A Morbid Science

A Morbid Science

By David Brill

“With any luck, you’ll serve out your entire careers and never have to deal with the stuff we’re going to cover over the next three days”

Dennis McGowan, former chief of operations for the Fulton County [Georgia] Medical Examiner’s Office, rises to a podium, faces 40 or so members of the U.S. Department of Energy’s protective forces, and gives a rather unorthodox introduction to the course he’s about to teach.

“With any luck, you’ll serve out your entire careers and never have to deal with the stuff we’re going to cover over the next three days,” he says.

McGowan is deputy director of the National Mass Fatalities Institute (NMFI) of Kirkwood Community College in Cedar Rapids, Iowa. NMFI’s course “Mass Fatalities Incident Response Planning” was created in 2002 to help mental-health workers, emergency responders, physicians, law enforcement personnel, funeral directors, clergy, coroners and medical examiners, and disaster-relief organizations deal with the aftermath of catastrophic events. Since 2002 the course has been offered nearly 30 times across the nation.

The University of Tennessee’s Institute for a Secure and Sustainable Environment (ISSE) co-sponsors the course offering.

McGowan and his colleagues are in Oak Ridge, Tennessee, to instruct Department of Energy security personnel on the finer points of dealing with incidents that produce enough fatalities to overwhelm local emergency resources. Such incidents, despite the attendant frenzy, demand a thoughtful and methodical response to dealing with the dead and the families that survive them.

The Example of September 11

McGowan’s credibility is solid, even if his resume tends a bit toward the macabre. He was summoned to New York City in the days following the attacks of September 11, 2001. His skills were tapped previously after Egypt Air Flight 990—with 217 souls on board—plunged into the Atlantic 60 miles south of Nantucket Island in 1999.

“The goal of the program is to train a diverse group of professionals in the local community to perform specific tasks and help them develop their mass-fatalities plans,” says UT’s Sheila Webster, director of ISSE’s Innovation for Education and Environment Program. “At the end of the workshop, participants understand the special circumstances associated with a mass-fatalities incident.” In summer 2003 at UT, ISSE’s predecessor organization, UT’s Energy, Environment, and Resources Center, co-hosted one of the first of the mass-fatality workshops with NMFI.

NMFI was founded in 2000 with a congressional grant administered through the Centers for Disease Control and Prevention (CDC). In a bit of dark irony, Douglas Feil, executive director of Kirkwood’s Environmental Health and Safety Training Programs, was discussing the grant on the phone with CDC personnel at the instant the first plane crashed into the World Trade Center in 2001.

But should an incident occur, McGowan assures his audience, “you’ll face the ultimate chaos.”

The odds are good that McGowan’s audience members will, indeed, enter retirement without ever having to deal with a mass-fatality event. But should an incident occur, McGowan assures his audience, “you’ll face the ultimate chaos,” with scores of wounded scattered among the dead but with only a vague idea of what has happened and an even more tenuous grasp on why. With incidents involving terrorist acts, response personnel must also contend with the possibility that the initial event was only the beginning of a multipronged attack.

NMFI’s promotional materials feature the headline If Only You Knew It Was Coming. Though predicting the where and when of such events is nearly impossible, course participants are equipped with the training and tools they’ll need to respond quickly and appropriately.

“Within the planning and responder organizations, we strive for awareness of the need to prepare for and respond to a mass-fatality event with a cooperative mindset,” says Rex Short, manager of ISSE’s Environment, Safety, and Health Education Programs. “The fewer counterproductive walls and barriers, the more expediently and smoothly we can accomplish the hard work of recovery.”

Mass Fatalities Incident Response Planning

Short coordinates the Mass Fatalities Incident Response Planning course. A 10-module document on CD complements the instructors’ presentations and offers additional resources.

One of the course presenters, Warren Hamlin, supervisor of the Knox County [Tennessee] Police Department’s Forensics Unit, discusses law enforcement’s approach to managing a crime scene and the complications that can arise when local, state, and federal agencies converge on the scene in the tense moments following an event.

“Law enforcement’s primary mission is to identify victims and perpetrators and to protect evidence,” Hamlin says. “But it may take a while for law enforcement to arrive, so those first on the scene need to help make sure no one tramples on evidence.”

As law enforcement personnel work the crime scene, others begin the process of establishing temporary morgues and locating and identifying decedents. In many cases, identifying remains poses a difficult task.

“In some instances, the incident destroys every trace of an individual,” McGowan says. “In other cases, the only remains of an individual are needed for DNA testing, leaving the family with nothing to bury.”

Day two of the course begins with an elaborate training exercise. Three men in protective suits move methodically around a mangled black SUV, a casualty of a roadside improvised explosive device (IED). A partially dismembered body [a mannequin]—one of several involved in the incident—spills from one of the doors of the disabled vehicle. Severed body parts—hands, legs, and feet—litter the roadside. The men chart the locations of the ersatz human remains and photograph the scene, gathering evidence.

What if . . .?

In essence, the mass-fatalities course trains participants to respond to a welter of questions that begin with “What if . . . ?”

What if these remains were real flesh and blood, instead of molded plastic? What if a roadside IED had actually detonated here in the Tennessee countryside? What if the community’s emergency-response resources were stretched well beyond the breaking point? What if the incident was but the first event in a chain of related attacks? What if the protective armor, shielding radioactive materials, had been breached, spreading contamination throughout the scene and leaving victims dead and radiologically hot?

NMFI was founded on the belief that exploring the cascade of “what if?” questions is essential for contending with those cataclysmic events that defy comprehension but nonetheless have happened—and will happen again.

Consider, for instance, that Oklahoma City was a vastly different community on April 18, 1995, from what it became at 2 minutes after 9 a.m. on April 19, when Timothy McVeigh’s rented Ryder truck detonated in front of the Alfred P. Murrah Building.

At 8:45 a.m. on September 11, 2001, workers in the North Tower of the World Trade Center went about their daily routies, unaware that within a minute, American Airlines flight 11 would plow into their building, triggering a scale of destruction and chaos never before witnessed on American soil.

Likewise, on August 28, 2005, residents of New Orleans and other cities dotting the southern coast of the U.S. braced for the arrival of Hurricane Katrina, but few anticipated that the category-5 hurricane and resultant storm surge would leave some 1,800 of them dead.

On those respective dates, the Murrah Building, the World Trade Center, and New Orleans joined a relatively short—but profoundly affecting—list of American mass-fatality sites, which includes Waco, Virginia Tech, and Columbine, along with a number of deadly plane crashes.

While the focus of a mass-fatality response is on the dead, McGowan makes it clear that the effort is undertaken essentially “for the living.”

In all these cases, emergency response personnel first focused their attention on assisting survivors, but once the injured had been treated and removed from the scene, responders faced the even more daunting task of contending with the dead—80 persons in the Branch Davidian compound in Waco, 168 in Oklahoma City, and 2,752 at the World Trade Center. Cause of death for the World Trade Center victims is officially listed as homicide. The number does not include the 10 hijackers who died in the incident, who are listed as suicides.

After the Twin Towers collapsed in New York City it became evident that local hospitals would not be overwhelmed by incoming patients. In fact, few victims survived. The event did, however, strain the ability of responders to recover and handle the remains of the victims. On top of the huge emotional impact of the devastation, Ground Zero was a crime scene, and human remains were considered evidence.

While the focus of a mass-fatality response is on the dead, McGowan makes it clear that the effort is undertaken essentially “for the living.”

One component of the NMFI workshop is designed to help responders deal sensitively and respectfully with victims’ remains, survivors, and family members amidst potentially chaotic situations.

Jim Coyle, a trained counselor and founding member of the Department of Homeland Security response teams, and Lisa LaDue, NMFI co-founder and skilled clinical social and mental-health worker, explore the emotional challenges that confront responding personnel as well as the families of the victims.

“Okay, you all are dead,” says Coyle, addressing the DOE participants. “Think about the people who love you, how they’re responding to your death, and how you would want them to be treated.”

Coyle continues the hypothetical. “Let’s imagine a scenario with four hundred fatalities,” he says. “For each fatality, ten family members will show up at the scene, and fifteen more will make contact via the phone.”

In many cases, these bereaved family members must be housed, fed, counseled, and kept informed of developments in the recovery effort, for example, the longer-term efforts to identify the remains, often through dental records, fingerprints, and DNA testing.

According to McGowan, the cost of DNA testing for the World Trade Center victims reached $20 million fairly early in the operation. Collection of remains continued actively for more than 10 months and is still an open process.

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David Brill is managing editor for the UT Institute for a Secure and Sustainable Environment in Knoxville. For more information, contact Rex Short, ISSE, 865-924-1619, or e-mail rashort@utk.edu.