, receive incident characterization and position assignment.  Notify supervisor of disaster-related assignment.  Report to the HCF BCP to receive instructions from assigned Assistant Manager – Operations.  Receive instruction from the Assistant Manager – Operations to determine goals and objectives for running the BCP.  Coordinate with Assistant Manager – Operations to identify the need for additional body handlers to complete the objectives.  Make appropriate notifications to additional personnel, if needed, and provide reporting instructions.  Ensure equipment is complete; all necessary equipment and supplies are staged in an easily accessed location. Test all equipment to ensure functionality prior to the commencement of operations.  Receive briefing from Assistant Manager – Operations regarding remains recovery protocols and priorities.  Coordinate with the Assistant Manager – Operations to identify protocols for transition of remains to the BCP.  Notify the Assistant Manager – Operations when the HCF Body Handler(s) is ready for the commencement of operations and ensure the HCF BCP is prepared to receive remains. Operational Responsibilities The HCF Body Handler is responsible for the following items throughout the operation. Several of these items will be ongoing or repeated through the course of the operation. The HCF Body Handler should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. • Coordinate with physicians and nurses to confirm remains are ready for removal Page 651 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • from the HCF room/bed. − Work with at least one partner or more as appropriate. − Use lifting and moving devices to physically relocate bodies from one location to another (i.e., gurney, sliding boards, and lifts). − Place bodies in human remains pouches (HRPs), if bodies have not already been placed in one; use ruggedized type HRP with lifting straps if available. − Tag the body and HRP in accordance with HCF policy and with the direction of the HCF Morgue Manager. Track decedents as directed by the Morgue Manager. Ensure that unique tracking or field specimen numbers are assigned to each set of remains and is documented on the remains recovery tag. Place decedents in BCP according to established protocol. Communicate with Assistant Manager – Operations regarding the removal of HRP from room/bed and transfer of HRP to the BCP. Ensure proper documentation of the transfer of remains from the room/bed to the BCP, including the unique identification number. General: • Attend all briefings/meetings as coordinated or requested by the Assistant Manager – Operations. • Maintain communication with the physicians and nurses regarding recovery of remains from the HCF. – Report any issues that arise or process alterations needed to meet needs. • Maintain communications with Assistant Manager – Operations on issues related to changes to or deviations from established procedures. • Check-in and out at the beginning and end of each shift. • Use applicable portions of position checklists. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Assistant Manager – Operations, or as requested. • Monitor use of supplies and notify HCF Logistics Manager of anticipated replenishment needs. • Be aware of colleagues’ well-being and maintain communication with the Health and Safety Team to ensure that assistance, medical or otherwise, is available to personnel. • At the end of each operational period, provide a situation report to the Assistant Manager – Operations related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • Decedent tracking forms BCP inventory forms Equipment and Supplies • • • • • Human Remains Pouches (various sizes depending on the incident characterization) PPE Tracking number tags Zip ties Sharpies Page 652 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Gurneys Best Practices and Considerations • Proper labeling should be maintained by affixing a duplicate tracking number on the outside of the HRP (or write the number on the exterior of the HRP). The number should be visible when stored in the BCP to aid in locating cases or confirming inventory. Page 653 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 654 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Personal Effects Manager HCF Personal Effects Manager Purpose/Mission To oversee the receiving, vouchering and securing of all decedent personal effects (PE) and maintenance of chain-of-custody of evidentiary items throughout the BCP operations ▪ Objectives ▪ ▪ Ensure personnel effects are properly collected, documented, packaged, vouchered, and secured Ensure items are released to the appropriate authorities or agencies for analysis or returned to next of kin (NOK) Maintain chain-of-custody of items from accession to final disposition Assigned Area HCF BCP Designated PE Storage Area Supervisor HCF Assistant Morgue Manager - Operations Activation Checklist □ Upon notification, arrive at the HCF BCP as directed by the Assistant Morgue □ □ □ □ □ □ □ □ □ Manager - Operations. Check in with the Assistant Morgue Manager - Operations and receive: – Incident Characterization and Situational Awareness – Health and safety protocols and requirements – BCP security protocols and credential/access requirements – Staffing and scheduling information Coordinate with Assistant Morgue Managers – Support and Operations to identify a suitable location for increased and long-term personal effects storage. Coordinate with Security Manager to determine protocols for securing the personal effects storage area. Based on the incident characteristics and the scale of the BCP operations, determine the Personal Effect management staffing needs. Based on the incident characterization, coordinate with the local law enforcement and/or investigative authorities to determine evidence protocols specific to the incident. Notify Personal Effects management staff and provide them with instructions to report to the HCF BCP. Ensure that all Personal Effects management staff has proper credentials to obtain access to the BCP and PE Storage area. Upon arrival at the morgue, meet with the PE Management staff and brief them on the following items: – Incident Characterization and Situational Awareness – Layout of the facilities – Operations, staffing, and schedules – Health and Safety briefing – Security briefing – Equipment/supply request procedure – Direct personnel to use their position checklists Assign PE Management Unit to specific tasks. Page 655 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths – Identify one staff member to serve as the scribe □ Ensure personal effects tracking system is in place and fully operational. □ Coordinate with Logistics Manager to set up equipment and supplies at the designated location. □ Ensure all personnel have access to the personal effects tracking system being utilized. □ Test all equipment to be sure all is in working order. □ Participate in “Just-in-Time” Training opportunities. □ Identify station resource needs and communicate all resource requests to Logistics Manager. □ Notify Assistant Morgue Manager – Operations when you are ready for the commencement of operations. Operational Responsibilities The Personal Effects Unit is responsible for the following items throughout the BCP operations. Several of these items will be ongoing or repeated through the course of the response. The Personal Effects Unit should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operational: • The Personal Effects Unit will collect all evidence or decedent personal effects (PE). • Ensure that items are thoroughly photographed. • Voucher all items properly, in accordance with law enforcement requirements. • Categorize materials as one of the following: General, Clothing, Personal Effects, and Identification Papers/Materials. • Record a detailed description in the tracking system being utilized. Descriptions must be consistent in the terminology used and the level of detail recorded. • Maintain chain-of-custody of all items collected and documented. Release all items, after all items are documented, via photography and written notation, and vouchered appropriately. o Note: Items may be released to appropriate law enforcement representatives or other agency for analysis or secure storage. They may also be released to NOK or County Administrator when appropriate General: • Attend all briefings/meetings as coordinated or requested by the Assistant Morgue Manager – Operations. • Maintain communication with the Personal Effects Unit Leader regarding operations. – Report any issues that arise or process alterations needed to meet needs. • Maintain communications with Personal Effects Unit personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Personal Effects Unit operational and staff schedule. • Ensure all Personal Effects Unit personnel check-in and out at the beginning and end of each shift. • Ensure all Personal Effects Unit personnel are using applicable portions of their position checklists. • Prepare and maintain Personal Effects Unit records and reports, as appropriate. Provide reports regularly to the Assistant Morgue Manager – Operations, or as requested. • Monitor use of supplies and notify Logistics Manager of anticipated replenishment needs. Page 656 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • Follow and adhere to all health and safety protocols. – Instruct personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all personnel adhere to PPE requirements Be aware of personnel well-being and maintain communication with the HCF Health and Safety personnel to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Logistics Manager to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Assistant Morgue Manager – Operations related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • Personal Effects – Log Sheet and Record Form Equipment and Supplies • • • • Personal effects tracking system Secure storage containers for evidence Plastic evidence bags (preferably tamper-evident) Evidence tape Best Practices and Considerations • • • • • • Personal effects should be decontaminated prior to release to NOK if there is a risk of transmission. Items that cannot be decontaminated should be treated as contaminated medical waste per health and safety recommendations specific to the incident. Item descriptions should be thorough and detailed. – Poor example: “One (1) ring” – Good example: “One (1) yellow metal ring with white stone and ’01.01.01 forever’ engraved on inner surface” Item descriptions must also be consistent and preferably standardized so that they can be searchable. – Prior to the commencement of operations, it would be advisable for all team members to be made aware of terminology specific to the incident. Any items found believed to have evidentiary purpose should be reported to the law enforcement and/or investigative authority. These materials will be photographed, documented and packaged prior to properly transferring the items to partner agencies. To release evidence to NOK: – Personal Effects staff will release PE to the NOK according to HCF protocol. – Personal Effects staff will release evidentiary items to the appropriate law enforcement agency. Law enforcement will be responsible for releasing any evidentiary items to NOK at the appropriate time. Valid contact information must be obtained for all individuals, departments, and agencies involved with personal effects collection. If multiple agencies are involved and evidence is released to multiple locations, it is imperative that all involved in the response be able to contact those having evidence or PE in their custody. Page 657 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 658 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Assistant Morgue Manager – Support HCF Assistant Morgue Manager – Support Purpose / Mission To oversee the provision of resources to support HCF BCP operations ▪ ▪ Coordinate and provide all necessary support to BCP and personal effects management operations Source necessary equipment, supplies, and/or staff from external vendors/agencies Troubleshoot logistical/operational issues as they arise Suggested Qualifications ▪ ▪ ▪ ▪ Senior Leadership position at HCF Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Assigned Area HCF Body Collection Point Supervisor HCF Morgue Manager Supporting Positions / Functions Security Manager Logistics Manager ▪ Objectives Activation Checklist □ □ □ □ □ □ □ Obtain information from the HCF Morgue Manager regarding the HCF’s implementation of their strategy. Identify Support staff. Review their JAS with them to ensure familiarity with their role and responsibilities. The following positions are likely to be necessary: − Security Manager ▪ Security personnel − Logistics Manager ▪ Logistics support personnel Brief Support staff on critical issues pertaining to the incident. Attend all briefings and cross-level information between the Support and BCP Management staff. Direct Support personnel to consider and identify needs. Direct Support staff to provide operational updates and details to necessary areas, as needed. Document all key activities, actions, and communications. Operational Responsibilities The Assistant Morgue Manager – Support is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Assistant Morgue Manager – Support should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Continue briefing Support staff on critical issues pertaining to the incident. • Attend all briefings and cross-level information between the Support and BCP Page 659 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • Management staff. Direct Support personnel to consider and identify needs, as the operations progress. Direct Support staff to provide operational updates and details to necessary areas, as the operations progress. Document all key activities, actions, and communications. General: • Attend all briefings/meetings as coordinated or requested by the Morgue Manager. • Maintain communication with the Morgue Manager regarding planning requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with Support staff on issues related to changes to or deviations from established procedures. • Develop and maintain the Support staff operational and staff schedule. • Ensure staff check-in and out at the beginning and end of each shift. • Ensure staff is using applicable portions of position checklists. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Morgue Manager, or as requested. • Monitor use of supplies and notify HCF Operations Center Representative of anticipated replenishment needs. • Be aware of staff well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the Morgue Manager related to the accomplishments encountered during the operational period. Equipment • • • • • Cell Phone Radio Note Pad Pens Clip board Best Practices and Considerations • • • • • Consider additional or specialized equipment/supply needs based on external aspects of operations (such as inclement weather, etc.). Consider specialized skills needed to conduct operations (such as specialized or heavy equipment operators). Extrapolate supply/equipment usage and work with appropriate entities to restock to the appropriate level. Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Page 660 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Morgue Logistics Manager HCF Morgue Logistics Manager Purpose / Mission To manage all activities supporting the HCF’s ability to manage a BCP during a biological incident surge response ▪ ▪ Determine the types and degrees of services that are necessary for the pandemic response Customize service needs to each operation, as appropriate Suggested Qualifications ▪ ▪ ▪ Knowledge of agency capabilities Ability to delegate and communicate effectively Familiarity with disaster response procedures Assigned Area HCF Body Collection Point Supervisor HCF Assistant Morgue Manager – Support Supporting Positions / Functions Logistics support personnel Objectives Activation Checklist □ □ □ □ □ □ □ Obtain information from the Assistant Morgue Manager – Support regarding the HCF’s implementation of their strategy. Identify Logistics support staff. Review their JAS with them to ensure familiarity with their role and responsibilities. Consider assigning individuals to the following areas: − Information Technology − Facilities − Equipment − Supplies Contact and become familiar with Support personnel. Attend briefings and report on critical issues pertaining to the incident. Attend all briefings and cross-level information between the Morgue Manager and support personnel. Coordinate with support personnel to provide operational updates and details to the Operations Center Representative, as needed. Document all key activities, actions, and communications. Operational Responsibilities The HCF Morgue Logistics Manager is responsible for the following items throughout the course of operations. Several of these items will be ongoing or repeated through the course of the response. The Logistics Manager should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Continue briefing all personnel on critical issues pertaining to the incident. • Attend all briefings and cross-level information between personnel and the Morgue Manager. • Direct personnel to coordinate with Operations personnel to identify needs. • Direct personnel to provide operational updates and details to Operations Center Representatives, as the operations progress. Page 661 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Document all key activities, actions, and communications. General: • Attend all briefings/meetings as coordinated or requested by the Assistant Morgue Manager – Support or Morgue Manager. • Maintain communication with the Assistant Morgue Manager – Support regarding logistical requirements and observations. • Report any issues that arise or process alterations needed. • Maintain communications with personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the staff operational and staff schedule. • Ensure staff check-in and out at the beginning and end of each shift. • Ensure staff is using applicable portions of position checklists. • Prepare and maintain records and reports, as appropriate. Provide reports regularly to the Morgue Manager, or as requested. • Monitor use of supplies and notify the NYCEM Operations Center Representative of anticipated replenishment needs. • Be aware of staff well-being and provide necessary resources. • At the end of each operational period, provide a situation report to the Assistant Morgue Manager related to the accomplishments encountered during the operational period. Equipment • • • • Cell Phone Note Pad Pens Clip board Best Practices and Considerations • • • • • • Consider additional or specialized equipment/supply needs based on external aspects of operations (such as inclement weather, media attention, etc.). Consider specialized skills needed to conduct operations (such as specialized or heavy equipment operators). Extrapolate supply/equipment usage and work with NYCEM and OCME personnel to restock to the appropriate level. Ensure careful documentation of all relevant information throughout the operations. Be mindful of potential gaps in communication/documentation, as staff members are likely to rotate throughout the course of operations. Coordinate staff trainings on any specialized equipment. Page 662 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths HCF Morgue Security Manager HCF Morgue Security Officer Purpose / Mission To provide for facility security and the security of all human remains, equipment, and personnel in the scene operations ▪ Objectives Ensure scene facilities are secure for the entirety of the operation Assigned Area Various areas / patrol Check-in and check-out Supervisor HCF Assistant Morgue Manager – Support Activation Checklist  Upon notification, arrive at the scene location as directed by the Assistant Morgue Manager – Support.  Meet with the Assistant Morgue Manager – Support and receive: – Incident Characterization and Situational Awareness – BCP Operations and Security Expectations  Perform site security assessment based on the location, facility characteristics, and incident characteristics. Brief the Assistant Morgue Manager – Support on the results of the assessment. – Identify immediate needs to secure the BCP facility: ▪ Establishment of perimeters surrounding the BCP. ▪ Access points for personnel (check-in / check-out station). ▪ Potential interagency representatives to be present in the BCP. ▪ Accepted credentials/identification for personnel and/or credentialing system to create identification for all personnel.  Based on the incident characteristics and the scale of the operations, determine Security staffing requirements.  Notify security staff and provide them with instructions to report immediately to the BCP.  Upon arrival at the BCP, meet with the Security personnel and brief them on the following instruction/information: – Incident Characterization and situational awareness – Results of the Security site assessment – Security operations, staffing, and schedules – Equipment / Supply request procedure – Security incident reporting procedure  Establish Security measures in anticipation of BCP activation. Optimally, security measures should be in place prior to the arrival of any personnel. – Establish and staff Check-in and Check-out stations for personnel. – Establish and staff necessary roadblocks to curtail vehicle access to the area. – Ensure all facility access points are secure and staff surveillance patrols as needed. – Ensure that all non-entry and other advisory signs are placed at all appropriate locations.  Participate in site walk-through with the Assistant Morgue Managers – Support and Operations and Morgue Manager. Page 663 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Provide Security Briefing to personnel, if requested to do so by the Assistant Morgue Manager – Support. – Identify credentials required to enter the BCP. – Identify the available access points and location of check-in and check-out locations. Emphasize the requirement of personnel accountability. – Identify mechanism for reporting potential breaches in security.  Determine security communication needs (i.e., radios, phones, video surveillance) and make request to the Logistics Manager.  Identify equipment/supplies required by Security Staff and make request to the Logistics Manager.  Advise the Assistant Morgue Manager – Support of any security issues, foreseeable or actual, and make corrective recommendations.  Notify the Assistant Morgue Manager – Support when scene is secure and ready for the commencement of operations. Operational Responsibilities The Morgue Security Manager is responsible for the following items throughout the BCP operations. Several of these items will be ongoing or repeated through the course of the response. The Morgue Security Manager should identify the tasks and personnel necessary to ensure these responsibilities are accomplished. Operations: • Obtain a list of authorized personnel that will be allowed access to the facility. • Monitor personnel accountability and that all personnel are utilizing check-in and check-out points. – Ensure Security staff is posted at check-in and check-out points at all times. – Ensure only authorized personnel have access to the BCP and proximal facilities as needed. – If utilizing a credentialing system to create identification for personnel, monitor functionality. – Monitor current personnel roster at all times at all checkpoints. • Ensure security personnel monitor the perimeter at all times. • Keep thorough written documentation of all patrols taken by Security personnel. • For any incident or breach in security: – Notify the Assistant Morgue Manager – Support of the incident. – Take corrective actions to address the issue. – Complete an incident report. • Remove any unauthorized persons entering the BCP facility. General: • Attend all briefings/meetings as coordinated or requested by the Assistant Morgue Manager – Support. • Maintain communication with the Assistant Morgue Manager – Support regarding Security operations. – Report any issues that arise or process alterations needed to meet Security needs. • Maintain communications with Security personnel on issues related to changes to or deviations from established procedures. • Develop and maintain the Security staff operational and staff schedule. • Ensure all Security personnel check-in and out at the beginning and end of each Page 664 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • • • • • • shift. Schedule and provide operational briefings with the Security staff at the beginning and end of each operational period. − Operational briefings should include, but are not limited to: ▪ Incident Updates / Situational Awareness ▪ Operational Period schedule; anticipated arrival or release of remains ▪ Alterations to workflow and/or procedures ▪ Review of sensitivities and considerations when working with remains ▪ Review of security procedures; perimeter and road blocks; credential requirements, etc. ▪ Provide Just-in-Time Training resources, if needed ▪ Time of next briefing Ensure all Security personnel are using applicable portions of their position checklists. Prepare and maintain Security records and reports, as appropriate. Provide reports regularly to the Assistant Morgue Manager – Support, or as requested. Monitor use of supplies and notify the Logistics Manager of anticipated replenishment needs. Follow and adhere to all health and safety protocols – Instruct Security personnel to follow all Universal Precautions against exposure to communicable disease and biohazards. – Ensure all Security personnel adhere to PPE requirements Be aware of Security personnel well-being and maintain communication with the Health and Safety personnel to ensure that assistance, medical or otherwise, is available to personnel. Coordinate with Logistics Manager to ensure that all work areas/station are clean and supplies are replenished at the end of the operational period. At the end of each operational period, provide a situation report to the Assistant Morgue Manager – Support related to the accomplishments/issues encountered during the operational period. Forms/Job Aids • • • Security log book Incident report form Personnel check-in and check-out form Equipment and Supplies • • • • • Checkpoint tables Office supplies Chairs Credentialing system and ancillary supplies (if needed) Communication needs (i.e., radios, phones, video surveillance) Considerations • Security personnel may want to issue identification badges unique to the incident. Confusion may arise if personnel are instructed to use their day-to-day work identification, as members of several different agencies may be present at the BCP and as the identification badges will not list each staff member’s correct position. Page 665 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • • • During a biological incident, it is likely that media/press will attempt to access the BCP site and/or interview HCF personnel. It is critical that Security is aware of the presence of media personnel and is able to prevent their access from sensitive locations. Consider coordinating with the NYCEM or HCF Administrators to identify a specific location for scheduled incident media briefings. Information is only released by the HCF Administrators or HCF Public Information Officer. In the case that the HCF does not have adequate security personnel to staff all required areas, the Security Manager may utilize law enforcement, auxiliary, or private contractor personnel to supplement the security staff. The Security Manager should always be aware of staff members’ well-being and maintain communication with the Health and Safety personnel to ensure that assistance, medical or otherwise, is available to personnel. Page 666 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Forms Remains Storage Inventory Form Purpose: The Remains Storage Inventory Form provides a tracking mechanism to account for all decedents placed into the HCF’s BCP. Preparation: The Remains Storage Inventory Form is completed by BCP personnel. Distribution: The Remains Storage Inventory Form will be located in the BCP. Completed forms may be kept in the Morgue Manager’s office. HCF personnel should provide OCME personnel with a copy of the form during the reconciliation prior to the BCP pickup. Notes: • Additional blank pages may be added as necessary. # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. 2 HCF Morgue Manager Enter the name of the individual assigned to manage BCP operations at the health care facility. 3 Health Care Facility Enter the name of the health care facility. 4 BCP Number Enter the unique identifier for the BCP the inventory represents. 5 Case Number Enter the unique identifier for each decedent placed in the BCP. 6 Date Entered Enter the date the decedent was placed in the BCP. 7 Time Entered Enter the time the decedent was placed in the BCP. Use 24-hour time notation for clarification. 8 Storage Position Record the location within the BCP where the decedent is placed (i.e. Row A, Section 1). 9 Initials Initials of the person who placed the decedent into the BCP. 10 Date Removed Enter the date the decedent was removed from the BCP. 11 Time Removed Enter the time the decedent was removed from the BCP. Use 24hour time notation for clarification. 12 Initials Initials of the person who removed the decedent from the BCP. 13 Released To Indicate who the decedent was released to. *Please note: additional documentation is required to release decedents. Page 667 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 668 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Personal Effects Chain-of-Custody Tracking Form Purpose: The Personal Effects Chain-of-Custody Tracking Form provides a tracking mechanism to account for all decedent personal effects collected during BCP operations. Preparation: The Personal Effects Chain-of-Custody Tracking Form is completed by personal effects personnel. Distribution: The Personal Effects Chain-of-Custody Tracking Form will be located in the secure personal effects storage area. Completed forms may be kept in the Morgue Manager’s office. HCF personnel should provide OCME personnel with a copy of the relevant forms if the personal effects will be transferred to OCME. Notes: • Additional blank pages may be added as necessary. # Block Subject Instructions 1 Incident Name Enter the name assigned to incident. 2 HCF Morgue Manager Enter the name of the individual assigned to manage BCP operations at the health care facility. 3 Health Care Facility Enter the name of the health care facility. 4 BCP Number Enter the unique identifier for the BCP the inventory represents. 5 Case Number Enter the unique identifier for each decedent placed in the BCP. 6 Date Entered Enter the date the decedent was placed in the BCP. 7 Time Entered Enter the time the decedent was placed in the BCP. Use 24-hour time notation for clarification. 8 Storage Position Record the location within the BCP where the decedent is placed (i.e. Row A, Section 1). 9 Initials Initials of the person who placed the decedent into the BCP. 10 Date Removed Enter the date the decedent was removed from the BCP. 11 Time Removed Enter the time the decedent was removed from the BCP. Use 24hour time notation for clarification. 12 Initials Initials of the person who removed the decedent from the BCP. 13 Released To Indicate who the decedent was released to. *Please note: additional documentation is required to release decedents. Page 669 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Page 670 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths 2. Ebola Virus Disease Operational Protocol Page 671 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. Page 672 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths NYC Office of Chief Medical Examiner (NYC OCME) EVD Operational Protocol for In-Hospital Deaths Draft Version 10 December 23, 2014 Background Information 1.0 The 2014 Ebola Virus Disease (EVD) epidemic is the largest in global history, affecting multiple countries in West Africa (Guinea, Liberia, and Sierra Leone). NYC agencies have been engaged in preparatory efforts to mitigate concerns related to the presence of an EVD case. NYC OCME, in coordination with partner agencies, has developed an operational protocol consistent with the CDC Guidance for Safe Handling of Human Remains of Ebola Patients. NYC OCME Operational Objectives 2.0 The NYC OCME has developed this operational plan to best respond to an infectious disease outbreak while mitigating the risk of exposure to NYC residents and OCME personnel. The operational objectives are as follows: • Ensure NYC OCME establishes and maintains jurisdiction over remains infected with EVD as they pose a significant public health risk. • Conduct all fatality management (FM) operations in a safe and efficient manner. • Ensure NYC OCME is promptly notified of a potential EVD case either by the healthcare facility as directed by the New York City Department of Health and Mental Hygiene (NYC DOHMH) or by first response agencies arriving on-scene (NYPD, FDNY). • NYC OCME Communications Division will compile accurate case information and initiate immediate notification of pre-identified NYC OCME personnel. • Deploy an NYC OCME Assessment Team to characterize the situation, liaise with partner agencies/organizations and assess the scene and the complexities and/or challenges to investigation and recovery of the remains. • Prior to deployment of additional personnel, utilize characterization to conduct operational decision making regarding deployment of additional personnel, equipment and supplies to include appropriate personal protective equipment (PPE). Page 673 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths • Maintain communication with partner agencies throughout the duration of the incident. • As needed, deploy specialized Medical Examiner Special Operations Response Team(s) (MESORT), as in accordance with best practices standard protocols to investigate, and recover human remains, during an infectious disease outbreak. 3.0 In-Hospital Cases 3.1 OCME Notification Healthcare facilities will notify OCME Communications (212-447-2030) of any suspected or confirmed death as a result of EVD as instructed by DOHMH. The OCME Communications Division will complete the following:  Place the case “on immediate hold until a Health and Safety Plan is developed”  Collect all relevant case information and email to pre-identified OCME personnel as defined in the table in Appendix A.  Contact all pre-identified OCME personnel directly and provide summary of information  Note in CMS the time positive contact is made with every position listed. Case Information Case #____-____-____ has been reported as a potential/ confirmed EVD case Item Decedent Information Case Name Case Type Location of Case (Facility Name and Address) Caller Name Caller Phone # Decedent Name Place of Death Page 674 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths TAKE NO FURTHER ACTION UNTIL CASE IS DISCUSSED WITH DISASTER RESPONSE COORDINATOR 3.2 OCME Activation 3.2.1 Initial Disaster Response Coordinator Actions Upon notification of a suspected or confirmed EVD death, the Disaster Response Coordinator (DRC) will:  Contact the hospital point-of-contact to obtain additional information related to the decedent identification and condition of remains.  Contact DOHMH to obtain additional information, as needed.  DRC will deploy Assessment Team to complete incident characterization and obtain case information. (See Section 3.2.1)  Contact NYPD Operations to provide security escort to and from the hospital facility and the off-site OCME facility.  Contact FDNY HazMat and/or NYPD HazMat to request decontamination unit to assist with the decontamination of OCME personnel outside the hospital facility.  Schedule Executive Briefing Call (See Section 3.2.2)  Schedule Operational Conference Call (See Section 3.2.3) 3.2.1 Deployment of Assessment Team As instructed, the Tour Commander and FM Branch Director will deploy to the hospital as the Assessment Team to complete the following:  Liaise with hospital personnel, DOHMH representatives and CDC Rapid Deployment Team prior to operations.  Confirm all decedent information from the hospital if available and an update on the condition of remains. Case Information Item Decedent Information Decedent Name Page 675 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Date of Birth (DOB) Time of Death Patient History Travel History Next of Kin names and contact information  Complete Incident Characterization based on the condition of remains and the operational areas.  Report information to the DRC 3.2.2 OCME Executive Staff Briefing: The DRC will host a conference call with the Executive Staff to brief them on the current situation and the operational plan.  Utilize secure conference line.  Executive Conference Call should include the following information:  Provide situational briefing  Identify operational strategy  Identify current deployment and schedule of operations 3.2.3 Operational Conference Call: An operational conference call will be hosted to ensure all personnel have situational awareness and to review the operational protocol to be utilized to recover, transport and store remains from an in-hospital setting.  The Operational Conference Call will be led by the Disaster Response Coordinator.  Disaster Response Coordinator will schedule a conference call to initiate FM Operations.  Invite Operational Leadership as outlined in the FM Branch Organizational Chart  Chief Medical Examiner  FM Branch Commander  Deputy FM Branch Director – Scene  Deputy FM Branch Director – PM  Health and Safety Officer  Security Officer Page 676 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths           Quality Assurance/Quality Control Officer Operations Center Coordinator Contamination Control Group Supervisor Remains Recovery Group Supervisor Investigations Group Supervisor Remains Storage Group Supervisor Logistics Group Supervisor Tour Commander Administrator on Duty (AOD) Deputy Chief Medical Examiner of the borough  Utilize secure conference line.  Operational Conference Call should include the following information:  Provide situational briefing based on incident characterization  Identify schedule for operations  Surge the Operations Center for information management  Identify personnel and equipment deployment  Determine muster point and time for deploying personnel  Review operational protocol  Instruct Operational Leadership to notify subsequent personnel needed for operations 3.3 Mobilization and Deployment 3.3.1 Muster OCME Operational Personnel  Deputy FM Branch Director – Scene will muster the following personnel for deployment in 2nd floor laboratory at Hirsch Building (421 E. 26th St.):  Investigations Group (if needed)  Remains Recovery Group  Remains Storage Group  Logistics Group  Health and Safety Officer  Security Officer  Contamination Control Group Supervisor  Quality Assurance / Quality Control Officer Page 677 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Brief personnel regarding operations based on specific case information.  Logistics Group Supervisor will ensure equipment and supplies are staged and ready for deployment (as outlined in Section 4.0)  Load personnel into transport vehicles  Direct Security Officer and Remains Storage Group to deploy to the off-site storage location for preparation of site to receive recovered remains.  Contact FM Branch Director to notify of deployment status and ETA to hospital. 3.3.2 OCME Deployment  Notify FM Branch Director upon arrival to the hospital.  Stage the transport vehicle at the designated exit; Motor Vehicle Operator will remain with the vehicle  Operational personnel will proceed to the isolation room with necessary equipment.  Deputy FM Branch Director – Scene will review any updated case-specific information and identify any changes to protocol.  Deputy FM Branch Director – Scene will perform a walk-through of the operation with all personnel to include:  Identify PPE donning and doffing location and protocols  Identify equipment staging locations  Review operation workflow  Review the exit route  Answer any questions related to the operation  Health and Safety Officer will provide a Health and Safety Briefing to all personnel 3.4 Staging and Preparation for Operations 3.4.1 Donning Personal Protective Equipment (PPE) Page 678 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Prior to the start of recovery operations, all personnel will don PPE in accordance with the EVD Health and Safety Plan (HASP).  Health and Safety Officer will ensure that vitals are measured and documented for all personnel donning PPE.  Personnel will don PPE in a systematic process according to the Donning Checklist  Contamination Control Group Supervisor and Health and Safety Officer will perform a double check of PPE donning process.  Make any alterations and/or corrective actions as needed. 3.4.2 Staging Equipment and Supplies  Stage the equipment in the appropriate locations for safe removal of remains without cross contamination of external container and/or additional hospital areas. [Equipment is as listed in Appendix D] - In the Clean Zone:  Grey remains tub  Remains tub cover  Remains Stretcher - To go in the Hot Zone:  Hospital gurney staged with the following:  Flat Sheet  Open HRP  BioSeal packaging staged open on top  5-gallon bucket containing:  BioSeal packaging system  Decedent Identification Equipment  Spray Bottle with bleach solution Page 679 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths 3.5 Remains Recovery Operations 3.5.1 Decedent Recovery Operations  One (1) Contaminated Remains Recovery Group member will enter the room.  Scribe will document the time Contaminated Remains Recovery Group personnel enter the hot zone.  Obtain an identification photograph of the decedent (overall, face and hospital wristband) and the orange remains wristband. Note any decedent information.  Be sure to keep camera and documentation materials clean.  Hand camera and documentation materials to the Clean Remains Recovery Group personnel.  Plug in the extension cord and the BioSeal heat sealer.  Place the heat sealer away on a safe, flat surface that will not potentially come in contact with anyone’s PPE.  Attach orange remains wristband to the decedent’s wrist  Stand clear of hospital bed while decedent is packaged. 3.5.2 Decedent Packaging  Two (2) Hospital staff will wrap the remains in sheets and impermeable plastic wrapping (per hospital postmortem packaging protocols) being careful to handle remains minimally to prevent the spread and/or splatter of bodily fluids and the contamination of PPE.  Upon completion of the Hospital postmortem wrapping, the Contaminated Remains Recovery Group will move the hospital gurney into the room and position for packaging of remains.  Using the bottom sheet, all four (4) personnel in the room will coordinate to move remains from the hospital bed towards the stretcher in a two-step coordinated effort. (“one-two-three, move”)  Carefully place wrapped remains in BioSeal packaging.  Clip edges of the BioSeal to align BioSeal edges. Page 680 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Seal package using heat seal machine.  Reseal all corners. Ensure all seams are sealed properly.  Unplug BioSeal heat sealer and leave on flat surface to cool.  Doff the first layer of PPE (apron, outer gloves and face shield) leaving the doffed PPE to be disposed with regulated medical waste by the hospital.  Tuck BioSeal packaged remains in the HRP.  Spray interior of HRP with bleach solution.  Ensure pouch is zipped closed.  Affix remains recovery seal to the exterior of the HRP.  Spray exterior of the HRP with bleach solution.  Move stretcher towards the doorway. 3.5.3 Transfer of Remains to Clean Zone  At doorway, utilizing the clean flat sheet, Contaminated Remains Recovery Group members (2) and one (1) Clean Remains Recovery Group member will move packaged remains to the grey remains tub. Be sure to prevent the packaged remains from touching the exterior of the tub.  Ensure no contaminated personnel cross the threshold of the hot zone.  Clean personnel immediately doff the exterior layer of PPE (apron, outer gloves, face shield) careful to prevent the cross contamination of clean PPE.  Close the door between the isolation room and the anteroom keeping the Contaminated Remains Recovery Group personnel in the hot zone during the removal of the remains tub.  Clean Remains Recovery Team members will place the cover on the remains tub; ensuring the cover is securely fastened for transport.  Secure the edges of the cover with tape  Mark exterior of remains tub with the Remains Recovery Number. Page 681 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Clean Remains Recovery Group personnel will move the remains tub to the clean stretcher for removal from the facility.  Document the time of removal of remains from the isolation room. 3.5.4 Remains Transport Operations  Deputy FM Branch Director – Scene will coordinate with hospital management to ensure exit route is secure.  Clean Remains Recovery Group will escort the remains along designated exit route from the facility accompanied by facility security personnel and the Remains Recovery Group Supervisor.  Clean Remains Recovery Group Personnel will transfer remains from the stretcher to the staged vehicle.  Scribe will document the time of transfer of remains to the transport vehicle.  Remains Recovery Group Supervisor will notify Deputy FM Branch Director – Scene when remains are ready for transport.  Coordinate the pre-arranged vehicle security escort and/or road closure.  Notify Security Officer and Remains Storage Group Supervisor of departure from hospital to the off-site storage facility.  Motor Vehicle Operator will transport remains to the NYC OCME off-site storage facility.  Document time of departure of vehicle to the off-site storage facility 3.5.5 Remains Storage Operations  The Remains Storage Group will notify the FM Branch Director upon arrival of the transport vehicle to the off-site storage facility  Remains Storage Group personnel remove remains from the vehicle and place on a cart / stretcher.  Transfer the remains to the designated storage facility.  Ensure security is present at the storage facility at all times.  Document the time remains are transferred to the storage facility. Page 682 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths 3.6 Decontamination and Doffing of PPE 3.6.1 Decontamination of PPE  Hospital staff will exit the Hot Zone first to doff PPE according the hospital protocol.  Upon completion of hospital staff doffing process, Contaminated Remains Recovery Group will exit the Hot Zone.  Document the time Contaminated Remains Recovery Group personnel exit the Hot Zone.  Prior to doffing, OCME personnel will undergo a wet decontamination in accordance with the HASP  Contamination Control Group members will assist with the decontamination process for each individual according to the Decontamination Checklist. 3.6.2 Doffing of PPE  All OCME personnel will doff PPE in accordance with the EVD HASP  Contamination Control Group members will assist with the systematic and controlled doffing of PPE according to Doffing Checklist  Be sure to collect potentially contaminated PPE in designated biohazard container for disposal with regulated medical waste.  All items to be decontaminated will be collected in the designated red biohazard bags and sealed.  Document the time personnel completes the doffing process.  Health and Safety Officer will ensure that vitals are measured and documented for all personnel doffing PPE. Page 683 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Appendix C FM Operations Organizational Chart Page 684 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Appendix D NYC OCME Equipment/Supply Resources The following table outlines the NYC OCME Equipment (including vehicles) that have been identified to support the recovery, transport, storage and identification of human remains infected with EVD. Resource Purpose Unmarked METT Vehicle Support Transport of Contaminated Remains. OCME Vehicle #112 Utilized for the transport of equipment and personnel. OCME Vehicle #47 Support HazMat operations; stocked with HazMat equipment and supply inventory OCME Trailer #59 Support Decedent Identification ▪ Camera (Nikon AW120) ▪ Orange Remains Recovery Wristband ▪ Remains Recovery HRP Seal Staged kits of appropriate PPE for response personnel to support the investigations and recovery of contaminated remains (See HASP for additional information regarding the types of PPE Required) Seal the remains prior to placement in the human remains pouch. ▪ BioSeal Type 5 (cut to 8 ft.) ▪ BioSeal Heat Sealer ▪ Extension Cord (10 ft. at 16/3) ▪ Spring Clips (4) ▪ Scissors (Tytek Medical) / Seat Belt Cutter ▪ Spray bottle with bleach solution Unmarked Cargo Van Unmarked HazMat Trailer Decedent Identification Equipment PPE Kits BioSealSystem Human Remains Pouch Remains Storage Tubs with covers Stretcher Wet Decontamination System ▪ Staging Location Orange disaster pouches Serves as the final stage of packaging remains for transport and storage ▪ Grey Remains Storage Tubs ▪ Blue elastic covers ▪ Duct Tape ▪ Sharpie Marker Support the movement of packaged remains from the clean zone ▪ Collapsible stretcher with cushion (Ferno model 23) ▪ Extended straps Complete wet decontamination for OCME personnel ▪ 2 – 5 gallon buckets –for glove decontamination and rinse Page 685 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Status Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths Resource Purpose Staging Location Status 2 – bucket trays for boot decontamination and rinse ▪ Scrub brushes ▪ Portable decontamination shower with catch basin ▪ Pump spray system with bleach/soap/water solution ▪ Drying towels ▪ Paper Tyvek for redressing Storage of contaminated equipment that is not considered single-use (HazMat boots, PAPRs, BioSeal Heat Sealers) ▪ Red Biohazard bags (See HASP for additional information regarding the disposal and/or storage of contaminated materials) Support Communications between operational Teams ▪ Biohazard Storage Containers 800 mHz Radios Appendix E Designated Hospital Requirements In order to safely and efficiently recover decedents from the hospital’s isolation room the hospital must ensure the following are in place:  Hospital beds will be fitted with impermeable sheets to assist in the packaging of decedents upon death.  Hospital will provide a simple metal gurney (with minimal attachments) for staging of HRP and BioSeal for use in packaging and moving decedent.  Hospital will staff two (2) staff members to coordinate with OCME Remains Recovery Group members in the proper packaging of decedent.  Hospital staff will don and doff PPE according to the pre-determined hospital procedures.  While awaiting OCME arrival, there should be minimal handling of the decedent. There should be no washing or cleaning of the body. Medical devices (catheters, central lines, etc.) must be left in place.  Under no circumstances will a hospital autopsy be performed on any known or suspected case of EVD. Page 686 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths  Hospital management will coordinate with OCME to identify locations for the following: o Parking of the unmarked vehicles o Staging of equipment and supplies o Donning and Doffing of PPE o Decontamination structure (at isolation room door) o Use of shower for OCME personnel  Hospital, in coordination with OCME Health & Safety, will identify proper receptacles for the disposal of contaminated medical waste.  Hospital will identify staff to assist in the measurement of vitals (temperature, blood pressure and pulse) for all OCME personnel before the donning of PPE and after the doffing of PPE.  Hospital will ensure that security staff are present for the following: o Limit access to the isolation area and check credentials of personnel o Escort Remains Recovery Group personnel along the exit route to the vehicl Page 687 of 688 FOR OFFICIAL USE ONLY – NOT FOR CIRCULATION Biological Incident Fatality Surge Plan For Managing In- and Out-of-Hospital Deaths This page is intentionally blank. 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