From Flu Wiki 2

Forum: Mass Fatality Management Plans 2

02 October 2006

crfullmoon – at 03:23
 http://tinyurl.com/hrhxz 

“PREPARING FOR THE PANDEMIC A guide for cemetery and crematorium managers (From a paper by Ken West, MBE, presented at the ICCM Corporate Seminar in April 2006.) The pandemic, is it an imaginary or a real threat? • How many of you feel it is a real threat? • How many of you have completed a plan? Representation on a Burial and Cemeteries sub group related to the London Resilience Plan has revealed a need to be prepared and the experts suggest that December 2006 to March 2007 is the next danger period” …

crfullmoon – at 03:30

(as to MadamS’ question about shelf life; guess it depends what the body bag is made of , and how well it is made?)

Just Googled this up -don’t know the company: http://www.simplerlife.com/bobadipo.html “Heavy Duty BodyBags/ Disaster Pouches” …”Shelf life: Ten years. Guaranteed against defect.” …

“Fabricated of heavy duty vinyl / laminated polyester fabric. Zipper completely sewn with nylon thread for greater durability. Will not deteriorate or mildew. Minimum odor detected when closed. Each pouch contains bio-hazard tag. Manufactured in the U.S.A. Will hold over 300 lbs. All seams are dielectrically sealed to prevent leakage. Will not tear, even if punctured”… ect -also comes in other models.

Any region been buying body bags, (and bet if the did previously, they been getting the cheapest ones if they did not imagining a pandemic year)?

crfullmoon – at 04:00

From the link at the top of the page. (I really like Ken West, at least, his paper is very sensible. Good luck to him. Like it better than anything I’ve heard locally.) Really worth printing out - it’s also a pdf

“The disposal of the dead is not a statutory service for local authorities, neither has central government any control of burial and cremation facilities. No government minister has responsibility for the component elements of the death industry. This includes the NHS, coroners and registrar’s service, cemeteries and crematoria, many of these latter two being operated by the private sector. Funeral directing, cremator and coffin manufacturers are entirely private and independent bodies. The integration of all these disparate elements into a pandemic contingency plan is difficult and probably impossible” …

“1.0 HISTORICAL PERSPECTIVE The last serious pandemic was in 1918 with less severe instances in 1957 and 1968. UK cemeteries seemed to have maintained business continuity in 1918 possibly due to the following reasons:

• They had ample new grave space • They had perhaps six times as many gravedigging and gardening staff to fall back upon, all working longer hours over 6 days. • Shoring was simpler, if used at all. • All disposals were by burial and based on manual work. • They were used to high death rates in winter from flu, excess cold, etc. • They were used to high death rates in summer from cholera, typhus, etc. • They were not reliant on gas, electricity and road fuel. • They had highly efficient manual booking processes. • Medical certification was more simplistic and post mortem numbers were much lower.• They could hire additional staff immediately and a large pool of manual employees existed.

It is important to note that the huge pandemic in 1918 was not anticipated nor observed until after it had killed high numbers. It is suggested that 20% – 40% of the world population were infected. It affected many army units and in view of the war no contingency preparations were made.

In the 2nd World War contingency arrangements were considered but they did not always prove effective. For instance, government demanded that civilian deaths use shrouds (to save the use of wood in coffins), be interred in mass graves (to save resources) and be interred where they die (to save bodies being repatriated around the country). Both public authorities and people completely ignored this demand and continued to hold conventional funerals. Government was shown to be entirely out of touch with the situation on that occasion.

The danger is that little or no investment in contingency arrangements will occur and a stand-off between public authorities and government could develop over who funds what. If this happens then we are likely to lurch into an emergency and be forced to concentrate on the practical issue of body disposal and leave very little resource to handle the psychological aspects with the necessary sensitivity.

The management of this large number of deaths cannot be resolved by technology and a huge amount of manual labour is going to be necessary in order to move and handle the bodies up to the final disposal.

2.0 THE CURRENT SITUATION IN CEMETERIES & CREMATORIA The reasons outlined earlier as to why we might have maintained business continuity in 1918 have entirely changed.

Most of us have little or no burial space, our capacity has been greatly reduced by restricting bookings to what can be managed by a minimal workforce working with a consistent and relatively stable death rate. The days of operation have been reduced to 5 and there is a total reliance on mechanical excavators. Grounds staff, long a crisis back-up, have been outsourced and are no longer available to perform back-up.

The death process now relies on technology and the loss of fuel for computers, cremators and excavators increases the risk of failure. The use of such equipment has also made it more difficult to introduce new staff, all of whom usually need a period of skills training.

Success in coping with the pandemic will be entirely reliant on the availability of trained staff to keep the operation going. Hospital capacity will also suffer like ours and many of our staff will have to stay at home to care for the ill.

3.0 ESTIMATED TOTAL NUMBER OF DEATHS …(he goes into a low-ball, “the infection rate anything up to 25% of the population, 2.5% mortality rate”, stats for a location, week by week. Still looks “frightening”) …”These figures appear less than the 1918 pandemic and closer to the epidemics in 1957 and 1968. Even more unreliable is estimates of the actual period of the pandemic. This suggests that a pandemic over a shorter period could have higher peak deaths and be less easy to manage than a pandemic over a longer period with lower peaks. Using the latest models assumes a pandemic to last 17 weeks and the worse case scenario suggests that 25% of the population will be infected (the “attack rate”) and will die (the “mortality rate”).

It is estimated that 42% of the deaths will occur at the 2 week peak. All of these deaths are additional to what we would normally do and, taking Croydon as an example, it suggests a total of 2840 deaths (about 500 more than a full year) and contained within just 17 weeks. The total deaths for this period, and numbers per bereavement section are estimated to be: Pandemic/expected 25% post mortems 14% burials 86% cremations”…

“This is a frightening number of deaths on a week-by-week basis so how do we respond? 4.0 MANAGING A HIGH NUMBER OF DEATHS One approach is to:

• Create a command centre at a central cemetery and crematorium office and control the section from that point. • Suspend the usual public service including memorial orders, attention to visitors and suchlike. • Make each unit responsible for their part of the “disposal” process and focussed purely upon their objective. In Croydon this relates to the mortuary, crematorium and burial sections. • To agree a programme of trigger points relative to the numbers of deaths increasing week on week, and introducing new teams of back-up staff to continually increase the capacity to accept more funerals. •

Where disposal failure is evident due to lack of capacity, staff, fuel, coffins, to have a collective (mass) burial site prepared. Let’s consider each of these operations in more detail:

5.0 COMMAND CENTRE - MANAGEMENT & SUPERVISION The command centre will be based at your main cemetery and crematorium office. Staff here will constantly liaise with your mortuary staff (if you have them) and hospital mortuary staff to keep updated on the situation. The command staff have to ensure:

a.) That mortuary capacity, burial capacity and cremation capacity keeps pace with demand. b.) That ‘trigger’ points are identified as bookings increase so that supplementary staff are drawn in to increase capacity. The centre will then organise and constantly monitor all cemetery and crematorium bookings with funeral directors. A manager and deputy need to be present at all open times to manage any issues and generally oversee all operations. They would also need to constantly liaise with senior council staff, Emergency Planning Officers and the coroner and funeral directors.

The first trigger would be: • An AMBER warning would apply when 75 funeral bookings arise in one week and the introduction of the contingency plan would be prepared.• A RED warning would apply if bookings continue to rise to 100 in one week and the contingency plan would be initiated. • The burial & cremation booking service would be expanded to 7 x 12 hour days.• All cremation and burial bookings would be dictated by you in order of receipt and with no choice of times. • Only the partner and children of the deceased will be able to attend each funeral with their funeral director

6.0 BURIAL SERVICE - Burial Liaison This small team will manage burial capacity and transfer all burial orders between the command centre and cemeteries. Both new graves and re-open graves will be utilised as normal. The potential for error with using less skilled staff for burial is recognised and to avoid this the burial liaison teams will ensure that each grave allocated and finally checked is marked with a laminated sign giving full details of the intended burial. This will ensure that all staff are visually aware of which grave is to be used as each funeral arrives.

Grave excavation will be done by day only with team hours restricted to five days to ensure that staff doing this heavy work are not overworked. It is also essential to ensure that ground space exists for each team to work individual plots so that teams are not intruding upon each other both physically and with regard to noise disturbing funeral services. There would be severe restrictions on the service such as all orders for new and reclaimed graves taking the next available grave and not be given any choice. It would also be unfair to delay other burials in order to offer burial within 24 hours to specific religions, so this option will be deleted. In Croydon they would need 7 teams completing 2 graves each 10 hour day x 5 days, a total of 70 graves each week. It would require 5 additional excavators, shoring and tools.

7.0 CREMATION SERVICE The cremation service would slowly expand to operate 24/7 and assuming 16 cremations per cremator every 24 hours Croydon can cremate 64 bodies each day and meet the target with capacity to spare. These could be accommodated with 30 minute bookings between 8am to 12 midnight each day. This would give funeral directors the ability to spread their funeral load over a long period andease their own staffing and capacity problems. Funeral directors have not yet produced their own national contingency plan.

How they will cope with the contingency, the denial of a choice of funeral times or grave locations, and the restriction on people attending their funerals, has yet to be considered. The storage of coffins at the crematorium will impede efficient operation so bodies must arrive to a “just in time” scenario, and be cremated fairly immediately.

8.0 PREPARING FOR COLLECTIVE BURIAL

The term collective burial is used where burials occur in a trench in rapid succession, each burial separate and identified. It can be provided by relatively unskilled staff and does not rely on technology or external help. It is not “mass” burial where the bodies are placed together and one on top of another.

It is recognised that collective burial is not likely to be seen as morally acceptable in a modern society. Even temporarily, it could have a serious psychological impact on the bereaved in that the body will not be finally placed for some months and the grieving process will be interrupted.

Much as I feel we must avoid collective burial this is only assured if a massive amount of chilled body storage is provided. The high cost of this will not be borne by many authorities and it is unlikely the government will fund it.

Collective burial would be necessary where: Firstly, the number of dead exceeds the capacity to store, inter or cremate them Secondly, where the dead have to be temporarily interred because autopsy, registration or the Coroner’s service has collapsed.

Collective burial would involve excavating a trench 4’ 6” (1350mm) deep, 300’ (90000mm) long and 8’ (2400mm) wide which would accept 100 coffins laid side by side 3’ (900mm) apart. One hectare would accept about 2,000 bodies. A collective burial site could be used purely to put bodies into a sterile environment, as soil has an antiseptic quality, in order to hold back decomposition. After the emergency the bodies could be exhumed for post mortem or reburial/cremation in the conventional way.

9.0 BACK-UP STAFFING NEEDS Having run through the implications of the plan we can now consider the back-up staffing requirement. In Croydon, assuming a sickness rate of 25%, they will need 53 back-up staff, twice their current full-time compliment. This does not include staff employed on collective graves. There are many other back-up needs, not least generators and stocks.

10.0 AVOIDING INFECTION The potential for infection is reduced by the restriction on mourners attending funerals, closing the routine office service and sending staff home where a family member is ill. Staff immunisation is not possible prior to the pandemic but if weare categorised as a critical service then the NHS might provide us with anti-virals, which have to be taken within 48 hours of infection in order to be effective.

It is important to note that there is no real risk of infection from bodies of people dying from the virus. It is expected that, assuming you survive, you will be ill for 5 – 6 days with the virus. The most important protection is personal hygiene andespecially handwashing.

11.0 POTENTIAL BOTTLENECKS OR PINCHPOINTS Apart from our own potential to fail we also need to consider:

• Failure of the registration service• Failure to obtain Forms B & C from NHS/Hospice/nursing homes • Failure of the Coroners service or mortuary service• Failure of Funeral Directors to deliver funerals • Failure of national road fuel supplies

12.0 ACTIONS Some of the actions we need to consider include: • Approaching cremator manufacturers about maintaining the operation of the cremators, and avoiding heat induced failures • Funding the expensive training and organising an exercise and simulation prior to next winter • Whether the pandemic could cause great hardship to some and particularly the disadvantaged. A response could include reducing the fees charged for burial and cremation. • How much the NHS will do on the psychosocial care of survivors bearing in mind current resources for such care are very poor. • How to ensure the psychosocial care of our own front line teams.

Conclusion The Home Office will issue guidance in the near future, including the extent of emergency powers. They are likely to highlight the need for equitable provision between authorities as the media will immediately focus on inconsistent standards and the impact this will have on psychological and grieving needs.

They may accept that it is not feasible to store the pandemic bodies at mortuaries, crematoria or funeral directors.

Neither is the use of refrigerated trucks for storage feasible in view of engine noise and pollution, and that moving bodies into and around these trucks is labour intensive, lacks decorum and requires a large discreet and secure parking area.

A further concern is that so many authorities will be in the same dilemma that an assumption that refrigerated trucks could readily be hired is erroneous.

The only solution is for each council to provide expensive temporary storage such as a chilled warehouse in order to avoid collective burial.

It seems likely the Home Office will accept that this is unrealistic and unaffordable. The Home Office may recognise that the disposal of a large number of bodies relies upon too many uncontrollable factors. These include the actual staff sickness rate, assumed at 25% even though some estimates are as high as 60%. Staff deaths cannot be discounted. The estimated attack rate has also varied over time and may well prove to be higher than the assumed 25%.

There are also high risk factors with regard to supplies of road fuel, gas, electricity, cremator maintenance and the supply chain for spares, coffins, etc. In London there is also a chronic shortage of burial land and skilled staff, especially mortuary staff and pathologists.

The possibility of the service breaking down is extremely high and if bodies begin accumulating, the situation could quickly become serious.

It appears that we are truly on the front line this time and the pandemic is going to tax our ingenuity and skills, if not our health, over the next few years. “

(my comment” 17 weeks? what about more than one strain circulating; waves? And try this one on your local plans: “worse case scenario suggests that 25% of the population will be infected (the “attack rate”) and will die (the “mortality rate”).” )

crfullmoon – at 04:22

Wyoming, June 2006 (off-topic; interesting Isolation Letter p46) I will go backwards through the alphabet for US state plans.

(Didn’t see a listing for Fatality management. Hopefully comes of waking up in the middle of the night, not mild, do-able-pandemic thinking. !- CDCFluAid 2.0, grr)Far as I can tell- It’s all about antivirals and vaccines and tracking forms, and the gov.checklists from pandemic flu.gov -“Not Started” would make a good placard, eh?- I’m going back to bed. )

Maybe a second read will find what they plan to do with fatalities.

Medical Maven – at 08:58

Here’s an add-on thought. What if all of the ruminants start dying along with us? Feedlots, barns, corrals stacked with dead. And the pig facilities. To dispose of them would be a massive undertaking, not to mention the loss of food supply and biodiversity.

Or they can die just from neglect, (more likely). Power goes out-no water, not enough heat (or cooling), inability to feed, etc. Either way, their rotting carcasses would be a biohazard as well.

crfullmoon – at 09:08

We haven’t heard any of *that* in our local planning, now, have we?

Going to be interesting.

Rather than look at the state plans (and we still should) perhaps sending Ken West, MBE’s paper, and your other suseptible mammals thought to everywhere we can, local plan ners, politicians, morticians, media included.

Wanders off for coffee, and getting some more of my too-long to-do list done this side of the keyboard…

crfullmoon – at 09:10

Wait- there was in-house composting of mega-farm carcasses - for the H5N1 chicken culls - where did y’all see that info?

Medical Maven – at 09:26

crfullmoon-It is one thing to compost chickens. It is another thing to compost thousands of 1100 pound steers.

crfullmoon – at 09:44

yup, sorry; had my two cups of coffee now. Population spike in, ok not vultures, perhaps, flies and carrion beetles, and later the things that feed on them, hopefully those don’t die off.

Tom DVM – at 09:51

Medical Maven and crfullmoon. Several years ago, I think it was the State of Wisconsin, decided to catch all deer in the state and incinerate them due to the risk of Chronic Wasting Disease jumping from the Deer to Wisconsin’s dairy herd.

Chronic Wasting Disease is a ‘prion’ disease identical to BSE (Mad Cow Disease) except it circulates in wild animal populations and is in many ways more ‘transmissible’ then BSE.

Anway, they canned the plan, which was to start six months later, when they realized that the cost of the gas (propane or natural) required to do the burning of the carcasses would break the state treasury.

The major cost of the BSE and Foot and Mouth outbreaks in Britain was also the cost of gas for the incineration.

crfullmoon – at 10:03

It is also why I scoff at plans that think they can do cremations, or use backhoes, fridges, ect, 24/7 in a pandemic year…

crfullmoon – at 10:47

Googling Wyoming another chance; anyone else want to check their Pandemic Plan for “what to do with bodies”?

(Ooh -here’s a nice soundbite,)

“If there is no infrastructure, then there is no emergency management”

(takes healthy people, with skills, to run infrastructures…)

Hm. http://www.massfatalities.com/staff.asp

Back to Wyoming, news,..Sept 29, 2006, …”Wyoming plans to stockpile anti-viral drugs in preparation for a possible pandemic influenza outbreak.”… “The $800,000 will pay for nearly 53,000 doses of the drug.”…

Here’s one Sept 26, 2006,

“The hospital also will need to plan for extra space if the morgue fills up quickly, Fitzgerald said.

“We have to prepare for the worst and hope for the best,” he said.

- CORONER: Campbell County Coroner Tom Eekhoff is working on a similar plan. His office also is working on a contingency plan for mass burials if they are needed.

“Everything is on a grander scale (with a pandemic),” he said.

Autopsy protocol will remain the same, with each body being examined to determine a cause of death.” (Buzzer sounds!)

“The coroner’s office also will be in close contact with the state health department to log and verify deaths caused by the flu, he said.”…

(Where are those devilish preparation details; how to do these things? Are the people ready to try and aviod being casualties?)

crfullmoon – at 11:01

Wisconsin, still “April 2004″? …”develop plans” for mass fatality management; right. ..”may request DMORT” (like everyone else?)ah- “if available”…

They had their Pandemic Readiness Summit - March 15, 2006.

I’m getting a headache. Have offline things to do. Y’all can check the next backward state in the alphabet, and I’ll come back later tonight.

Medical Maven – at 11:51

I guess this line of thought still applies to this thread, but I think livestock managers who live near creek systems in relatively rural areas (Plains States and Intermountain West) need to be considering releasing stock from feedlots, corrals, pens, etc. At some point the animals would have a better chance that way (as opposed to no chance without water and feed). Let them go “free-range”, or feral (like the pigs), and the population could round them up later or pick them off one at a time for meat on the hoof.

I expect that out here on The Plains that if the Grid went down and the above was not implemented, that the first stench of death would be wafting in from miles away, thousands of animals rotting in place.

Leo7 – at 14:13

MM:

This is not the best of topics is it? But it’s important. You’re right about the large animal farms. I could never wrap my mind around the reasons to store so much water until my mind visualized thousands of dead animals floating in rivers, streams etc, because I’m afraid those carcassess you mention will wind up there.

Jane – at 15:58

crfullmoon- first post-(UK): It is important to note that there is no real risk of infection from bodies of people dying from the virus. It is expected that, assuming you survive, you will be ill for 5 – 6 days with the virus. The most important protection is personal hygiene andespecially handwashing.

Is this related to their ideas of staffing? Or to quell fears? It’s wildly optimistic, no?

03 October 2006

anon_22 – at 00:32

Definitely wildly optimistic.

Oremus – at 00:59

Yes, optimistic. Some of the bird flu survivors were hospitalized 30 and 40 days.

crfullmoon – at 06:44

Jane, yes, “5 -to 6 days” It’s wildly optimistic” (Isn’t that more your lifespan after catching the bad strain with no care? uh, anyway.)

I do think he is saying more sensible/practical things to his industry to get prepared than I have heard of here.

Still doesn’t mention additional collateral damage from supply chain problems, grid failures, lack of normal medical care, right? Did he tell them to stock up their homes and safeguard their families?

But, he is up front about things being harder now than in 1918 for gravedigging, reliance on cremation fuel, ect, and, thought about the stages between someone dying and their body not getting left piled up somewhere, for “normal legal proceedure processing.

Most plans here are the sort, “and if it’s worse than that there’s nothing we can do anyway”, people will take off, we’ll request federal DMORT assistance, ect, without the practicalities of thinking they can pile bodiers up in an ice rink or other collection areas, and have one doctor/coronor, ect, process all the paperwork/dead bodies once a day, and being able to imagine the consequences of planning to do it that way and getting completely overwhelmed after the first fortnight.

Mega-factory-farms are not good for the environment, nor animals/humans who are a part of it. Keep it simple and local and right, if we get a next time. (Tom DVM, please write a children’s teaching unit or something. After y’all get prepped. <grin>)

lugon – at 06:58

re mega-factory-farms please see http://www.themeatrix.org

lugon – at 07:03

SORRY - it’s http://www.themeatrix.com (not .org, but .com)

crfullmoon – at 13:41

Has anyone heard any local level, or county level mass fatality plans (other than, “we’ve got plenty of land for mass graves, so, we’re all set”?)

08 October 2006

crfullmoon – at 12:56

West Virginia - didn’t find a plan; only a draft, and nothing about mass fatality management. (Be happy to hear otherwise.)

crfullmoon – at 13:29

Wasington state? (I’m just not seing the info, feel free to add it!)

King County plan pdf Appendix C, p4 says, the Medical Examiner’s office will “Lead mass fatality planning and response efforts. Coordinate with and support hospitals regarding mass fatality planning and response. Incorporate funeral home directors into planning efforts for pandemic response. In conjunction with community partners, coordinate planning and development of victim assistance centers. Activate mass fatality plans when necessary.”

(Can’t seem to find anything on the examiner’s website about that…)

crfullmoon – at 13:59

pdf CDC, Disposing of liquid wastes from autopsies in tsunami-affected areas interem guidance. (Liquid from mass fatalities and untreated community sewage disease warnings, Disinfection proceedures, PPE Universal precautions; still looks like useful stuff here (maybe can also go to the main wiki under Waste disposal/sewage, ect?)

(…”Vaccinations for all employees handling human autopsy waste should include tetanus and diphtheria (Td), hepatitis A, typhoid, Hepatitis B, and polio.”…)

(…”Environmental considerations for the Selection of Land Dsiposal sites”… distances for bodies to be kept away from well and drinking water sites, ect)

crfullmoon – at 14:37

(Vermont : Assumptions: …”The novel influenza virus will have properties consistent with known human influenza virus” ..

:-/ Huhh?? )

“…no vaccine…for 6 to 9 months”… ok,

no; I can’t find what they plan to do when people die.

Googled up a May, 2006 Greenhammer post that says, they’re already violating “mass-fatality-management etiquette”.

10 October 2006

Jumping Jack Flash – at 10:46

Could any of you medical types venture an estimate as to how long before a body becomes nothing but bones and it is no longer a bio-hazard?

Also. How far do you think the stench will carry out of NYC?

crfullmoon – at 11:10

Would it really help to know? Cross-species contamination, water contamination, outdoors is a daunting prospect. But someone will have to deal; let’s make better preparations.

From the Version 1.2.3 March 2006, Harvard School of public Health Center for public preparedness Tabletop excercise Number 1. pdf

“Day 6″ p.27 Q: “What will hospitals do with their excess of infected corpses?

“Refrigerated trucks and ice rinks have been used when necessary as temporary morgues. State public health officials can help request federal disaster mortuary response teams (DMORTs) when appropriate.”

So, local “planning” people;

Pandemic Influenza is not a “temporary” mass fatality surge disaster.

Being able to “request” and actually getting any help, are two different things;

each and every municipality would also be overwhelmed and ready to ask for help (and they’ve been told, to expect help would be “tragically wrong” by Leavitt at every state pandemic summit).

Federal, state, and “mutual” aid should not be assumed. Get the local levels, including the private sector, faith communities and public brainstorming on this while no one is having to react to an influenza (or, XDR TB, ect, we’re overdue for a bad one) pandemic.

Getting people ready to cope might also reduce ammounts of bodies to figure out what to do with.

tony – at 11:59

Depending on weather conditions, and enviromental factors: anywhere from 3 wks to 6 months. If its frozen… never no threat.

Wind conditions West coast no problem. Local people oh well gross, months and months till a very hard freeze.

disgruntled – at 12:24

The other week our agency did our Continuity of Government/Emergency Plan training. It lists our agency (environmental cleanup-type) for removing/moving dead bodies.

crfullmoon – at 19:37

And how devilish were the details, disgruntled?

Could your agency function, under what conditions for how long? (Will the surviving public be outraged by the proposed process?) How prepared are your employees (and their loved ones) for a pandemic influenza year?

(And, did they say how death certificates will be created?)

14 October 2006

volunteers needed – at 16:55

If anyone would like to ask in the coming week, at least one funeral home, or cemetery department, or local faith community that buries their own dead, or county emergency management department, or hospital, (or politician, haha) how they have prepared for mass casualty surges against a pandemic influenza year, and drop their report in this thread, feel free! (Can also go in your own state’s thread as well.)

Thanks in advance (and good luck) \:-)

If you want to print out “PREPARING FOR THE PANDEMIC A guide for cemetery and crematorium managers” From Ken West, MBE, (the pdf link is at at post 04:00 ) and give it to whoever you talk to, maybe we can get KimT to name one of her new kittens after you or something.

17 October 2006

volunteers needed – at 20:05

Originally posted by Sniffles in the Stopping Cutting Bait and Start Fishingthread:

…” Funeral home directors have also been excluded in all levels of the planning process in our state. My local funeral home director is either the current president or past president of their state association and said point blank that no one has approached any of them.

He thought avian flu was another type of seasonal flu and knew absolutely nothing. He said if the hospital or others were planning to “dump all of the bodies” at funeral homes, they had better think again.

Most funeral homes only have the capacity to store 4–6 bodies onsite at one time and many would not have the staff to process large numbers of dead. When I mentioned that the plan for the hospitals was to stack bodies in refrigerated trucks, he said that the trucks could not be taken care of only by funeral home directors and they are not in any of the planning loops at all. The casket salesman that was also in the room looked very ill when we were discussing how many people could become ill and the case fatality rates.”

(Please get the Flu Wiki site to as many death certificate clerks, funeral homes, and cemetery departments, casket makers, crematoria owners, and faith leaders, as you can, and perhaps they can get onto their state threads, or, “talk shop” somewhere “outside of the box”. crfullmoon)

gharris – at 21:28

My local funeral director (a friend) rubbed his hands with glee when I discussed mass fatalities with him!! He didnt seem at all concerned that they might be overwhelmed by a surge! I sent him Ken West’s paper & the link for fluwiki - but he still thinks I am wacko on this subject. :-((

18 October 2006

crfullmoon – at 09:38

Maybe he didn’t get the “ban public gatherings, no time for funerals”, ect? People not having money to bury a few family members at the same time, ect? Live and learn. Or, not.

Thanks for asking, gharris!

LMWatBullRunat 17:20

Probably the most realistic description of what might happen to a big city if the grid crashed during a pandemic is from “dies the fire” by SM Stirling…..

I doubt anybody really understands the impact this might have, and I hope we are allowed to continue in our ignorance.

I must confess that I had not considered that I’d have to cope with free-ranging livestock, but it’s a really good point. That brings another thought- What about the zoos? Yet another- my elephant gun may actually have a useful function. Sigh.

crfullmoon – at 18:02

(Promise me you’ll only shoot the elephant in your pajamas, LMWatBullRun.)

Some funeral homes have websites and email contacts and some don’t; going to try at least one more this week.

ICP – at 19:29

I am in rural town in SC and hospital infection control nurse. While working on local and hospital plan, talked to all local funeral homes and they can only handle up to 4 EMBALMED bodies. Talked to local county coroner, and there are NO plans at this time addressing management of deceased, whatsoever…..

There is one empty large grocery store which still has the frozen food cases and refrigerated cases in place and electricity still on that could be commandeered. County Administrator was surprised power was still on in that building and after our conversation, it probably no longer is! ;.(

crfullmoon – at 19:49

(Howdy, ICP ! Have you been to the SC people thread yet?)

Seen the threads about how hard the electrical grid may be to keep up?

One thing I know all places will need, is a workable, prepared plan for what to do with bodies.

(Especially if they haven’t told households to stock up for supply chain, grid, and medical care disruptions, had open community contingency planning brainstorming meetings, ect! Think of the collateral damage.)

I’d say, as long a couple of people (many categories of people) together are deputized to id, pronounce death, make legal death certificates, (where are lots of forms?) let the family see the deceased or make some sort of photographic record, better to skip embalming, skip “storage” and get the bodies interred on a day-by-day basis. (Some religious communities manage to do so, currently.)

(Are officials going to plan to skip current cemetery rules or just wait a week or two until they have run out of coffins, caskets, grave liners, ect, then do “whatever”? DMORT teams are not so numerous as to go help every neighborhood in the country, either, and most of the military and national guard may be, uh, busy.

Oops -see I didn’t make a link carried over from the first of these threads - get the people coming to look at the Main Flu Wiki, (the current case ages and mortality rates, too) and looking at what others have already said won’t work for mass fatalities the length of which we’ve never lived through before.

Better to plan for the worst and get pleasantly surprised, than to hope for the best and get unpleasantly surprised, and, have to deal with the natural consequences.

crfullmoon – at 19:53

Here is the earlier Mass Fatality Management Plansthread page.

Useful info from Canada’s earlier pandemic flu mass fatality planning is on that page.

crfullmoon – at 20:04

Just to look, http://oep-ndms.dhhs.gov/dmort.html

http://www.dmort.org/

http://www.dmort.org/DNPages/DMORTDPMU.htm …”There are currently two DPMU units. Their permanent staging areas are in Maryland and California.

The DPMU can be deployed to the incident site by rail, truck, plane or military transportation. “…

…”How long does deployment last? Typically, we ask for a two week commitment, but this is dependent on the disaster.”…

…”Although DMORT will pay you a federal salary based on your DMORT position, we cannot reimburse your employer for your time. You need to arrange with your employer any aspects of your service with DMORT. Keep in mind that DMORT is a volunteer organization, and thus does not require participation (as is the case with the military reserves or National Guard).”…

http://www.dmort.org/DNPages/DMORTContact.htm

HHS Sec. Leavitt, at every single state’s Pandemic Influenza Summit: Any community that fails to prepare, with the expectation that the federal government or, for that matter, the state government will be able to step forward and come to their rescue at the final hour, will be tragically wrong, not because the government will lack a will, not because we will lack a collective wallet, but because there is no way that you can respond to every hometown in America at the same time.

crfullmoon – at 20:15

http://www.dmort.org/news/index.html

…”General Session, Pandemic Flu: Planning and Responding to a Worldwide Threat

Speakers: Howard Backer, MD, MPH, Gary Osman, MD, MPH Benjamin Schwartz, MD

This presentation described the pandemic influenza threat, highlighting the H5NI avian influenza situation. It explained the potential impacts of a pandemic threat, summarized critical response activities, and reviewed the planning and preparedness activities that will increase the effectiveness of a response at the local, state, and Federal levels.

Where It All Comes Together: Information Resources

Speakers: Donald Bloom, DMORT FAC Deputy Commander, David Hunt, DMORT Region V Deputy Commander, Brad Targhetta, DMORT Region V Deputy Commander

The management of fatality-related data is critical to the successful outcome of a mass fatality operation. A shortage of qualified personnel for this job was apparent during the 2005 hurricane responses. This session utilized the Disaster Portable Morgue Unit (DPMU) Information Resources equipment to provide an active, hands-on exercise designed for those DMORT people who have a basic knowledge of computer data entry. After a period of instruction, attendees were presented with a mock set of ante and post mortem data and were tasked with entering that data into the VIP (Victim Identification Profile) program. The VIP program was updated to FileMaker 8 during the last deployment. There was a review of the new sign-in, password features, time stamping, record locking, and an overview of the types of reports generated during deployment. The standard operating procedures for working with the VIP program in the Information Resources section were discussed. This exercise gave attendees a basic understanding of how to create new records and search for identifying characteristics.”…

(wonder what this info was -might be useful?)

…”CISM – Incident Stress Management…James Offrink, Region V Member

Incident Stress can be a silent enemy, having adverse effects on a unit’s mission and performances. The focus of Incident Stress Control is to maintain the readiness and optimal capabilities of the unit’s most valuable resource – its members. Incident Stress is a normal reaction to unusual or traumatic events.

Stress responses in normal situations differ from those associated with a deployment. Physical and mood changes can occur with altered levels of epinephrine, adrenaline, and norepinephrine. Long-term stresses can cumulatively result in permanent changes of neurons, the limbic system, and even DNA.

Jim described factors that can contribute to Incident Stress and the signs and symptoms of Incident Stress. He also distributed a handy guide with tips on post-deployment behavior for the team member and reunions with a spouse, children, and co-workers…”

pogge – at 20:51

Closing for length. Discussion can continue here.

Bronco Bill – at 21:01
Retrieved from http://www.fluwikie2.com/index.php?n=Forum.MassFatalityManagementPlans2
Page last modified on October 18, 2006, at 09:01 PM