Temporary Morgue Facilities Planning for Mass Fatality Incidents in the U.A.E - Research Proposal Example

Temporary Morgue Facilities Planning for Mass Fatality Incidents in the U.A.E. Abstract The UAE has a population of about 10 million people comprising of Muslims, Christians, and Hindus. Each of these religious groups has their own way of handling dead bodies. For instance, Christians and Muslims bury the bodies while Hindus burn them. To avoid unnecessary religious tensions following a mass fatality incident, it is essential that mass fatality teams design a criterion that can guide them in selecting an ideal temporary morgue facility. The proposed project aims at determining some of the factors that are considered for selecting facilities for use as temporary Morgue and storage locations for mass fatality management in the United Arab Emirates. It seeks to solve the problem of lack of standardization criteria to guide the selection of temporary morgue facilities in the UAE. The proposed project will focus on secondary data collection. About ten different mass fatality management plans will be examined. The proposed study expects to determine some of the factors that are considered for selecting facilities for use as temporary Morgue and storage locations for mass fatality management in the United Arab Emirates. Mass Fatality Management Proposal Introduction Disasters are unpredictable. When they occur, they have the potential of killing enough people that can overwhelm any particular jurisdiction. It is vital, therefore, that communities prepare in advance to manage any potential consequences that may arise in the aftermath of a disaster. For communities to prepare adequately, they need to be equipped with the right combination of incident management, training, supplies, and personnel. Some of the assets that the communities may find valuable include body bags, forensic and storage facilities, disaster response/recovery team, search and cadaver dogs, and crisis and grief counsellors. Lack of temporary morgues facilities can pose a number of challenges some of which include the following. Lack of temporary morgues exposes the bodies to high decomposition in the open. Hospitals may also be overwhelmed due to lack of space or risk of cross-contamination between inpatients and the dead bodies. Lack of temporary morgues facilities poses a threat of epidemic outbreak as there is no separation of the diseased from the living (Sadiq & McEntire, 2012). The purpose of this research is to determine the factors considered for selecting facilities for use as temporary morgues during a mass fatality incident in the United Arab Emirates. Description of the Problem The main question to be answered in this research is, how can we select temporary morgue locations for mass fatality management in the UAE? Considering that there are no universal standards for temporary morgue selection, we need to answer the following sub-questions. Why are temporary morgues important? In past disasters in different countries what were the temporary morgue locations selected? What are the advantages and disadvantages of these different types of temporary morgues? What are other countries/ cities doing to identify and plan for temporary morgue locations? What are the factors that can be standardized from reviewing the sections in MFM plans? Literature Review Section Mass fatality management refers to the ability of various agencies, including emergency management, law enforcement, healthcare, and medical examiner, to coordinate with each other in ensuring that there is proper recovery, identification, handling, transportation, tracking, storage, and disposal of human remains and personal effects (Sadiq & McEntire, 2012). Challenges in Mass Fatality Management There exists a number of challenges that are associated with mass fatality management. Among the common challenges that have been cited by most scholars include poor MFM plans, lack of expertise in handling bodies, disfigured bodies and bone fragments, lack of predeath data, and cultural and religious preferences for handling the dead. With regards to poor MFM plans, a number of reasons have been identified. One of these is the “it won’t happen” mindset. With this kind of mindset, it becomes quite hard for the individuals responsible to pay attention to the plan. Another common challenge is that the resolution of mass fatality management plan usually takes time; it may take days, weeks or more. Another potential challenge lies in the determination of the kind of specialists that might be needed to augment local capabilities and mobilize the available resources. According to Sadiq & McEntire (2012), other potential challenges in MFM include aftershocks, debris which may consists of glass and metals, movement and tampering of bodies by ordinary citizens, lack of resources, the smell of decomposing bodies, the threat of epidemics, environmental factors such as storm surges, animals, and weather, unidentified bodies, psychological stress, and looting by survivors. Apart from these challenges, there are those that often arise in the temporary morgue. Some of these include communication problems, problems with transportation and evacuation, and depletion of temporary morgue supplies. Other challenges often experienced in temporary morgues include poor record keeping and rapid decomposition of the body remains due to lack of enough refrigerated containers. There are three elements of mass fatality management (Sadiq & McEntire, 2012). These are the body recovery, temporary morgues, and family assistance Figure 1. 1. Body recovery Body recovery refers to the collection of the remains of the diseased after a mass fatality incident like earthquakes, terrorist attacks, floods, and industrial explosion (Sadiq & McEntire, 2012). Recovery entails "the search for and the extraction or extrication of a descendant from the disaster debris and is generally associated with fire and rescue operations (Maryland Department of Health and Mental Hygiene, 2012, p. 35). Body recovery process must be coordinated effectively as it forms a critical step in the investigatory and identification process. Most plans outline rapid recovery as a priority as it helps in identification and reduces the psychological burden on survivors. All effects, partial remains, and remains must be collected during recovery while any portion that is 50 per cent or larger should be regarded as a whole remain (Northeast Region – State of Wisconsin, 2015, p. 47). Dissociated remains also need to be begged together within a 10ft radius. 2. Temporary Morgues With mass fatality, it is more likely that the capacity in hospital morgues and local mortuaries will be exceeded. This engenders the need for Coroner to activate temporary morgue facilities. A temporary holding morgue refers to the site where remains are held until they are transported to the incident morgue (Richey, 2016). The site comprises of a permanent or semi-permanent structure near the incident site (which can be a refrigerated tent or container), shelves for storing remains, consistent 35-38o F temperature, and an ongoing security. Temporary morgue facilities help support morgue operations, decent identification, and data management, all of which are critical in ensuring that the deceased is identified as inefficient, accurate, and timely manner. Important characteristics of a temporary morgue include ventilation, telecommunications, lighting, availability, regular access, refrigeration, heating, water supply, and radiology (Phillips et al., 2008). According to Richey (2016), a temporary incident morgue must be conveniently accessible from the incident site, be of adequate size, have the infrastructure for communications, and be easily accessible. A possible temporary morgue facility must, therefore, meet certain requirements for size, layout and support infrastructure. Below is a detailed description of some of these requirements. Structure type - In the event of a mass fatality incident, mobile truck, temporary tents, aeroplane hangars, and abandoned malls can all be used as temporary morgue facility. Other facilities that can be used as temporary morgue include reception halls and fairground facilities (Gupta, 2015). Facilities used by the general public such as public auditoriums and school gymnasiums, however, need to be avoided. In cases where the number of bodies exceeds normal transportation and storage capacity, refrigerated trucks provide an ideal alternative. In the Indian Ocean tsunami incident, for instance, refrigerated storage containers were used to store about 3600 bodies (Phillips et al., 2008). Temporary shelter. Retrieved from https://www.losberger.com/us/en_US/applications/rapid-deployment-systems/civilian_deployments/mortuary-response/ While transporting the remains, they need to be packed in bags and identified, transported via vans or tracks, and refrigerated. According to Gershon, Magda, Riley, & Merrill (2011), a temperature of 4 degree Celsius is recommended. Scanlon & Hunsberger (2011) cautions against freezing the bodies as such may make it difficult to conduct tasks like the detailed description for identification purposes. Another potential consequence of freezing is its interference with the autopsy. Another consideration to make while temporarily storing human remains is to avoid keeping them in health service vehicles and ambulances. Moreover, the floor of the vehicle used in transporting the bodies needs to be covered to avoid possible contamination with liquids that may leak from the bag (Morgan, Tidball-Binz, & Van Alphen, 2006). This is mostly applicable in scenarios where the remains being transported are decomposed or when dealing with tissues or body fragments. According to Missouri mass fatality plan, a temporary morgue facility should have a hard, weather-tight roofed structure, a separate space for administrative needs, and a separate accessible office space for investigations (Missouri Emergency Management Agency, 2012). The structure should also have non-porous floors (concrete) that can easily be decontaminated. Size of the temporary morgue - The size of the temporary morgue depend upon the maximum number of bodies to be stored and the maximum number of foreseeable disaster victims to be carried out. While designing a temporary morgue, it should be made large enough to allow for the accommodation of the disaster victims (Morgan, Tidball-Binz, & Van Alphen, 2006). The morgue should also allow for the accommodation of distribution boards. According to Phillips et al. (2016), human remains should be gathered at a holding area near the disaster site upon completion of the survey work and removal of the remains. Keeping the remains near the disaster site facilitates their preliminary examination and eventual transfer to the site where final examination and disposition is conducted (Gupta, 2016). According to Gershon, Magda, Riley, & Merrill (2011), there are a number of considerations that need to be made with regards to the ideal size of a temporary Morgue. These include the number of dead bodies that have been recovered, the condition of the corpses and the refrigeration capacity of the morgue where the corpses are to be stored. According to Missouri Mass Fatality Plan, a temporary morgue facility should have a minimal size of 10,000-12,000 square feet (Missouri Emergency Management Agency, 2012). Kansas City Region Mass Fatality Incident Plan also details a minimum size requirement of 10,000-15,000 square feet of floor space (Kansas City Region, 2013, p. 19). The two plans also outline that the facility should be tractor-trailer accessible, have 10-foot by 10-foot door with loading dock access or ground level as well as allow easy access for vehicles and equipment. Here or later on after you do the review of all the plans creates a table like this: Name of Plan Size Structural requirements 1. Missouri State MFM Plan 2. Kansas City Region 3. .. Resources required to set up the temporary morgues - There are a number of resources that are required to set up a temporary morgue. These include water supply and wastewater containment, drainage and medical waste holding tank, electrical power or large generators, provisions for staff such as restrooms and recovery area, and ventilation, air conditioning, and heating (Conlon, 2014). The need for temporary morgues depends on the magnitude of a disaster, professional sources to deal with the disaster, accessibility of the morgue, social circumstances at the disaster site, and the condition of the human remains (Karp et al., 2007). In the scenario where a disaster occurs in rural areas, search and recovery of human remains may take days and sometimes weeks or months (Conlon, 2014). It is thus vital for temporary morgues to be established to facilitate the transfer of the remains. In the case of hurricanes, boats may be used as temporary morgues, although the condition may be unfavourable. Generally, at least three working areas need to be designated when planning for temporary morgues families. They include holding area, viewing area, and examination area (US National Institute of Justice, 2005). In terms of electrical requirement, a temporary morgue facility should have access to electrical equipment that uses the standard household current of 110-120 volts (Anderson, 2017). The power should be obtained from accessible on-site distribution panel, while electrical connections to distribution panels should be made by local licensed electricians. With regards to water supply, a temporary morgue should have a single source of cold and hot water with a standard hose big connection. It should also have a water hose, hot water heaters, sink, and connector. With regards to communication requirements, a temporary morgue facility should have access to broadband internet connectivity, existing telephone lines for telephone capabilities while the telephone lines may be expanded depending on the mission requirements. In terms of sanitation and drainage, pre-existing restrooms within the facility should be preferred. When establishing a temporary morgue site, the following supplies are needed; personnel equipment, administrative supplies, instruments, forensic equipment, and miscellaneous supplies (Zhi, Merrill, & Gershon, 2017). Some of the personal equipment needed include personal protective equipment, fresh water, and appropriate clothing. Examples of administrative supplies needed include fax machines and scanners, photocopy machines, morgue forms, computers and printers, desks, chairs, and etcetera. Examples of forensic equipment needed include anthropological equipment, examination tables, DNA equipment, dental equipment, and etcetera. Examples of miscellaneous supplies and equipment needed include removal vehicles, body, and personal effects bags, cameras, stretchers, and etcetera. 3. Family Assistance Family refers to any person who regards himself or herself as part of the victim’s family, regardless of whether there is a legal familial relationship or not (Georgia Mass Fatality Plan; Chatham County Emergency Operations Plan). Family, as detailed in the mass fatality management plan, is different from the legal next of kin who is authorized legally to make decisions regarding the decedent. In the aftermath of a mass fatality incident, it is important to establish a safe and secure place for families to wait as recovery operations are ongoing. Most plans provide for an establishment of a Family Assistance Center where families of the deceased and injured or missing survivors can grieve and wait for information regarding their loved ones. The Center also serves the purpose of protecting families and survivors from the media and curiosity seekers. Description of the Project Proposed Methodology This research will use a content analysis method to review mass fatality management plans from different regions of the world. Write a paragraph about why content analysis? About ten mass fatality management plans will be reviewed and their criterion for selecting a temporary morgue facility determined. The ten plans include Georgia Mass Fatality Plan, Michigan Emergency Management Plan, Missouri Mass Fatality Plan, Kansas City Region Mass Fatality Incident Plan, State of Alaska Emergency Operations Plan, Bannock County Emergency Operations, Chatham Mass Fatality Plan, Louisiana Mass Fatality Plan, Maryland Mass Fatality Plan, and Wisconsin Mass Fatality Plan. All the plans are in the U.S. The U.S. plans have been chosen because, throughout history, the U.S. has experienced many defining moments in terms of Mass Fatality Incident, including the Pentagon on September 11, Hurricanes Katrina and Rita, and the bombing of the Federal Building in Oklahoma City. As a result, it has clearly realized the challenges of responding to mass fatality incidents. The estimated population as at 2016 in each of the regions chosen is as follows (Ryan & Bauman, 2018). Georgia has an estimated population of 10,310,371 people. Michigan has an estimated population of 9,928,300 people. The estimated population in Missouri is 6,093,000. The estimated population in Kansas is 2,907,289 people. The estimated population in Alaska is 741,894 people. The estimated population in Bannock is 84,377 people. Chatham has an estimated population of 289,082 people. The estimated population in Louisiana is 4,681,666 people. Maryland has an estimated population of 6,016,447 people. The estimated population in Wisconsin is 5,778,708 people. The aim will be to identify some of the factors that can be considered for selecting facilities for use as temporary morgue and storage locations for mass fatality management in the United Arab Emirates. The study will review the mass fatality management plan. Data obtained will be compared between various regions with regards to where they chose the location of the temporary morgue. Conclusion In conclusion, the proposed project will focus on determining the factors considered for selecting facilities for use as temporary morgue and storage locations for mass fatality management in the United Arab Emirates. The project will obtain data by reading mass fatality management plans from different regions. The project will review ten mass fatality management plans and then determine their criterion for selecting a temporary morgue facility. The project will seek to solve the problem of the lack of standardization criteria in guiding the selection of temporary morgue facilities in UAE. References Journals Gershon, R. R., Magda, L. A., Riley, H. E., & Merrill, J. A. (2011). Mass fatality preparedness in the death care sector. Journal of occupational and environmental medicine, 53(10), 1179-1186. Phillips, B., Neal, D., Wikle, T., Subanthore, A., & Hyrapiet, S. (2008). Mass fatality management after the Indian Ocean tsunami. Disaster Prevention and Management: An International Journal, 17(5), 681-697. Scanlon, J., & Hunsberger, A. (2011). Dealing with the Dead in Disasters: A Professional and International Process. The Brown Journal of World Affairs, 17(2), 99-111. Scanlon, J., & Stoney, C. (2014). Ad hoc Rules, Rights, and Rituals: The Politics of Mass Death. Journal of Contingencies and Crisis Management, 22(4), 223-237. Case Study Gupta, K. (2015). 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