Coroner’s Office

Parish of Lafourche

Dr. John C. King, Coroner

Mass Fatality Plan

March 30, 2017

Prepared by

Mark Goldman FI, D-ABMDI

Chief Investigator/Administrator

Purpose

The purpose of this plan is to provide employees of the Lafourche Parish Coroner’s Office with a comprehensive plan of action in the event of either a natural or man- made disaster including, but not limited to the following:

  1. Severe weather events such as tornadoes, hurricanes, floods, etc.
  2. Man-made events such as an explosion, hazardous materials release, plane crash, or criminal activity.
  3. Any other even that would adversely affect the daily life of the citizens of Lafourche Parish. This plan shall be placed into operations should the number of deaths arising from any of these disasters exceed the normal capabilities of the Lafourche Parish Coroner’s Office. A copy of this plan shall be made available to every employee of the Lafourche Parish Coroner’s Office and to any public agency or official who may be called upon to assist in a time of disaster. A mass fatalities incident is defined as an occurrence of multiple deaths that overwhelms the usual routine and capabilities of an agency. When a mass fatalities incident occurs, the following action plan be implemented by the Lafourche Parish Coroner’s Office.
  4. Evaluation Team An evaluation team from the Coroner’s Office will respond to the site of the incident to coordinate actions with other responding agencies and
    to evaluate the following:

    A. Number of fatalities.

    B. Condition of bodies.

    C. Determine equipment and personnel needed.

    D. Formulate a plan of action.

    E. Determine facilities needed.

    F. Evaluate the scene for safety hazards.

Note: If the incident is of such a magnitude that personnel and equipment may be necessary from outside the Coroner’s Office, the following agencies should be considered:

A. Louisiana Mass Fatality Task Force.

B. DMORT (Disaster Mortuary Team)

C. Mobile Morgue

D. Terrebonne Parish Coroner’s Office

E. St Charles Parish Coroner’s Office

F. Jefferson Parish Coroner’s Office

2. Three Major Areas Of Operation

A. SCENE: Documentation and Body Recovery.

B. EXAMINATION CENTER: Body Identification and Processing.

C. FAMILY ASSISTANCE CENTER: Collection of Information, Assist Families.

The following will be assigned to supervise of each operation. All three need to be set up and coordinated at the same time. Other agencies involved in the operation must be part of establishing these sites. A. SCENE: Coroner and Chief Investigator

B. EXAMINATION CENTER: Forensic Investigators Lafourche Parish Coroner’s Office and Terrebonne Parish Coroner’s Office, Jefferson Parish Coroner’s Office if needed.

C. FAMILY ASSISTANCE CENTER: Office Secretary and coordinate with Lafourche Parish Sheriff’s Office Victims Assistance Unit.

Pre-planning can save time and headaches when a disaster occurs. The following are things that should be planned in advance:

A. Communications: Phones, Radios, Pagers, Faxes, etc.

B. Body Bags: Where to get them in a hurry.

C. Refrigerated Trucks: Needed for both the scene and the morgue.

D. Transportation: For personnel and bodies.

E. Security: For all areas of operation.

F. Identification: I.D. badges for all personnel.

G. Examination Site: Select a suitable site for temporary morgue (if necessary)

H. Family Assistance Site: Church, Hotel, Community Centers.

I. Equipment and Supplies: Know where to get them in a hurry.

Prior to the beginning of actual operations, a staging area must be established as well. This area should be near the scene and large enough to accommodate personnel and equipment. All personnel and equipment should report to the staging area to be logged in and wait for assignments. Identification for workers is issued at the staging area. The staging officer is in charge of this site.

A. SCENE:

The scene is the most important place for attention to be focused. Remember, a crime may have caused the incident. As a result, time must be taken to document and preserve the scene, evidence, the bodies, and personal effects. This operation must be coordinated with law enforcement agencies. Once all has been identified and documented, the process of removal can begin.

1. Everything must be marked at the site then labeled. Use simple numbers for labeling (I.E.) B1, B2, B3 for bodies. P1, P2, P3 for body parts. E1, E2, E3 for personal effects.

2. Everything must be bagged and tagged.

3. Scene Recovery Teams

A. Body Recovery Team(s) comprised of the following:

1. Coroner’s Forensic Investigator

2. Funeral Home Representative

3. Scribe (For Documentation)

4. Body Moving Team(s) comprised of 4 people to move body from scene to transport vehicle.

**NOTE** All worker’s time on a scene must be limited to no more than 3 hours at a time. Ample time must be allowed between work shifts for rest and relaxation to avoid psychological problems.

4. Transport Bodies from the Scene to the Examination Center: Unmarked funeral home or contract vehicles should be used.

B. Examination Center (Temporary Morgue)

Personnel and equipment should be in place prior to bodies being removed from the scene. A single person must be in charge of the morgue operation. Another person must be assigned the sole task of procuring supplies and equipment. Someone else must track the workers in order to limit the time worked each day.

The following should be considered basic necessities for the temporary morgue:

1. Convenience to the scene.

2. Completely securable.

3. Adequate capacity.

4. Access for vehicles.

5. Ventilation.

6. Hot/Cold water and drainage.

7. Electricity.

8. Communication capabilities.

9. Office space.

10. Rest area.

11. Refreshment area.

12. Restrooms.

The following personnel should be considered basic for the operation of the morgue:

1. Director

2. Procurement Officer

3. Secretary

4. Pathologist

5. Ondontologist

6. Anthropologist

7. X-ray Technician

8. Guards/Security

9. Body handlers

10. Photographer

11. Fingerprint technician

12. Personal effects officer

13. Evidence custodian

14. Toxicologist

The temporary morgue should be set up in stations. Preferably in some type of assembly line fashion. Bodies should be moved in one direction through the line. Body trackers should be used to escort the body and paperwork from station to station. The following is a list of stations and their purposes:

1. Reception Station:

Document receipt of body/part from the scene.

2. Documentation/Examination/Photography/Station:

Record remains and personal effects as received. Photograph everything and secure Property/Evidence. This stage should be coordinated with law enforcement.

3. X-Ray Station:

Full body X-rays must be taken. X-ray all body parts

4. Body Examination/Pathology:

A. External exam.

B. Body parts examined by anthropologist.

C. Autopsies performed by pathologists.

D. Toxicology if necessary.

5. Ondotology:

A. Complete charting.

B. X-rays.

C. Removal of jaw if required.

D. Compare to Ante-Mortem records.

6. Fingerprinting:

A. Utilize local experts or FBI team.

B. All bodies should be fingerprinted if possible.

7. DNA Stations:

A. Appropriate Bone/Tissue samples should be collected to aid in identification.

8. Release Stations:

A. Holds bodies/remains for decision about final disposition. Release should be made to authorize funeral homes only. Refrigerated storage areas should be available at both the entry and exit areas of the morgue. Bodies/Remains should be placed in clean pouches once the examination is complete.

Security should be tight. Parking lots, Entry/Exits points, Check points should be manned by armed Police. Space may be required for embalming bodies. This will depend on the capabilities of local funeral homes.

FAMILY ASSISTANCE CENTER

The Coroner‘s Office will be in charge of the initial set up of the family assistance center. The following should be considered:

1. SITE SELECTION: It is extremely important that the site selected by functional for the incident. The main consideration is whether family members are local or will be coming from out of town. This will determine the size of the building needed and whether housing will have to be provided. The location should NOT be close to the scene and should be easily accessible to the families.

2. ADMINISTRATION: A registration system is needed for incoming family members. Ante-mortem victim information should be collected at the time of registration.

3. SECURITY: Armed police are required for the parking lots, outside checkpoints and for family escorts. The family assistance center should be limited to works and family (next-of-kin) ONLY.

4. IDENTIFICATION: The family must provide information sufficient to establish that they are the victim’s next-of-kin. Verify credentials of all workers.

5. COMFORT FOR THE FAMILIES: Be open about the Coroner’s Office and Incident Operational Policies. Be sensitive to cultural differences. F.A.C. workers should be professional and properly dressed. Have medical personnel stationed at the F.A.C.

6. FOOD SERVICES

7. COMMUNICATIONS

8. TRANSPORTATION

9. MENTAL HEALTH PROFESSIONALS

10. RELIGIOUS SUPPORT

11. SITE-SUPPORT: Custodial, Maintenance, Etc.

Equipment necessary at the F.A.C.:

1. Telephone Bank

2. Cell Phones

3. Copy machine

4. Fax machine

5. T.V./Radio for news reports

Other Considerations:

a. Working with the Media

1. The Coroner or Chief investigator will designate Media Person

2. Information should be routed through the P.I.O.

3. A relationship should exist with the local media

4. Set up a work area for the press near the scene. AWAY from the F.A.C.

5. Keep the media informed

6. At incident involving multi agencies, it may be best to have one P.I.O. for the incident.

B. Press Releases:

1. Talk to the families before releasing information.

2. Distribute written information.

3. Do not speculate.

4. If possible, allow a tour of the site.

5. Remember, the media can be a resource.

6. NOTHING is ever OFF THE RECORD.

ACTIVATION:

Investigators for the Lafourche Parish Coroner’s Office are responsible for the initial response to death scenes. Upon arrival at the scene the investigator shall determine whether the Coroner of Chief Investigator should respond as well.

Investigators are notified by the Lafourche Parish Coroner’s Office secretary or by the Answering Service at (985) 537-7055 CORONER, DR. JOHN C. KING

DEPUTY CORONER, DR. JACK HEIDENREICH

DEPUTY CORONER, DR. RYAN WOLFORD

INVESTIGATORS CONTACT NUMBERS: CHIEF INVESTIGATOR: MARK GOLDMAN INVESTIGATOR: JAME FOLSE

INVESTIGATOR: ANGIE MATHERNE

INVESTIGATOR: KAYLA BENOIT

SECRETARY: ANGELA ADAMS

Emergency Contacts:

Mass Fatality Plan

The Lafourche Parish Coroner’s Office has a mutual agreement for assistance from Terrebonne

St. Charles

St. Mary

St. John

St. James

Assumption Coroner’s Offices for Region III Disaster response.

Definable Mass Fatality Events

1. Natural Disasters: Hurricanes, Tornadoes, Floods, Hail and Snowstorms, Communicable Infectious Diseases, Epidemic, Pandemic

2. Man Made Disasters: Biological Warfare, Chemical Warfare, Conventional Warfare, Nuclear, School Related Incidents, Mass Suicide, Mass Murder

3. Accident Related Disasters: Aircraft, Train, Bus, Boat, Motor Vehicle Accidents, Drowning, Building Collapse, Fire, Explosion, Chemical

There are three major operational areas in a mass casualty incident response:

1. Search and Recovery Locating and removing bodies, body parts, and personal effects. This initial phase of the mass fatality plan should start only after search and rescue has ended and all survivors of the incident have been accounted for.

Every mass fatality site shall be treated as a crime scene until the coroner and local law enforcement agencies state differently. During Search and Recovery, search teams will systematically search and mark where bodies, body parts, and personal effects are located with pin flags and document findings.

A team member will assign a number to that particular finding. Each finding will be photographed and logged. Pin flags shall be color coordinated for bodies, body parts and personal effects. Each pin flag will be assigned a number and each pin flag will remain in place after recovery made.

The mass fatality area will be divided with boundary tape into grids of equal sized areas which will organize the scene into manageable units. Fluorescent paint will be used to paint letters to the left side and numbers to the bottom of the grid panel.

A

B

C

D

1 2 3 4 5

Identification Procedures:

Photographs and videotapes will be obtained of mass fatality scene before and after grid outline and number assignment. Each body, body part and personal effect found in a particular grid will be given a number 1 through 1000 along with an identifying grid letter and number.

Tag Bodies HB# and document grid number found in.

Tag Body Parts BP# and document grid number found in.

Tag Personal Effects PE# and document grid number found in.

Example of bodies, body parts and personal effects found in grid C4:

HB1 C4, HB2 C4, HB3 C4

BP1 C4, BP2 C4, BP3 C4, BP4 C4

PE1 C4, PE2 C4

Bodies and body parts must be treated with dignity and respect. Each finding will be tagged with the number assigned by the search team. Bodies and body parts will be placed into a body bag or acceptable substitute A tag with the same identifying number as the contents contained within the bag will be placed on the outside of the bag. Personal effects found on the body should not be removed from the body. Personal effects not found on body shall be numbered and placed in appropriate sized plastic bags. If transporting to staging area, transport all bodies, body parts and personal effects together and place together at staging area.

2. Incident Morgue Operations

The Incident Morgue site will be determined based upon the size and nature of the mass fatality event. Lafourche Parish Coroner’s Office 123 Texas Street, Raceland, La. will be the designated Incident Morgue site unless the Coroner designates another location as Incident Morgue site. Transportation to Incident Morgue site will be coordinated with the Lafourche Parish Sheriff’s Office and OEP Lafourche Parish. Other Incident Morgue sites may be chosen based upon the site and type of mass fatality event.

The main purposes of the Incident Morgue are to determine cause of death, identify victims, and to secure and identify personal effects. Post mortem records will be completed for every body and body part as they are processed. Post mortem records include personal effects, photography, radiographs, anthropology, fingerprints, dental and pathology reports. The post mortem records will be compared to the ante mortem records obtained from the victim’s family and other sources such as fingerprint repositories and hospital records. Personal effects such as driver licenses found on the victim or statements of recognition should not be used as positive identification, but rather tentative identification. Positive identification will be the responsibility of the coroner.

After identification is established and coroner investigation completed, the coroner will release the body and, or body parts based on the desires of the next of kin. Victim identification will be established using the following methods.

Presumptive Identification:

If visually recognizable, direct visual or photographic identification of the deceased will be made. Also, personal effects, circumstances, physical characteristics and tattoos will be used in the identification process.

Confirmatory Identification:

Fingerprints, Forensic Odontology, Radiology, DNA analysis and Forensic Anthropology.

3. Disaster Mortuary Operational Response Team

DMORT will be contacted for assistance in any mass fatality event occurring within Lafourche Parish. DMORT is a federally funded team of forensic and mortuary personnel experienced in disaster victim identification. DMORT provides a mobile morgue, victim identification and tracking software, and specific personnel to augment local resources. DMORT is part of the National Disaster Medical System, a division of the U. S. Department of Health and Human Services. 1. The DMORT portable morgue requires a building for morgue operations.

2. The federal government pays for travel, lodging, food, salary, and other expenses of DMORT personnel, except in the case of activation under the Public Health Act.

3. The DMORT team supports the local medico-legal authority by providing expertise, personnel, supplies, and equipment. The responsibility for assigning the cause and manner of death, signing of death certificates, and death notification remain with the local authority. All records created by DMORT will be left with the local authority. DMORT will provide identification reports and a computer program documenting the information collected during their response.

4. The DMORT Family Assistance Center team provides assistance in the organization and operation of the Family Assistance Center.

5. If a DMORT team member is activated from your agency to work at a disaster, that employee should present a copy of their travel orders to you as proof of activation.

DMORT can be activated by four methods:

6. Federal Disaster Declaration:

The Federal Response Plan dictates how federal agencies respond following a disaster. A request for DMORT assistance must be made by a local official through the state Emergency Management Agency, who will then contact the regional office of the Federal Emergency Management Agency (FEMA). Based on the severity of the disaster, FEMA can ask for a presidential disaster declaration, allowing the DMORT team to be activated. This process can take 24-48 hours.

7. Aviation Disaster Family Assistance Act:

Under this federal act, the National Transportation Safety Board (NTSB) can ask for the assistance of DMORT. The act covers most passenger aircraft accidents in the United States and U.S. territories. The NTSB coordinates with the local medico-legal authority to assess local resources and capabilities, and can activate DMORT upon the request of the local authority.

8. U.S. Public Health Act:

Under the U.S. Public Health Act, the U.S. Public Health Service can provide support to a state or locality that cannot provide the necessary response. Under this act, the state or locality must pay for the services of DMORT, including salary, expenses, and other costs.

9. Memorandum of Understanding with Federal Agency:

The DMORT may be requested by a federal agency to provide disaster victim identification. Under this mechanism, the requesting agency must pay for the cost of the DMORT deployment. As an example, following the crash of United Airlines Flight 93 in Pennsylvania on September 11, 2001, DMORT was activated under an MOU with the FBI.

Family Assistance Center (FAC)

A Family Assistance Center will be established with American Red Cross staffing and assistance. The location of the Family Assistance Center shall be located away from the site of the mass fatality event and staging area. The Family Assistance Center is one of the most sensitive operations in a mass fatalities event. Its purposes are:

2. To provide relatives of victims with information, counseling and access to services they may need in the days following the incident. 3. To protect families from the media and curiosity seekers.

4. To allow investigators and the Coroner access to families so they can obtain ante mortem information more easily.

A FAC should be established quickly, in an area such as a hotel, conference center, school, or church. The area selected should be secured, in order to give privacy to the families. Regular briefings by the Coroner or staff will be done to help keep the families informed.

Meeting with the families on an individual basis early on makes it possible to start the process of collecting ante mortem records for use in the morgue operations. The FAC has become so important that federal law recommends one to be established whenever a major aviation disaster occurs. Staffing for the FAC is important.

Grief counselors should be available. Personnel from the American Red Cross possessing trained counseling skills and funeral service personnel are good at working with grieving families. Translators may be necessary when working with families from foreign countries. PSS (Police Social Services) from the Lafourche Parish Sheriff’s Office will be utilized for assistance in the FAC.

PURPOSE

A mass disaster could be defined as any incident in which the number of casualties and/or fatalities overwhelms the capabilities of local resources to handle the situation. With mass disasters come multiple casualties and fatalities. The purpose of this appendix is to provide general guidance for procedures to be used in the dental identification of the fatalities resulting from a mass disaster event.

GENERAL GUIDELINES

Upon notification from proper authorities, the mass fatality identification protocol will be placed into operation. The following is a typical sequence of events that occur in a mass disaster:

A. Mass disaster event occurs and appropriate authorities respond.

B. Disaster response units arrive on the scene to contain the disaster and remove survivors.

C. Disaster site is declared safe by proper authorities.

D. Assistance is requested by the appropriate authority if dictated by the size of the disaster and limitations of local resources.

E. A staging area and forensic identification center/temporary morgue are established.

F. Body recovery teams enter the area. G. Location of fatalities is documented via videotaping, photography, and grid charting. H. After proper location documentation, bodies, body parts, and personal effects are bagged and transferred to assigned morgue facilities. I. Bodies are processed through the identification center.

J. After completion of autopsy and identification procedures and when cleared by proper authorities, the bodies are prepared for shipment and transport to final destinations.

DISCUSSION: MASS DISASTER EVENT

Mass disaster events can include mass transit accidents such as airplane crashes, natural disasters such as earthquakes and typhoons, industrial mishaps, terrorist activities, and military exercises. Common aspects of all mass disaster scenarios include property damage, personal injury and mass fatalities.

DISASTER RESPONSE UNITS

Depending on the jurisdiction, various local and government agencies have preestablished response protocols. The response includes police and fire/rescue units whose function is to rescue survivors, minimize further damage and injuries, contain the disaster site, and keep spectators out of the way. A 2000-foot security cordon is established around the site. The deceased, along with personal effects and other evidence, are left in place, if possible. Bodies should not be identified at the scene. Uniformed guards should be placed in charge of the bodies.

BODY RECOVERY TEAMS

Once the disaster site has been declared safe, proper authority will determine the need for body recovery and identification teams to assist in the management of the site. The medical examiner or coroner is in charge of the bodies and he/she will determine who will assist, the time to report, equipment to bring, route to take, and what to wear. Disaster response team members should be easily identifiable with such items as hats, vests, labels, and identification badges. Team members should wear latex gloves, rubber boots, and protective apparel. Excess people on the scene causes confusion so the number of participants should be kept as small as possible. Body recovery teams should be familiar with a preassigned staging area. The staging area is where personnel and equipment are logged in and wait for assignment. It should be easily accessible to the disaster scene. It is important that a record be kept of incoming equipment and personnel along with their time of arrival. Identification cards can be issued at this location.

DOCUMENTATION OF BODY LOCATIONS

Preservation of evidence is critical and it is imperative that every item be documented including bodies, body parts, wreckage, and personal effects. Supplies needed to document the disaster scene include stakes and flags, toe tags, charts and clipboards, video and 35 mm cameras, boundary tape, fluorescent paint, and measuring devices. The disaster site is cordoned off as previously mentioned and the entire scene videotaped with the individual videotaping standing at each corner of the site and panning the entire area from side to side. Conventional color photographs are also taken. If possible, aerial videotaping and photography should also be done.

There are several ways to record the disaster site and its contents. The following is one possible method. The entire disaster scene is broken down into squares of 20 feet lengths on each side. Boundaries of the grid system can be marked by rope or tape. The grid scheme can be simple with letters and numbers marking the specific grid, such as A-1, B-2, C-5, and so forth. Teams can be assigned to work in specific grids.

Each piece of evidence is labeled with a letter and a number with its location denoted by a stake and a tag. There are various ways a tagging and labeling procedure can be set up but the important factor is consistency. Bodies are labeled with the letter "B" in the order that they are recovered within each grid, such as B-1, B-2, B-3, etc. Dissociated body parts are labeled separately with a "P" in the same manner. Personal effects are labeled sequentially with an "E." If the body/body part is located on a hard surface, spray paint can be used instead of a stake. Distances from fixed structures should be recorded.

Each body, body part, or piece of evidence should be individually photographed with the identification label clearly visible in the photo. Associated personal effects are placed in plastic bags before placing them into the body bag. These plastic bags should be labeled with an item description, location, grid coordinates, time, and signature. Dissociated personal effects should also be labeled with a stake and tag. Unattached body parts should be placed in separate bags. After all of the remains and personal effects have been documented by grid location on paper, the scene should be revideotaped and rephotographed. After proper documentation and with authorization from proper authorities, the bodies and personal effects are placed into individual body bags. Each body bag should have the following information recorded: body number, location by grid coordinates, transport vehicle identification number, and signature of the person handling the remains. Body bags are stored in refrigerated cooler trucks until transported. These trucks should have metal floors with no company names visible.

REMOVING BODIES FROM THE SCENE

Body bags should be transported to the designated identification center/morgue facility in escorted, unmarked vehicles. Prior to transfer, the body bag is opened and the body and bag numbers are checked. The bag numbers are logged as are the vehicle number, personnel, and time of dispatch. The driver signs the sheet and is accompanied to the incident morgue. The body bag’s location at the morgue is recorded.

ESTABLISHMENT OF STAGING AREA, MORGUE FACILITIES, AND FORENSIC IDENTIFICATION CENTER

Depending on the size of the disaster and the number of fatalities, temporary facilities may need to be established. Alternative morgue facilities/forensic identification centers may include warehouses, airplane hangars, large garages, or armories. There are many factors to consider in selecting a site, including accessibility to the disaster site, electrical capacity, ventilation, and water supply.

The identification center is comprised of twelve separate sections and remains should be processed through the center in a logical sequence. A large-scale mass disaster requires the combined talents of a number of local and federal agencies and each section would have its own unique requirements for equipment and staffing. The location of each body should be recorded on an index card, which will accompany the body each time it is moved to a new location. The overall processing sequence would include:

• in-processing

• photography

• personal effects

• fingerprints

• radiology

• oral surgery

• dental radiology

• dental examination

• pathology/anthropology

• laboratory

• mortuarial processing

• storage and shipping

OVERVIEW: DENTAL IDENTIFICATION

Formal documentation of death demands positive identification. Three scientifically reliable methods of identifying unknown remains are fingerprint comparison, dental identification, and DNA evidence. The use of dental records and dental radiographs by a team of trained forensic odontologists can greatly assist in the expeditious identification of the victims of a mass disaster. The dental identification team is one of several that comprise the identification center.

TEAM PERSONNEL

Ideally, the dental identification team will have an experienced forensic odontologist to lead it. The remainder of the team can consist of dental personnel with skills in dentistry but perhaps limited training in forensic dentistry. The size of the team will vary with the size of the disaster, condition of the remains, and the number of shifts required.

SPECIAL SKILLS REQUIRED

Special skills required for the dental identification team would include:

• Dentists with forensic training

• Dental hygienists and/or assistants for compiling dental records

• Computer specialists for using computerized identification programs in large scale disasters

• Psychologists trained in Critical Incident Stress Disorder (CISD)

• Experienced individual to serve as a liaison with other sections of the identification center

• Communications experts to maintain communication within and between sections of the identification center

• Clergy

RULES AND REGULATIONS FOR PARTICIPATION ON DENTAL IDENTIFICATION TEAM

Team members should be bound to certain rules and regulations that govern their conduct during this evolution. A code of ethics agreement should discuss such items as nondisclosure of privileged information, procedures for reporting to the designated staging area (and only when notified to do so), and authorization for contact with the media and authorization for photography. Press interviews should only be given by an official spokesperson, which could be the identification center chief or the public affairs officer. Written authorization is required from the coroner, medical examiner, or other authorized individual to conduct a limited autopsy. This authorization should specify the methods used to gain access to the dentition, whether jaws can be removed, and what tissues can be retained.

Other jurisdictional issues that need to be considered include resolution of any conflict between the identification team’s guidelines and an existing emergency government disaster plan, limitations on the team’s area of operations, any state or governmental licensure considerations (if applicable), insurance protection of team members (workman’s compensation/liability insurance if there are civilian participants), and any mutual aid agreements already in effect with other dental identification teams. Another consideration centers on the liability of workers and their immunity for actions, errors, or omissions while exercising due care in the performance of their duties.

ACTIVATION PROCEDURES

Members should be notified of team activation via a preestablished phone tree. To activate the dental identification team, appropriate authority should contact the chief forensic odontologist who will then assess the situation by contacting the disaster site authorities to determine the extent of the disaster and the level of manning required to identify the casualties. It will be the chief forensic odontologist’s responsibility to notify the needed team members with instructions about where and when to report equipment to bring, route to take, and what to wear. It should be emphasized that team members are to report in only when directed to do so by the chief forensic odontologist.

IDENTIFICATION OF AUTHORIZED TEAM PERSONNEL

It is imperative to maintain strict security not only at the disaster site but also at the identification center. Only authorized team members are allowed in the working areas. Team members can be identified in a number of ways. They should all be listed on a personnel roster generated by the chief forensic odontologist. This roster should also be given to Disaster Site Command Center so that security personnel will allow authorized individuals to enter designated areas. Other identification methods include photo identification cards clipped to the outer garments, distinctively colored and/or lettered baseball caps, and colored protective clothing. Identification badges should be changed daily.

DENTAL IDENTIFICATION TEAM ORGANIZATION

The dental identification team is headed by the chief forensic odontologist and is divided into three sections, each headed by a section supervisor. The chief forensic odontologist is responsible for assignment of section supervisors and staff. The following is a description of the responsibilities for each section:

• Chief Forensic Odontologist responsibilities include:

• Overall operation of the forensic dentistry team

• Reporting to identification center director

• Briefing all team members as to the charting system to be used

• Reviewing all identifications made by the team

• Forwarding information on positive identifications to the chief of the identification center

• Monitoring personnel in the dental radiology section to ensure that they are not over-exposed

• Antemortem Records Section responsibilities include:

• Reporting to chief forensic odontologist

• Obtaining flight manifest from the involved airline (if applicable)

• Locating victim’s dental records and developing composite antemortem dental records for each victim

• Postmortem Dental Examination Section responsibilities include:

• Reporting to chief forensic odontologist

• Oral surgery (if permissible) to gain access to and/or resect oral structures

• Photography and radiology of dental structures

• Charting of dental remains onto a composite postmortem dental chart

• Records Comparison Section responsibilities include:

• Reporting to chief forensic odontologist

• Using either manual or computer comparison of the antemortem and postmortem composite dental charts, come up with a positive dental identification

• Forward dental identifications to the chief forensic odontologist who is responsible for doing the final sign-off indicating a positive dental identification of the remains

SAFETY AND HEALTH CONSIDERATIONS FOR TEAM MEMBERS

The safety and well-being of team members should be a primary consideration. OSHA regulations apply to locations within the United States. Team leaders and members must be properly trained and aware of potentia

• Psychological counseling: dental identification work can be psychologically taxing and team members should have

• Work shifts: most experts recommend working normal hours and avoiding shift work if at all possible. Long hours increase critical incident stress, mistakes, and accidents, and do not allow for adequate cleaning of the identification center facilities. Limitations should be placed on the maximum length of time that a member may work each day.

• Immunizations: members should have documentation of immunization for hepatitis B and tetanus plus others as indicated by medical authorities.

• Creature comforts: sanitation facilities should provide toilets, toilet paper, hot, running water, and soap. A food and rest area for team members should be set up separate from the identification center proper. Food and drink can be provided from a number of different sources including the Salvation Army, Red Cross, service groups, and churches. Mandatory breaks should be instituted. Provide chairs and stools for workers. Consider reserving blocks of local hotel rooms for use by team personnel.

• Protective apparel: personal protective apparel should ideally be disposable and include scrubs, cover gowns, examination gloves, head covers, foot covers, face masks/shields, and eye protection; coveralls and rubber boots would be needed by recovery team members at the site of the disaster.

• Perimeter security: this is the responsibility of the ranking law enforcement authorities and is a necessity to protect the personal effects of the victims, exclude the curious, and to prevent unauthorized photography.

EQUIPMENT AND SUPPLIES

Because of the unpredictable nature of disasters, equipment and supplies should ideally be prestaged for immediate access. The type and amount of supplies needed vary with the size and nature of the disaster. Most forensic odontology texts have lists of equipment, supplies, and facilities needed based on the number of casualties. Samples of antemortem, postmortem, and summary charting forms can also be found in textbooks.

Pandemic Influenza Measures

The Avian Flu, H5N1 influenza virus, is a novel strain of influenza that has infected humans with a greater than 50 percent mortality rate. We as a community may not be able to prevent an epidemic or pandemic of the Avian Flu, but we can work together to be prepared and limit the impact on our community.

Initially, no vaccine will be available to combat the Avian Flu and it will take between six to seven months after an epidemic or pandemic starts for a vaccine to be made available.

Initially, no vaccine will be available to combat the Avian Flu and it will take between six to seven months after an epidemic or pandemic starts for a vaccine to be made available.

Antiviral Medications that may limit complications if taken within the first 48 hours. It must be noted that they may not be effective against the Avian Flu.

• Amantadine

Initially, no vaccine will be available to combat the Avian Flu and it will take between six to seven months after an epidemic or pandemic starts for a vaccine to be made available.

Initially, no vaccine will be available to combat the Avian Flu and it will take between six to seven months after an epidemic or pandemic starts for a vaccine to be made available.

Initially, no vaccine will be available to combat the Avian Flu and it will take between six to seven months after an epidemic or pandemic starts for a vaccine to be made available.

• Rimantadine

• Zanamivir

• Oseltamivir

Measures to limit spread of the Avian Flu:

• Isolation, the separation of infected individuals from others

• Quarantine, the separation of contacts or suspected contacts of infected individuals from others

• Reduce social contact, increase social distance in workplace and community

• Limit employees at workplace to essential staff only

• School closures, develop alternative procedures for learning

• Alternative faith-based planning, prayer Will rely upon voluntary cooperation for above measures unless instructed otherwise by federal and, or state government.

Personal Responsibility Measures:

• Stay at home when sick

• Stay away from sick people

• Cover your cough

• Wear mask

• Wash hands regularly

• Avoid touching eyes, nose and mouth

• Social distancing in workplace and community

• Pneumococcal Vaccination per recommended guidelines

• Prepare by stockpiling a three week supply of essential water, food and medicines

What you need to know about Zika:

Zika virus disease is caused by the Zika virus, which is spread to people primarily through the bite of an infected mosquito (Aedes aegypti and Aedes albopictus). The illness is usually mild with symptoms lasting up to a week, and many people do not have symptoms or will have only mild symptoms. However, Zika virus infection during pregnancy can cause a serious birth defect called microcephaly and other severe brain defects. There has not been any local transmission of Zika in Louisiana to date.

• The best way to prevent Zika is to prevent mosquito bites. Use an EPA-registered mosquito repellent, stay in places with air conditioning or window and door screens, and remove standing water from around your home. Click here for more information about preventing Zika.

• Zika is linked to birth defects. Zika infection during pregnancy can cause a serious birth defect called microcephaly that is a sign of incomplete brain development. Doctors have also found other problems in pregnancies and among fetuses and infants infected with Zika virus before birth. If you are pregnant and have a partner who lives in or has traveled to an area with Zika, do not have sex, or use condoms the right way, every time, during your pregnancy. Pregnant women should not travel to areas with Zika.

It’s important to include Zika in your travel plans. Check the CDC’s website for travel recommendations before your trip. The Louisiana Department of Health is committed to protecting the citizens of Louisiana by minimizing the risks from the Zika virus. About Tetanus

Tetanus is different from other vaccine-preventable diseases because it does not spread

Today, tetanus is uncommon in the United States, with an average of 30 reported cases each year. Nearly all cases of tetanus are among people who have never received a tetanus vaccine, or adults who don't stay up to date on their 10-year booster shots.

Tetanus is an infection caused by a bacterium called Clostridium tetani. Spores of tetanus bacteria are everywhere in the environment, including soil, dust, and manure. The spores develop into bacteria when they enter the body.

Common Ways Tetanus Gets Into Your Body

Stepping on nails or other sharp objects is one way people are exposed to the bacteria that cause tetanus. These bacteria are in the environment and get into the body through breaks in the skin.

The spores can get into the body through broken skin, usually through injuries from contaminated objects. Certain breaks in the skin are more likely to get infected with tetanus bacteria. These include:

• Wounds contaminated with dirt, poop (feces), or spit (saliva)

• Wounds caused by an object puncturing the skin (puncture wounds), like a nail or needle

• Burns

• Crush injuries

• Injuries with dead tissue

Rare Ways Tetanus Gets Into Your Body

Rarely, tetanus has also been linked to breaks in the skin caused by:

• Clean superficial wounds (when only the topmost layer of skin is scraped off)

• Surgical procedures

• Insect bites

• Dental infections

• Compound fractures (a break in the bone where it is exposed)

• Chronic sores and infections

• Intravenous (IV) drug use

• Intramuscular injections (shots given in a muscle)

Time from Exposure to Illness

The incubation period — time from exposure to illness — is usually between 3 and 21 days (average 10 days), although it may range from one day to several months, depending on the kind of wound.

Most cases occur within 14 days. In general, shorter incubation periods are seen with more heavily contaminated wounds, more serious disease, and a worse outcome (prognosis).

Diagnosis and Treatment

Diagnosis: Doctors can diagnose tetanus by examining the patient and looking for certain signs and symptoms. There are no hospital lab tests that can confirm tetanus.

Treatment

Tetanus is a medical emergency requiring:

• Care in the hospital

• Immediate treatment with medicine called human tetanus immune globulin (TIG)

• Aggressive wound care

• Drugs to control muscle spasms

• Antibiotics

• Tetanus vaccination

Depending on how serious the infection is, a machine to help you breathe may be required.

Prevention

Vaccination and good wound care are important to help prevent tetanus infection. Doctors can also use a medicine to help prevent tetanus in cases where someone is seriously hurt and doesn’t have protection from tetanus vaccines.

Vaccination

Being up to date with your tetanus vaccine is the best tool to prevent tetanus. Protection from vaccines, as well as a prior infection, do not last a lifetime. This means that if you had tetanus or were vaccinated before, you still need to get vaccinated regularly to keep a high level of protection against this serious disease. Tetanus vaccines are recommended for people of all ages, with booster shots throughout life. Learn who needs to be vaccinated and when.

Good Wound Care

Immediate and good wound care can also help prevent infection.

• Don't delay first aid of even minor, non-infected wounds like blisters, scrapes, or any break in the

• Consult your doctor if you have concerns and need further advice.