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MASS-FATALITY MANAGEMENT The planning process is exceptionally important. It is during this time that EMS agencies can make other entities aware of their resources and operational realities. defi ned as: “An incident where more deaths occur than can be handled by local resources.” This defi ning point is an important distinction, as some juris- dictions could easily handle 10 or more fatalities at the same incident scene, while others would be quickly overwhelmed. Although various jurisdictions have different lead agencies in regard to mass-fatality planning, EMS needs to ensure it has a seat at the table. This means being involved with the various planning and response elements—emer- gency management, fire, law enforce- ment/public safety and hospitals—on a day-to-day basis. This strong pre-existing relationship will ensure you are invited to the table and your concerns will be heard and addressed. Planning The first step in the planning process should be a hazard vulnerability assess- ment, which will, at a minimum, establish specific hazards that have impacted your jurisdiction (this can be local, county, regional or state) in the past and have the potential to impact it in the present and/or future. Understand that this is not something an EMS agency conducts on its own, and EMS plays a valuable role in this regard. Questions surrounding your HVA could typically include: • What types of natural disasters/ severe weather, such as fl ooding, hurri- canes, tornadoes, major snowstorms, have impacted your community in the past? • Do you have an airport, seaport or other transportation hub? • Are there major highways running through your jurisdiction? 50 JULY 2011 | EMSWORLD.com • Is there major industry, and what is it? • What are the typical large-scale planned events? • What past events have occurred in your community? Have these included acts of terrorism? This planning process is exception- ally important, and the need for part- nerships is paramount; thus, having all of the key players involved in the plan is critical. It is also important to have a representative from the coroner’s or arching incident priorities, and the various responsibilities of all entities responding to or receiving patients from the incident. A solid example of the template approach mentioned above comes from the Thomas Jefferson Emergency Medical Services Council based in Charlottesville, VA (available at http://www.tjems.org/ TJEMSMCIPlan2009.pdf). This plan includes all of the elements mentioned above and others, including a list of potential high-risk entities in the region, “The first step in the planning process should be a hazard vulnerability assessment.” medical examiner’s office at the meeting, as well as someone from the state or local funeral home association. Typically, these entities in the death-care industry are better informed about operational realities in dealing with mass-fatality management (such as handling large numbers of bodies). During the planning process, it’s important for EMS agencies to make the others at the table aware of their resources and operational realities, including number of vehicles per shift (both ALS and BLS), typical crew makeup, specific protocols regarding mass- fatality incidents (if applicable), mutual aid agreements, memoranda of under- standing, and additional considerations. Your plan, at a minimum, should include relevant definitions, the scope of the plan, authorities involved, over- a comprehensive list of initial actions to be taken at the scene of a mass-fatality incident, a list of the distinct roles of both EMS entities and medical care facilities, as well as standard precautions all EMS providers should take at such an incident and a deactivation component for the plan. Another example of collaborative planning was promulgated by the Los Angeles Department of the Coroner; Los Angeles Department of Health Services, Emergency Medical Services Agency; and the Los Angeles County Department of Public Health (http://ems.dhs. lacounty.gov/ManualsProtocols/MFIM/ MFIGuidanceForHospitals808.pdf). This plan, too, is comprehensive and is specif- ically directed at the healthcare aspects of mass-fatality management. The plan includes lists of key contacts with phone numbers and e-mail addresses, as well Adam DuBrowa/FEMA