DMORT Teams and Their Role in MFIs

Disaster strikes – and there are more fatalities than local resources can manage. An operational definition of a Mass Fatality Incident (MFI) is “one more than local authorities can handle.” The specific death tolls in MFIs that the nation’s Disaster Mortuary Operational Response Teams (DMORTs) have responded to since 1993 range from 11 fatalities to almost 3,000.

Fortunately, DMORTs are now available to assist local authorities as part of the National Disaster Medical System (NDMS) of the U.S. Department of Health and Human Services (DHHS).  When deployed, a DMORT works for the local coroner/medical examiner.

Public concerns and expectations following mass-fatality incidents – whether due to accidents, natural disasters, or terrorist activity – have resulted in the increasing application of forensically based multidisciplinary approaches to managing victim identification and other aspects of the incident, including evidence recovery.

That change is reflected in the composition and organization of the ten U.S. regional DMORT teams, which provide varying levels of assistance to local coroners/medical examiners – who still possess legal responsibility for control of the victims’ remains. Typical DMORT teams are composed of forensic anthropologists, odontologists and pathologists, medicolegal investigators, computer specialists, and other support personnel, in addition to the morticians who first voiced concern about the proper care of victims, and who serve as the organizational backbone of the DMORT concept.

DMORT team members are intermittent federal employees who leave their “day jobs” when activated during MFIs. The types and numbers of personnel deployed to a specific MFI vary with the availability of local resources and the number of victims.  The basic approach to handling an MFI is likely to be similar, however, starting with:

  • The recognition, recovery, and documentation of victim remains and associated evidence at the scene of the incident. These scenes have varied from rural flooded cemeteries to airplane crashes; from fields, forests, and tropical Pacific settings to both the Atlantic and Pacific Oceans; from an Amtrak train crash in a small town to large regional areas devastated by natural disasters including tornadoes and hurricanes (Katrina, for example); and, of course, to terrorist incidents, large and small, involving such sites as the Murrah Federal Building in Oklahoma City, and New York City’s World Trade Center – the latter immediately becoming the largest crime scene in U.S. history.  Climatic circumstances also have ranged widely, from a wind-chill temperature of 48 degrees below zero Fahrenheit with snow and ice in Monroe, Michigan, to over 100 degrees Fahrenheit combined with “super typhoons” on Guam.

  • The selection of a site for, and establishment of, a Family Assistance Center (FAC) to aid in the acquisition of victim antemortem information, while also providing progress reports for victims’ families.  Hotels where out of town kin can be housed while receiving and providing information have been very useful for this purpose.

  • The setting up and staffing of an Information Resource Center (IRC) to receive, process, and manage the antemortem and postmortem victim data.  The latter usually is obtained by forensic specialists from the remains themselves at the morgue.  DMORT computer programs are used for data processing.  Forensic specialists will attempt to positively identify the victims by comparing the morgue data with the computer data.
  • The selection of a site for, and establishment of, a temporary Incident Morgue (IM) for the processing and identification of recovered remains.  Local authorities have sometimes made use of school facilities, but this should be avoided, because such locations are likely to become “tainted” in the eyes of local residents.  Medical-examiner offices, military facilities, airport hangars, and warehouses also have been used, and rented tent-like structures with appropriate utility attachments have shown great potential for future use.

DPMUs, the Disaster Scene, and NTSB Involvement

The work at each of the above locations is facilitated by the use of what are called Disaster Portable Morgue Units (DPMUs).  The typical DPMU is stocked with a broad spectrum of supplies and equipment including gurneys, personal protective equipment, remains examination tools, and computers as well as digital full-body and dental x-ray equipment.  All DPMU equipment owned by the federal government is palletized and ready for immediate deployment, by air or overland transport, to incident locations.  There are presently one DPMU on each coast, and one in Texas.  Specially trained personnel travel with the DPMU to set up, maintain, and later return the DPMU to its point of origin.

Team members often aid in the recognition and recovery of remains and associated evidence while also documenting their location. However, as mentioned above, the disaster scene itself remains under the control of the pertinent local, state, or federal jurisdiction.  Many disaster scenes also are considered crime scenes, and thorough documentation – followed by continuing documentation when the remains are processed at the morgue – avoids the types of mistakes that may hamper criminal and/or civil proceedings.  Documentation has become even more important in recent years because of concerns about possible terrorist activity.  The FBI’s Evidence Response Teams (ERTs) also have become increasingly involved.

While emphasizing the forensic aspects of documentation it should not be forgotten that the National Transportation Safety Board (NTSB) and other agencies are charged with determining what specifically went wrong in accidents involving aircraft and/or other modes of transportation so that, in addition to helping to assign legal responsibility, those agencies also are involved in the effort to prevent future accidents.

An Inside Look at the Family Assistance Center

The Family Assistance Center (FAC) is an integral part of any mass-fatality response.  The FAC serves several purposes. It serves, for example, as: (a) A central location where family members of the deceased can provide antemortem information on the victim, such as a detailed physical description, dental records, medical information, and DNA reference samples; and (b) A convenient meeting place where the families of victims can receive accurate, timely information regarding victim identification – and have their own questions answered.

In the case of aircraft accidents, the Aviation Disaster Family Assistance Act (the legislative “bible” for such accidents) places responsibility for running the Family Assistance Centers on the National Transportation Safety Board itself – which has available a small cadre of well trained DMORT members to help provide FAC support.

Family members can assist in the identification of their loved ones at the FAC by providing information about the victims.  Antemortem information about clothing, jewelry, physical characteristics, medical and dental procedures, and health history is collected for comparison with similar postmortem information derived from the victims’ remains.  The FAC is usually where the process of locating and obtaining victim antemortem dental and medical radiographs and related information is initiated. It is also where family members usually are interviewed – by funeral directors who are accustomed to working with grieving families. 

Many of the interviewers also have backgrounds in mental health and/or social work.  DMORT has recognized the important nature of this work by forming a Family Assistance Center Team (FACT) that provides a cadre of highly trained and experienced interviewers.

Information Resource Centers & the Incident Morgue

The Information Resource Center (IRC) uses a software Victim identification Program (VIP) that has evolved in relation to each incident.  The IRC usually will be set up in an area with close access to the morgue work area, and a separate data-entry area may be set up at the FAC for the input of antemortem data; the data gathered is then electronically transferred to the IRC. After all antemortem data has been collected and entered, a careful search of the accumulated data is carried out, using the postmortem data points as the primary basis for the searches. Under no circumstances, it should be emphasized, does the VIP program make an identification per se; what it does do, and very competently, is narrow the number of possible matches that must be checked scientifically.

The other important piece of software that will be running in the IRC is the WinID program, which is used to match dentition in the Dental Section.

The Incident Morgue (IM) is used for all postmortem examinations. Morgue operations are modular in organization and can be modified to address the needs that become obvious during and after a specific disaster.  The morgue layout is standardized, though, with an organized flow of the remains from initial documentation to postmortem examination to identification to release.

After being taken into the morgue, victims’ remains pass through a triage process to remove: (a) unidentifiable material; and (b) material considered to be unsuitable for DNA testing.  The remains of each victim are assigned both a number and an escort person – to ensure continuity of both the evidence chain and the documentation of victim remains and personal effects. The documentation includes both photographic and radiographic recording of the remains.  All remains also are photographed before they move through the morgue process.

Pathology and Other Medical Specialties

Immediate incident-scene radiographic documentation is needed to locate airplane parts as well as other foreign objects that may be a hazard to personnel and/or be needed by the NTSB or FBI for their analyses. Radiographs also are used to record loose teeth, medical/surgical devices, and unusual or otherwise distinctive characteristics of the remains that may aid in identification.  Customary clinical views of the remains are taken for comparison with any antemortem radiographs.

As in normal practice, pathologists attempt to determine the cause and manner of death.  The latter may seem simple in transportation and natural disaster incidents, but homicides not related to the crash or flood have been found by careful examination of the remains.  Also, improvements in safety have come about as a consequence of determining the actual cause of death.  For instance, the fact that death in some crashes was due to smoke inhalation rather than to the blunt force associated with impact has resulted in the use of fire-resistant materials for seating and interiors.  Moreover, the notation of injury patterns can lead to design changes that can reduce future injuries and save lives.

In addition, pathologists describe remains and, if and when the condition of the remains allows, pathologists: (a) note the victim’s sex (based on examination of the body’s external and/or internal soft tissues); (b) make a rough estimate of the victim’s age (as suggested by internal organs); and (c) record the presence of moles, scars (and their significance), tattoos, medical devices, etc.  In a transportation accident, the pathologist is also required to take samples from specified crew members (of the aircraft or locomotive, for example) for analysis. 

Other medical specialists contribute significantly to development of the overall postmortem process. A basic contribution of the forensic anthropologist, for example, in the standard forensic setting (coroner/medical examiner office) is to create a biographic profile based on a skeletal assessment of sex, age, ancestry, stature, etc. for the unidentified individual so that appropriate antemortem dental and medical radiographs can be obtained from a variably sized pool of missing persons for comparison. The biographic profiles also may include fleshed characteristics, if and when available.

In an MFI, the immediate need is to create biographic profiles for each set of remains, whether an intact body or a body fragment, so that when (and if) the antemortem radiographs arrive, potentially matching postmortem radiographs can quickly be made available for comparison.

The specific anatomical structure present (useful in re-associating separate units and called for in DNA protocols) and other descriptive information are also documented.

Antemortem and postmortem clinical-view radiograph comparisons are usually carried out by anthropologists – who also may use antemortem photographs of distinctive body features (i.e., ear form) in the same fashion, after first matching biographic profiles.

Forensic odontologists (dentists) locate and radiographically record the teeth, restorations, and other dental characteristics present in the remains.  This information is compared to the antemortem dental radiographs (written records may not be accurate) obtained through the FAC. (Historically, dental identifications have accounted for a majority of identifications of disaster victims.)

Fingerprinting, DNA, and Returning the Remains

When available, fingerprints are usually handled by specialists from the FBI Disaster Squad.  DNA evidence also has become an important tool for both positive identification and the re-association of remains.  Just as in other identification methods, DNA requires the use of postmortem samples and antemortem or family reference samples.  DMORT has adopted the protocols of the Armed Forces DNA identification Laboratory (AFDIL) for collection of postmortem DNA samples and victim and family reference samples.  DMORT collects family and victim reference samples through the FACT.

After passing through the above stations – and others if and when required by special circumstances – the remains are stored in refrigerated trucks awaiting additional identification information and eventual release to the families.  After a positive identification has been recommended by the forensic team, the final determination is made by the local coroner/medical examiner.  The remains may then be embalmed by DMORT morticians prior to returning them to the next of kin, or they may be embalmed by local morticians selected by the next of kin.  The process of releasing the correct remains to the proper funeral home is an exceptionally critical process demanding thorough documentation.

As the general public (specifically including victims’ families) has become more sophisticated and knowledgeable about the forensic sciences – in part, undoubtedly, because of the popularity of several television programs focused on the forensic sciences – expectations have been heightened concerning the positive identification of victims in Mass Fatality Incidents. The role of DMORT, and its forensic scientists and support personnel, has probably for that reason alone become more important than ever before in responding to the needs of the victims’ families.

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Frank P. Saul

Dr. Frank P. Saul is Associate Dean and Professor Emeritus, Anatomy, of the Medical College of Ohio, and also serves as commander, Region V Disaster Mortuary Operational Team (DMORT), of the National Disaster Medical System. Dr. Saul is also a forensic anthropology consultant to coroner/medical examiner offices in Toledo, Ohio, Detroit, Michigan, and other cities, as well as to the Cleveland (Ohio) FBI Evidence Response Team.



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