Guidelines for Mass Fatality Management During Terrorist Incidents Involving Chemical Agents

摘要

Natural disasters, terrorists' attacks, and accidents such as plane crashes have the potential to produce catastrophic numbers of fatalities. The United States has suffered such incidents, for example the bombing of the Alfred P. Murrah Federal Building in Oklahoma City, Oklahoma in 1995 resulted in 168 fatalities and the crash of TWA flight 800 in 1996 in Long Island, New York claimed the lives of 230 people. Outside the United States, an earthquake in India produced over 30,000 fatalities in 2001, while an earthquake in El Salvador the same year produced close to 1,000 fatalities. In Bhopal, India (1984), an industrial chemical accident resulted in over 6,000 fatalities. Attacks using weapons of mass destruction (WMD) have the potential to create extraordinary numbers of fatalities similar to the numbers seen in large accidents and natural disasters. Presently the United States is unprepared to manage catastrophic numbers of fatalities at the local and regional level. At the federal level, the Disaster Mortuary Operational Response Team (DMORT) is the only response organization prepared to handle large numbers of fatalities. The Improved Response Program (IRP) established a Mass Fatality Working Group, comprised of experts, to address fatality management in the event of a chemical terrorist incident on US soil. A well-executed chemical terrorist incident will likely result in the same large number of fatalities mentioned above; however, the agent contamination poses new concerns for the medical examiner and directly influences how a jurisdiction manages the processing of remains. Jurisdictions experience a gap in their response capability as hazardous materials (HAZMAT) teams have experience operating in contaminated environments, but are unfamiliar with medical examiner procedures for processing remains and vice versa. Very few state and local medical examiners have the necessary equipment, training, and resources for operating in a contaminated environment. 7.