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MASS-FATALITY MANAGEMENT fatality, consider two, three, and so on. Understanding this process is critical, because you must identify those resources that are necessary, how those resources are exhausted and when. You must know when the local system will have the poten- tial to fail or need support so you can plan to request additional resources. Target Capabilities The Department of Homeland Security Target Capabilities List (TCL) “provides a guide to addressing the priorities and achieving the National Preparedness Guidelines. Capabilities provide the means to accomplish a mission and achieve desired outcomes by performing critical tasks, under specifi ed conditions, to target levels of performance.” One such response capability is defined as fatality management (http:// www.fema.gov/pdf/government/training/ tcl.pdf). Compare your current “single- fatality plan” to the activities described in the fatality management capability, which includes 10 specific activities: • Develop and maintain plans, procedures, programs and systems • Develop and maintain training and exercise programs • Direct fatality management tactical operations • Activate fatality management operations • Conduct on-scene fatality manage- ment operations • Conduct morgue operations • Manage ante-mortem data • Conduct victim identification • Conduct final disposition • Demobilize fatality management operations. The capabilities in the TCL are considered national standards. Many of these activities are not specific to the traditional EMS role; however, depending on the jurisdiction, EMS resources may be necessary to accomplish these activi- ties in cooperation with other agencies. Hazard and Vulnerability Assessment Once the number of fatalities exhausts your resources, you must determine if your capability is appropriate for the risks that 54 JULY 2011 | EMSWORLD.com Planning to Improve Capability In this article, we have discussed: Current capability—how many fatalities exhaust local resources? Target capabilities—what should you be able to do? Hazard and vulnerability—how many fatalities can you reasonably expect? Now that you know all that, how do you use it? Here is an example: CURRENT CAPABILITY Your planning process reveals there are only four medical examiners legally authorized to process human remains in your locality. Each one can process two fatalities from a single scene, so your current capability is halted at 8 fatalities. TARGET CAPABILITY The medical examiner is a key resource throughout the fatality management TCL, and you have validated your current local process is consistent with the federal TCL. HAZARD AND VULNERABILITY You are a large jurisdiction, with more than 1 million population, and several major interstates and passenger rail lines. You have had experience in dealing with several incidents with more than 10 fatalities in the past several years. Your HVA target for fatality management is reasonably established at 20. You have clearly identifi ed a gap in your capability—specifi cally, an inadequate number of medical examiners. How can you address that? Is it a planning, personnel, training, facility or equipment problem? For this example, consider it a personnel problem. The medical examiner’s offi ce is woefully underfunded and cannot aff ord to hire additional personnel. How do you get medical examiners from neighboring jurisdictions? How can you increase each medical examiner’s capability? How do you get from a current capability of 8 to a reasonable planning fi gure of 20, and is the dearth of medical examiners the only shortfall that keeps you from that planning fi gure? That is the strength of defi ning and understanding the process in your planning eff ort. The ability to see all the interactions and resources necessary gives you the ability to consider alternatives to address your shortfalls, which must be addressed by either accessing those resources elsewhere or by changing standards of practice or procedures. If the medical examiners were planning by themselves, they may not understand that other gaps exist. In other words, the fi x may not have fi xed anything. face your jurisdiction. This is the role of the HVA. What is a reasonable number of fatalities your system may encounter? How many fatalities have you encoun- tered in the past from a single incident? Planning to the concept “more than can be handled” may leave you questioning your capability to respond. Exercising that concept is also diffi cult, as measuring performance against a vague concept is nearly impossible. A more concrete expec- tation needs to be developed to establish both your agency and jurisdictional expec- tations for performance. Conclusion Emergency incidents involving mass fatalities have the potential to be some of the most hectic and dynamic scenes EMS agencies will encounter. Recent events in Japan showed that traditional response entities and authorities have seen expanded roles when large-scale incidents arise. The logistics behind responding to exceptionally large-scale mass-fatality incidents are way outside the scope of most mass-fatality plans but need to be in the forefront of EMS agencies’ minds. Understand that knowing your part- ners in advance and utilizing those rela- tionships to assist in developing well- researched response plans can result in an efficiently run response to what has the potential to be a very difficult emergency scene. Raphael M. Barishansky, MPH, is chief of public health emergency preparedness for Prince George’s County (MD) Health Department. A frequent contributor to and editorial advisory board member of EMS World Magazine, he can be reached at rbarishansky@ gmail.com. Dennis C. Wood, MS, NREMT-P, is the major of Emer- gency Medical Services for the Prince George’s County Fire/EMS Department in Maryland. He has been in the fi re and emergency medical services for more than 20 years. He can be reached at dcwood@ princegeorgescountymd.gov.