I saw two autopsies today. I was surprised at my own reaction, which was akin to scientific wonder and professional admiration as the technicians did their work. I didn’t know anything about the two deceased individuals on the tables. Quickly, in my mind I began to question how they got there, what their lives were like, and who now would be missing them. Within the last few years my family experienced a personal loss so heart wrenching, I just didn’t know what my reaction might be to entering the county morgue.

Just before viewing the autopsies as part of a tour of a new facility, we had completed our monthly regional mass fatality planning meeting. This ten-county group of coroners and medical examiners are some of the most dedicated, caring, and personable individuals I have the honor of working with. One colleague recently talked to us about their experience with the Aurora, Colorado theater shooting in 2012. One gunman, 12 dead, including a six year old girl. After a crime scene is secure, the coroner’s office is the lead for conducting processes to confirm the identity of an individual. As you can imagine, any family member of any person even thought to be at an identified crime scene would want to know the status of their loved one as fast as possible. Good working relationships built over time among coroners’ offices and law enforcement are crucial to making this happen. Positive relationships with county or local jurisdictional attorney’s offices, local public health departments, and private hospitals are also important in order for the coroner’s offices to accomplish their work that impacts the lives of so many family and friends.

Seeing someone at the end of their life, in the hands of someone trained to determine cause of death was humbling. Yet it also reaffirmed a spirituality in me that sometimes gets put aside in order to compartmentalize the work many of us in emergency management and homeland security do. It is our job to think through the unimaginable scenarios, in order to determine how we would respond with our partner organizations if the time came to do so. Yes, in the monthly fatality management regional committee meetings, we may ask, “What do you do with 500 dead bodies?” Or 1,000…or more? These are the things we plan for, so that we are sure to provide the utmost respect, privacy, and compassion in dealing with the deceased and their loved ones.

A tool we found to be useful in this endeavor is a simple spreadsheet that indicates how much of a given resource each county has on hand. This includes the number of staff such as pathologists, doctors, autopsy technicians, and investigators each office employs or contracts with. It also includes how many of a specialized type of equipment an office has, such as portable x-rays, digital fingerprint machines, and high quality digital cameras. One other important item to know is the space each office has onsite for body storage, and any offsite or contracted agreements that are in place. If every county and many hospitals all have in their respective plans to contract with a specific cold storage company, that resource may not be available to everyone when needed. Finally, each county should provide their “routine” daily workload, which allows for a better understanding of daily coroner capacity on a regional basis. In aggregate, this information provides a snapshot of regional capability on a normal day, and gives us a good understanding of our surge capacity. That is the basis from which to plan for what might be needed in a mass fatality event.

Both capability and capacity are important to understand, since a mass fatality event is not defined by a number — it is defined as an event with enough casualties to overwhelm a jurisdiction. For a rural department or one that has not had a need to surge for a response, even a small number of casualties may mean a mass event. The ability to quickly know cold storage capabilities; staff capacity to conduct exams and collect and analyze antemortem and postmortem information for positive identification and cause of death; and coordinate effectively with families is key in determining what might mean a mass fatality event for your jurisdiction.

So what do you do with 500 dead bodies? Secure the scene with law enforcement, investigate the scene and collect evidence and personal effects with coroner’s staff, and get the bodies to cold storage. Chain of custody is key for human remains and personal effects. Cold storage capacity dictates external resources needed. Pathologists and technicians can be brought to the lead coroner’s office for support, or more likely bodies will be transported to surrounding coroner’s offices for processing and identification. If there were an incident with hundreds of fatalities, state to state assistance is available via the Emergency Management Assistance Compact (EMAC). Federal assistance is available upon request in the form of a DMORT, or Disaster Mortuary Operational Response Team. There are also teams out of the Air National Guard called Fatality Search and Recovery Teams (FSRT). Both of these teams have specialized training to assist a locality in the management of a mass fatality incident.

Many people ask how I can conduct meetings talking about dead people. Using compartmentalization to focus on operational and tactical details, and focusing on what we can do is what makes this work. Incorporating mental health support services in our plan for those working a scene is also an important aspect of event management, to have it available both immediately, and for months or years after an incident. Coroners and medical examiners deal with the deceased, but just as importantly they deal directly with families experiencing loss. This is a highly charged emotional time for all involved.

The spirituality I spoke of earlier manifested itself, to me, in a deep knowledge that the soul of a person does not lie in their flesh once they have passed. It lies in the minds and the hearts of those who knew and loved them. Coroners’ and medical examiners’ offices are committed to those who have passed, and are dedicated and compassionate in providing comfort to those who remain to carry on their memory.