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Know you morgue's limits, then prepare for an overflow


June 1, 2009

Disaster planning should include storing and securing multiple bodies

Under Joint Commission standard EM.02.02.11, there is a brief mention of managing mortuary services in the event of a disaster. Such concerns also figure into 96-hour planning under EM.02.01.01.

Many of you won’t have a hard time imagining your hospital morgue overfilling during a catastrophe. Scott Janssens, RRT, MBA, CMRP, director of materials management and safety at Heywood Hospital in Gardner, MA, recently experienced this firsthand.

In December 2008, when ice storms knocked out power for a good chunk of New Hampshire and northern Massachusetts, Heywood’s morgue began filling up. Local funeral homes couldn’t take in any more bodies because they had neither power for refrigeration nor light for embalming.

On top of that, the hospital was holding one body for the local medical examiner, who could not make it to the hospital due to road conditions.

Space is limited for corpses

Heywood’s morgue has the capacity to hold four bodies. During the storm, the morgue held three bodies as the hospital treated two patients near death and funeral homes were knocked out of commission. To put it bluntly, if anyone else died, Heywood needed a plan B.

The hospital’s emergency planning committee had been working on a fatality management plan as part of a detailed pandemic flu response, but it was still in the draft stage.

Emergency managers met with local funeral directors in the storm’s aftermath, and one director was eventually able to take a body from the morgue.

Responders then discussed an overflow plan that was in development—commandeering an ice rink—although the idea probably wouldn’t have come together quickly because security and transportation issues weren’t easily resolved, Janssens says. That left stacking bodies in the morgue as the most practical backup plan, which wasn’t a particularly savory concept with physicians and other staff members.

Luckily, the weather improved, roads were cleared, and the lights came on before a morgue surge forced the alternatives.

“We were fortunate that we never did hit overload, and the road conditions improved enough for the local funeral homes,” Janssens says. “And the medical examiner [finally made it] to Gardner.”

Exercise showcases the challenge

One facility’s countywide drill with various agencies and neighboring hospitals yielded a wealth of tips for others who are working to develop their fatality management plans.

Bob Connor, project manager for safety and emergency management at Parrish Medical Center in Titusville, FL, says the event they chose was a shooting incident at a local college involving 28 mock victims brought to his facility from several campuses.

“We have a pretty detailed emergency operations plan and a fairly detailed incident command setup that includes start-to-finish triage, so we think we’re relatively prepared for that kind of occurrence,” Connor says.

Parrish Medical’s morgue has a capacity for three bodies; however, a temporary morgue can expand to hold 15 victims while awaiting a refrigerated truck to take the cadavers away.

How to set up temporary morgues

Connor offers the following advice for planning for an influx of casualties, based on his facility’s plan and the experience from the drill, which occurred in March:

  • Designate a zone—in Parrish Medical’s case, it’s a black zone that goes with green, red, and yellow zones for patients of different acuities—where casualties will go during incidents once the morgue fills up. Parrish Medical’s temporary morgue is a storage room that gets cleared out and is connected to a loading dock for refrigerated trucks.
  • Make sure that any temporary morgue has means of refrigeration or air-conditioning that can be turned all the way up and verify that there is adequate ventilation.
  • Provide security for temporary morgues by locking them down and stationing security officers around the clock.
  • Have materials management representatives draft memorandums of understanding with refrigerated truck companies to transport bodies if needed. You may need more than one truck if there is a large mass casualty event.
  • Develop a plan for handling unidentified victims (e.g., where to hold them until they can be identified and how to connect with responders and families for identification).
  • Scale up your hypothetical scenarios, figure out the point at which you can’t accept any more bodies, and meet with public health agencies and other authorities to draft a plan for those cases.

“I don’t think you can plan enough,” Connor says. “I think you plan all you can effectively plan ... and what you did this year, you rethink next year. It’s a never-ending game.” (Connor shares his thoughts about news coverage in “Limited media access to morgue operations is personal for one safety pro” below.)

What Heywood learned from its near-miss morgue situation was that fatality response plans may be needed in more scenarios than a pandemic flu response, which had been the case before a real-world situation changed the facility’s thinking.

“In our case, it was an ice storm, but it could have been due to a tornado, blizzard, hurricane, or earthquake,” Janssens says, adding that Heywood is filling out more fatality management details in its response plan in the wake of the ice storm experience.

Looking at a temporary morgue as a tool reflects more of an all-hazards approach. “We have done a significant amount of planning for pandemic [flu],” Janssens says. “Hopefully, we will never have to use those plans, but … when the situation occurs, we can take that plan out with the knowledge that some thought and planning has already gone into solving the challenges.”

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