Trends in United States Mass Fatality Incidents and Recommendations for Medical Examiners and Coroners

Abstract

It is imperative that medicolegal jurisdictions prepare for the occurrence of a mass fatality incident. Despite the trend to plan for catastrophic and complicated incidents, this analysis of recent mass fatality events seeks to better inform authorities regarding the scale and types of incidents that could potentially impact their jurisdiction. The guidance provided by this study serves as a tool to guide the development of plans, acquisition of appropriate resources, and training of staff. To perform this analysis, data were collected from mass fatality incidents occurring in the United States from January 1, 2000 to December 31, 2016 that resulted in ten or more fatalities. Specific data points were collected for each incident including the date, location, number of fatalities, incident type (e.g., man-made or natural), incident subtype, and description (e.g., mass shooting, hurricane, aviation). A total of 137 incidents fit the criteria for inclusion in the analysis, resulting in a total of 8462 fatalities. The average number of incidents was eight per year during the study period. The analysis demonstrates that most mass fatality incidents (88.8%) result in between ten and 50 fatalities and are variable based on incident type and geographic location. This study includes several large-scale incidents, which as outliers have influenced fatality management operations and preparedness efforts on a national level. In particular, the World Trade Center attack of September 11, 2001 and subsequent remains recovery and identification operations have served to inform the New York City Office of Chief Medical Examiner of the capabilities required to manage a complex, protracted victim identification process involving extensive body fragmentation and commingling. While the World Trade Center attack has been shown to be outside the normal trends of mass fatality incidents, it has nonetheless offered the medicolegal community several invaluable lessons.

Mass fatality and disaster response preparedness across medical examiner and coroner offices in the United States

“…These are all issues that have been identified as crucial in after action reports following MFIs [ [9] , [10] , [11] , 15 , 16 , 54 ]. Even though the literature shows it is beneficial for MEC offices to use standard operating procedures and training, studies point out that existing plans may be incomplete, and it is important to prepare for the probability of an “all fatal” incident [ 4 , 55 ]. Additionally, although a majority of MEC offices reported access to mass fatality trainings or resources and participated in emergency response drills, the rate is not reflective of the frequency or quality of material review or participation levels.…”

“…It is also notable that MECs in the Midwest and South reported less access to emergency response resources than their counterparts in the Northeast and West. This is important because the Midwest and South tend to have more rural areas that depend on less-resourced coroner offices [ 7 ] and serve areas where natural disasters such as tornadoes (South and Midwest) and hurricanes and coastal storms (Southeast and Gulf Coast) occur most often [ 55 ]. In the absence of disaster planning and preparedness in part or in whole, and in light of known workforce shortages and training budgets among MECs [ 37 ], the federal government can dispatch Disaster Mortuary Operational Response Teams (DMORTs) to areas affected by an MFI and can also bring organizational structure through frameworks such as Emergency Support Functions via the Administration for Strategic Preparedness and Response [ 56 ].…”

National Association of Medical Examiners Position Paper

“…Medical examiner/coroner response capabilities will depend on the scale of the disaster and the number of fatality incidents associated with the disaster. 16 A 2014 study of 122 ME/Cs showed that some ME/Cs might be overwhelmed by any additional deaths that surpass their typical number of cases. 17 The study also found that 42% of respondents would be overwhelmed by 24 or fewer additional fatalities over a 48-hour period.…”

The need for innovation in deathcare leadership

“…First, it can lead to psychological trauma and stress among first responders and survivors (Entress et al , 2020; Gupta and Sadiq, 2010). Second, it can damage public trust and the victims' families' trust in the medical examiner or coroner (Carroll et al , 2017). Third, it can result in ineffective response and delayed recovery (Morgan et al , 2006).…”