Resource Factors in Mass Fatality Management
Tsunami Health ConferenceWorld Health Organization
May 5, 2005
Thomas J. BrondoloDeputy Commissioner
Office of Chief Medical ExaminerCity of New York
Purpose of Talk
• To identify and discuss four factors of Mass Fatality Incidents (MFI’s) that impact resource requirements.
Presentation Outline• Identification:
– The primary medicolegal task in an MFI• Four factors
– Number of fatalities– Rate of recovery– Manifest– Condition of remains
• Three Case Studies:– WTC Terrorist Attack– Crash of Flight 587– Thailand tsunami disaster
Identification
• Four Factors– Number of fatalities– Rate of recovery– Manifest– Condition of remains
SEPTEMBER 11, 2001
WORLD TRADE
CENTER
NEW YORK CITY
WTC – Four Events
• 8:46am Flight 11 hits North Tower• 9:03am Flight 175 hits South Tower• 9:58am South Tower collapses• 10:28am North Tower collapses
Within 10 seconds 1,350ft tower reduced to 70 foot pile of compressed rubble
Manifest
Manifest
Partial Manifest
Partial Manifest
Fragmented Remains
FragmentationSlow Recovery
Triage Station
Memorial Park
Distribution of Fatalities• North tower, above impact 1356• South tower, above impact 618• Both towers, below impact 146
– Approx 15,000 escaped • Unknown location in towers 26• Bystanders/nearby bldgs 18• No information 17• First responders 421
– NYFD 343– PAPD 37– NYPD 23– Other 18
• Airplanes 147• Total 2749
Importance of a ManifestNumber of Fatalities
Totals09/11/01 20,00010/01/01 7,00012/01/01 3,05001/01/04 2,749
Initially 20,000 (88 foreign countries)Now 2,749 (67 foreign countries)
Rate of Recovery 9//11/01 - 9/11/04Condition of Remains
0
100
200
300
400
500
600
9/11
/200
1
11/1
1/20
01
1/11
/200
2
3/11
/200
2
5/11
/200
2
7/11
/200
2
9/11
/200
2
11/1
1/20
02
1/11
/200
3
3/11
/200
3
5/11
/200
3
7/11
/200
3
9/11
/200
3
11/1
1/20
03
1/11
/200
4
3/11
/200
4
5/11
/200
4
7/11
/200
4
9/11
/200
4
Date
Rem
ains Received
R-IDV-ID
WTC Summary
-High volume-Fragmented-No Manifest-Slow recovery
American Airlines Flight 587 November 12, 2001
• Airbus 300 – 600• JFK to Santo Domingo• 251 passengers and 9 crew• Belle Harbor, Queens, 81 sec. after takeoff• 5 fatalities on ground
American Airlines #587
• 265 total fatalities, all identified in 1month• Remains recovered: 2,058• Remains identified: 1,750 85%• Remains not identified: 308 15%
Final Disposition
• Family groups have not decided on resting place for unidentified and unclaimed remains.
• Hundreds of unidentified and unclaimed remains are stored in a trailer at our office.
Flight 587 Summary
-Med volume-Fragmented-Manifest-Fast recovery
Thailand Tsunami• High number of fatalities (5,395)
– Over large geographic area (across six provinces)• No manifest
– Multiple nationalities– Limited antemortem data
• Fast recovery– Many collection points
• Intact bodies– High heat, fast decay
Thai Tsunami Summary
-High volume-Intact bodies-No Manifest-Fast recovery
Resource Issues
– Number of fatalities• Higher the number
– More labor intensive– Need for quick command and control– Body storage, primary goal
– Manifest• No manifest
– Dedicated resources to antemortem collection
Resources Issues
– Rate of Recovery• Fast recovery
– Will overwhelm initial resources– Need for quick command and control– Body storage, primary goal
– Condition of Remains• Fragmented or decomposed remains
– No manifest, the identification process will take months, even years
Case Study SummaryRemainsExam
DNA Death Certificate
Cost IT/Records ResourceFactors
WTC 6/2002 Continues Continues $100 million
< $530,000
<$ ???
High volumeFragmentedNo ManifestSlow recovery
Flight 587 5 days 20 days 30 days
Continues
60 daysMed volumeFragmentedManifestFast recovery
ThaiTsunami
> 4 months
Continues ContinuesContinues
High volumeIntact bodiesNo ManifestFast recovery