APPENDIX IV: MORGUE SERVICES TAB A: MORGUE SERVICES ...

1 EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-1 APPENDIX IV: MORGUE SERVICES TAB A: MORGUE SERVICES ORGANIZATION EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-2 TAB B: STAFFING TABLE Small Medium Large Large Catastrophic Incident Command: MORGUE Safety Officer 1 1 1 1 1 Administration / Finance Section Chief 1 1 1 1 1 Logistics Section Chief 1 1 1 1 1 Operations Section Chief 1 1 1 1 1 MORGUE Operations Group MORGUE Operations Group Supervisor 1 1 1 1 1 MORGUE Operations Group Deputy Supervisor 0 0 1 1 1 MORGUE Autopsy Unit MORGUE Autopsy Unit Lead 1 1 1 1 1 Intake Team Lead 1 1 1 DMORT DMORT Intake Staff 1 3 4-5 DMORT DMORT Escort Team Lead 1 1 1 DMORT DMORT Escort Staff 4 5-8 10-12 DMORT DMORT Triage Team Lead 1 1 1 DMORT DMORT Triage Pathologist 1 2 3 DMORT DMORT Triage Autopsy Techs 1 2 3 DMORT DMORT Pathology / Autopsy Team Lead 1 1 1 DMORT DMORT Pathologists 1-2 2-3 3-4 DMORT DMORT Autopsy Techs 1-2 2-3 3-4 DMORT DMORT Anthropology Team Lead 1 1 1 DMORT DMORT Anthropology Staff 0 1 3-5 DMORT DMORT MORGUE Sub Total.

2 20-22 28-33 41-48 7 7 MORGUE Data Collection Unit MORGUE Data Collection Unit Lead 1 1 1 1 1 Photography Team Lead 1 1 1 DMORT DMORT Photography Staff 0 1-3 1-3 DMORT DMORT Radiology Team Lead 1 1 1 DMORT DMORT Radiology Staff 1 2 2 DMORT DMORT Dental Team Lead 1 1 1 DMORT DMORT Dental Staff 1 2 2 DMORT DMORT DNA Team Lead 1 1 1 DMORT DMORT DNA Staff 1 1-2 2-4 DMORT DMORT EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-3 Small Medium Large Large Catastrophic Fingerprint Team Lead 1 1 1 DMORT DMORT Fingerprint Staff 1-3 3-5 5-8 DMORT DMORT MORGUE Sub Total: 10-12 15-20 18-25 1 1 MORGUE Information Processing and Disposition Group MORGUE Information Processing and Disposition Group Supervisor 1 1 1 1 1 MORGUE Information Processing and Disposition Group Deputy Supervisor 0 0 1 1 1 Evidence / Property Team Lead 1 1 1 DMORT DMORT Evidence / Property Staff 1 2-3 3-5 DMORT DMORT Identification Unit Lead 1 1 1 1 1 Postmortem Staff / Antemortem / Comparison Staff 2-4 5-10 10-20 10-20 20+ Death Certificate Unit Lead 1 1 1 1 1 Death Certificate Issuing Staff 0 1-2 2-5 2-5 5+ Information Systems Unit Lead 1 1 1 1 1 Information Systems Staff MORGUE Sub Total: 8-10 13-20 21-36 17-29 30+ EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-4 TAB C.

3 FLOW CHARTS HANDLING HUMAN REMAINS FLOW CHART Hospital Death Identified and Natural Death Yes No Death Certificate Signed Yes No Temporary Cold Storage Coroner Case Autopsy ID OBTAINED Yes No DNA TEMPORARY COLD STORAGE FINAL DISPOSITION NOK Yes No MORTUARY PICK UP CASE COUNTY MORGUE PICK UP CASE EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-5 MASS FATALITY CORONER S OFFICE FACILITY FLOW CHART EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-6 THIS PAGE INTENTIONALLY BLANK EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-7 TAB D: MORGUE SERVICES CENTER & SUPPLY CHECKLIST This material applies in part to both the Temporary MORGUE and the MORGUE /Examination Center. The DMORT web site ( ) contains suggestions for equipment and supplies. 1) Equipment: Early considerations a) Site selection based on the findings of the Evaluation Team b) Security/ID badges; different colors reference function and access.

4 C) Unique numbering system separate from your usual case numeric system. d) Refrigerated trucks with ramps to allow access and egress 4 e) Communications - telephones, radios, fax, PA (paging systems); local cell operators may designate a specific reserved air wave. f) Computers programs and operators all electronic files (including WIN ID, supplies, tracking, etc.) should be backed up daily. g) Records i) Personnel log including name, agency, SSN & in and out time. ii) MORGUE /Examination Center Registrar iii) Antemortem and postmortem formats and forms iv) Entry operators/Data analysts h) Disaster Victim Packet should contain all forms and paperwork necessary for every examination station i) Station Processing Plan flexible to fit the situation j) Worker Safety and Comfort Supplies i) Healthcare provisions in place. ii) Immunization records iii) Rest areas including toilet facilities iv) Nutrition needs v) Critical Incident Stress Debriefing 2) Station System and Personnel (suggested procedure local adaptation will be necessary) a) Registration in Body Receiving Area i) Receipt of DMORT Transportation Log or like document completed at the Temporary MORGUE ii) Log in documentation from Temporary MORGUE : date, time, and numbering (from the scene) iii) Assignment of permanent body tracker EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-8 iv) Transfer of chart and all required documentation (Disaster Victim Packet) to the individual tracker.

5 B) Screening Station: Personal effects and clothing documentation/anatomic charting/further evidence collection. This is the point at which a decision can be made for a specimen (body part, fragmentary 5 remains, and partial body) to take a long path through all subsequent stations or a shorter path with an examination at the morphology station and DNA only retrieved. Criteria for long or short path need to be established before the disaster. i) Coroner s officer ii) Coroner s officer assistant iii) Scribe iv) Photographer and assistant v) Personal Effects Technician vi) Evidence Technician vii) Anthropology consultant viii) Bomb Tech or other specialist as indicated ix) Complete necessary forms and return to tracker : Paperwork generated at this station (Disaster Victim Packet) must be placed in the case file to go with the tracker and body to the next station. This procedure is repeated at every station. x) Option of DNA or other convenient specimen procurement (requires lab tech for transmission) c) Print Station (finger, palm, foot) i) Print Specialist Local Law Enforcement, FBI Disaster Squad ii) Print all bodies iii) Complete proper documentary form iv) Fingers or hands removed only at the discretion of the Chief Coroner.

6 If removed place in a properly identified container and place them back with the body after processing. d) Radiology/X-ray Station i) Radiologist ii) X-ray technician/assistant iii) Portable x-ray units, film and developers iv) Full body x-rays are mandatory v) Dental x-rays may be a part of this operation or are often a part of the Dental Station operation as 6 dictated the Chief Odontologist. A bomb technician or other specialist as indicated may be needed here. vi) Log all films (1) MORGUE ID # (2) Date/time EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-9 (3) Radiograph # (4) # of films taken (5) Initials or signature of technician e) Dental Station i) Odontologist ii) Dental assistant iii) Photographer iv) Evidence technician v) Scribe vi) X-rays if not previously performed vii) Charting The universal numbering system, 1-32 with the upper right 3rd molar as #1, upper central incisors as #8 & #9, upper let 3rd molar as #16, lower leg 3rd molar as #17 and lower right 3rd molar as #32 is usually preferred.

7 There is also a FDI numbering system available. viii) Immediately enter data into WIN ID II (2002) ix) Jaws are only removed on non-viewable bodies (the funeral director is an excellent consultant) at the discretion of the Coroner at the request of the Chief Odontologist. If removed place in a properly identified container and place them back with the body after processing. Many medical examiners feel that jaw removal is antiquated and unnecessary with modern dental technology. f) Autopsy Station i) The decision to do complete or partial autopsies resides with the /Coroner authority locally responsible for body processing and death certification. Some reasons for complete autopsies: (1) Homicides terrorism (2) Indeterminate manner of death (3) Flight crews the same pathologist should do all members (4) Unidentified remains (5) Federal request (6) Coroner request ii) Forensic pathologist iii) Autopsy assistant iv) Evidence technician v) Bomb tech or other specialist as indicated vi) Scribe vii) Photographer viii) Lab technician ix) DNA (4 mL blood in a purple top tube; 5 10 gm skeletal muscle, spleen, liver, bone, and/or teeth), toxicology and other specimen procurement.

8 EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-10 Some may have already be obtained at the initial screening station in some operations requires lab tech for proper documentation and transmission. x) Evidence collection continues xi) Completion of form designating preliminary autopsy findings Victim Identification Profile (VIP)/DMORT Program, Pathology examination of partial or complete remains) xii) Documentary forms to the tracker xiii) Histology specimens to the lab tech xiv) Toxicology specimens to lab tech for transmission g) Anthropology/Morphology Station i) Personnel needed: (1) Anthropologist (2) Anthropology assistant (3) Scribe (4) Evidence Technician (5) Photographer (6) Radiographer (7) Forensic pathologist ii) Fragmented, incomplete, charred, commingled remains iii) Documentation to the tracker with the remains iv) If a bone section or the like is retained, place in a properly identified container and place it back with the body after processing.

9 If it is a specimen for DNA, for example, it is to be properly documented and transmitted to a laboratory technician. h) Body Storage i) Individual tracker returns the body to the receiving area. ii) The body or part, with the direction of the receiving registrar is transferred to the appropriate secure designated processed refrigerated area and documented. The refrigerated area must be fully staffed with receivers and security. iii) The Examination Center Registrar receives the Victim Disaster Packet from the tracker and assures proper transfer to the Records Management Team. iv) Special storage sites should be designated for specimens such as DNA & Toxicology. i) Records Management Team i) Personnel needed: (1) Supervisor/Registrar (2) Computer entry clerks (3) Data clerks (4) File clerks EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-11 (5) Security (6) Communication clerks telephone, e-mail and fax (one member made an entry here I was unable to read) from other sites (scene, family assistance center, command post) ii) Establish tracking procedures for files iii) Establish back-up protocols for computer files MORGUE SUPPLY LIST 1) Supplies needed for all groups: a) Protective clothing - gloves, scrubs, aprons, shoes, shoe covers, masks, coveralls, headwear, respirators b) Log book / forms 2) Necessary office supplies: a) Prepare processing packets (pre-numbered with labels on each form, extra labels in folder) with basic forms and/or additional forms as required by Coroner available at each station.

10 B) Start with only 20 folders to allow for changes discovered as processing begins. c) Two-way communications equipment d) Computer e) Photocopier/printer f) Barcode label maker g) Supply of necessary forms for all Teams of the MORGUE h) Log books 3) Intake Team a) 2 tables b) 4 chairs 4) Radiology / X-Ray a) 1 table b) 2 chairs c) X-Ray Imager d) Digital x-ray computer system or leased equipment on-site 5) Registration a) 2 tables b) 4 chairs EOP / INCIDENT ANNEX J / APPENDIX IV MORGUE SERVICES ORGANIZATION IV-12 6) Records Management a) 2 tables b) 4 chairs 7) Anthropology / Morphology Station a) 2 tables b) 4 chairs 8) Pathology a) 2 tables b) 4 chairs c) Pathology Instrument Kit d) Portable autopsy tables e) Lighting 9) Anthropology a) 2 tables b) 4 chairs c) Anthropology Kit: 10) Print Station a) 2 tables b) 4 chairs c) Fingerprint Post Mortem Kit 11) DNA / Autopsy Station a) 2 tables b) 4 chairs c) DNA Instrument Kit d) Autopsy Table / Kit 12) Dental Station a) 2 tables b) 4 chairs c) DEXIS digital dental x-ray system d) Hand held dental X-Ray unit e) WinID dental laptop computer and printer f) Odontology Post Mortem Instrument Kit g) Digital Camera.