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The Role of DMORTs in Mass-Fatality Management in US Civilian Domestic Disasters
Disaster Mortuary Operational Response Teams (DMORTs) are multidisciplinary groups that work to support local authorities and provide technical assistance and personnel to recover, identify, and process deceased victims during disasters. A part of the Department of Homeland Security’s National Disaster Medical System (NDMS), DMORT may be activated under several legal authorities including the National Response Plan, the Public Health Services Act, the Aviation Disaster Family Assistance Act, Presidential Mandate, and federal and state existing agreements, according to the National Association of Medical Examiners Mass Fatality Plan available at: http://www.dmort.org/FilesforDownload/NAMEMFIplan.pdf.*
This document defines mass fatality as: “Any situation in which there are more human bodies to be recovered and examined than can be handled by the usual local resources.” DMORTs are activated only upon request of local coroners or medical examiners who may find themselves overwhelmed with mass fatalities. DMORTs follow regional boundaries set for all NDMS teams. The other NDMS team types are: DMAT (Disaster Medical Assistant Team); VMAT (Veterinary Medical Assistant Team); FCC (Federal Coordinating Centers); NPRT (National Pharmacy Response Team) and NNRT (National Nurse Response Team). Origin and History of DMORTs The DMORT initiative originated “[i]n the early 1980’s [when] a committee was formed within the National Funeral Directors Association (NFDA) to address disaster situations and specifically, mass fatality incidents. This group found that no standardization then existed and worked toward creating a national protocol for the formation of a proper response. Initially, they were concentrating on just the role of funeral directors, but it was soon discovered that funeral directors and no one profession could handle all of the aspects of such an event. A multi-faceted nonprofit organization open to all forensic practitioners was formed by the committee to support the idea of a national level response protocol for all related professions. This group formed and purchased the first portable morgue unit in the country and their equipment has supported DMORT missions in Illinois, Indiana, Guam, Michigan and Del Rio. “Soon after this nonprofit group of volunteers had formed, government interest in this topic came to the forefront. Families who had lost loved ones in airline incidents felt that the treatment that they had received was inadequate and demanded a response from congress. As a result, Congress passed The Family Assistance Act in October of 1996 and required all American based airlines (and later all those operating in the US) to have a plan to assist families [see below for description of “Family Assistance”] in the case of an accident. DMORT is one federal team which can be called in to help if needed. “DMORT has grown from its humble beginnings in the early 1990’s to the current group of over 1,200 trained and capable volunteers who respond at a moments notice to assist those in need.” http://www.dmort.org/DNPages/DMORTHistory.htm DMORT III and United Flight 93 Crash, September 11, 2001, Somerset County, Pennsylvania For example, activation of a DMORT III team occurred following the crash of United Flight 93 on September 11, 2001 in Somerset County, Pennsylvania. On board were 44 passengers and crew; of these 44, 6 were crew members and 4 were terrorists. The local coroner was overwhelmed, understood his limitations, sought assistance from the DMORT team, and stayed in continual contact with the DMORT team, according to a presentation made by DMORT III (Mid-Atlantic) Commander Paul Sledzik, a forensic anthropologist and curator of the anatomical collection at the National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, DC. The Power Point presentation is available at: http://ndms.umbc.edu/conference2002/Proceedings/Session%2062B_files/frame.htm#slide0245.htm.
Approximately 50 DMORT members participated; 45 were from DMORT III region. The Federal Bureau of Investigation was involved because the crash was a crime scene, and was involved in some way with vetting morgue protocols, which “evolved as circumstances changed,” according to Sledzik. The three documents used to guide procedures during the mass-fatality incident, according to Sledzik, were:
The United 93 triage station was the intake site of the morgue. It was staffed by a pathologist, anthropologist, and a dentist, and an FBI agent was available for consultation. The team sorted potentially identifiable from unidentifiable remains, and numbered the identifiable remains starting with number 1. The coroner assigned case numbers after identification was completed.
The United 93 DMORT response used for the first time a DNA team, which had received training a few months before the crash. The DMORT used a contract disaster portable morgue unit supplied by the private firm Kenyon International Emergency Services. This morgue was similar to two disaster portable morgue units owned by the US Government and stationed in Maryland and California, but was smaller in size. DMORT work was augmented by local supplies and equipment, borrowed scientific equipment and Kenyon staff called “red shirts.” DMORT members copied all records and provided the originals to the coroner and copies to the FBI. DMORT volunteers continued to assist the coroner in additional recovery and examination after regular DMORT deployment ended (two week deployments are typical). Numbered specimens needed reassociation after DNA analysis was complete. DMORT volunteers assisted the coroner in this process, worked out some problems with reassociation databases, and verified all identification information. The final figures, from the DMORT perspective, on United Flight 93 are as follows:
DMORT III medicolegal issues arose in the aftermath of the work, according to Sledzik. For example, the FBI had questions about identification methodology and morgue procedures. DMORT wondered whether the National Medical Disaster System had experience in such issues and could assist DMORT members in court testimony. Sledzik ventured the question: Should DMORTs do forensic pathology? DMORTs and Hurricane Katrina, August-September 2005, US Gulf States DMORTs are still operating in the Gulf States at the time of this writing, so information is scanty. We know that on Tuesday, September 13, 2005, Kathleen Blanco, Governor of Louisiana, which the United Health Foundation ranks #50 of all states in the US in the health status of its citizenry (http://www.dhh.state.la.us/news.asp?Detail=386) nevertheless scolded Department of Homeland Security Secretary Michael Chertoff for slow corpse recovery presumably by DMORTs and other teams working at various sites, as well as his failure to sign a contract with Kenyon International Emergency Services. Kenyon is owned by Service Corporation International (SCI), which is to death what H&R Block is to taxes, according to Hoovers.com. SCI, the largest funeral and cemetery services company in the world, owns more than 1,200 funeral homes and 400 cemeteries as well as crematoria and flower shops in eight countries, primarily in the US and Canada; most of its other operations are in Europe. Services include embalmment, burial, and cremation. The company also sells prearranged funeral services, caskets, burial vaults, cremation receptacles, flowers, and burial garments and owns disaster recovery company Kenyon International Emergency Services. Call it unburied treasure: SCI has some $4.7 billion worth of unperformed funeral contracts. Kenyon’s website at http://www.kenyoninternational.com/ states in a September 1, 2005 press release the following: “Kenyon International Emergency Services, the world’s leading disaster management company, has activated an emergency action team to respond to the needs of Baton Rouge, Louisiana in the aftermath of Hurricane Katrina under an agreement with the US Government and the Department of Homeland Security. “Kenyon has deployed one of its full-equipped mobile morgue kits and a 10-member specially-trained team to provide morgue support to the area. The mobile morgue includes equipment for search and recovery, victim identification, and pathology. It is one of three mobile morgues held world-wide by Kenyon. Earlier this year, Kenyon also deployed a mobile morgue and a large response team for the tsunami efforts in Phuket, Thailand. A second undated Kenyon press release states that it “had been activated by the Federal Emergency Management Agency to conduct recovery of human remains in Louisiana. Teams assemble each morning at base of operation and set out to locations throughout the greater New Orleans area. At the locations, team members may encounter human remains in situ (still in the place where the storm left them) or already enclosed in body bags, prepared by other relief teams. Recovered remains are loaded into transport vehicles and delivered to one of two transfer sites managed by the Federal Disaster Mortuary Operational Response Team (DMORT) where they are held in refrigerated storage. DMORT provides mortuary support and processing of the human remains. Over 100 Kenyon team members are presently deployed and are housed at the Welsh Funeral Home in Baton Rouge.” (See http://www.kenyoninternational.com/Resources/Recovery%20effort.pdf.)
DMORT work in Louisiana is not glamorous, according to a DMORT II Commander Cliff Oldfield who has published his “Katrina Log” online for his team members and others who are interested in the personal (meals, lodging, and showers) side of working a DMORT job. (Please see: http://www.dmortregion2.org/log.htm). On September 5, 2005 , the following federal NMDS teams had been deployed to Louisiana and Mississippi: • In Louisiana, there were 30 Disaster Medical Teams (DMAT); 2 Veterinary Assistance Teams (VMAT); 1 Mental Health Team; and 4 Disaster Mortuary Operational Response Teams (DMORT). • In Mississippi, there were 11 DMATs; 1 Mental Health Team; 2 VMATs; and 4 DMORTS. In summary, DMORTs are federally-sanctioned, hopefully credentialed, volunteers with special skills, who support local authorities in mass fatality management following disasters. DMORTs are not the only mass-fatality units deployed to sites. Kenyon International Emergency Services is also active; in fact, some workers are members of DMORTs and also work for Kenyon. Editor’s Note: Mass-fatality management following disasters by groups of well-meaning, federally-sanctioned private citizens presumably with relevant skills sounds like a concept that may benefit from reevaluation. *All websites listed in the text above were successfully accessed on September 18, 2005. |
Kenyon, being a private business organization, apparently resisted doing further work on or around September 13, 2005, until it had a signed contract stating that it would get paid for its work. Apparently Governor Blanco instructed her Louisiana Department of Health and Hospitals director, Fred Cerise, MD, MPH, to draft and sign a contract, which he did and even posted it online! (see 
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