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Management of Dead Bodies after Disasters: A Field Manual for First Responders (Second Edition)

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Manual and Guideline
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Foreword

Natural disasters can have catastrophic consequences, causing large numbers of deaths and overwhelming local and even regional emergency response services. Local organizations and communities are usually the first to respond to a disaster, which includes rescuing and caring for survivors and managing the dead.

The humanitarian community recognizes that proper management of the dead is a key component of disaster response, together with the recovery and care of survivors and the supply of basic services. Experience from events such as the 2004 Indian Ocean Tsunami and the 2013 Typhoon Haiyan in the Philippines have reaffirmed that first responders – including local residents and volunteers – play an important role in managing the remains of those killed.

These first responders throughout the world need simple, practical and easy-to-follow guidelines, ensuring that they can carry out this task in a proper and dignified way. This includes taking the necessary steps to aid future work by forensic specialists and investigators in identifying human remains and clarifying the fate of the missing. Such guidance is also necessary for planning adequate disaster preparedness.

The first edition of this manual was published in 2006 precisely to respond to those needs. It marked an important practical step towards improving management of the dead in disasters, promoting an understanding of why proper and dignified management of the dead in disasters is important, and helping people to recognize the role of first responders in this task.1 The manual has since been in steady demand worldwide. It is now available in several languages and has shown its utility in major disasters and mass fatality events around the world. It has become a source of reference for many mass fatality response plans. Although it was drafted and designed for contexts where forensic services are scarce or non-existent, it has also been well received, including as a useful tool for disaster preparedness, in countries with well-resourced and highly developed forensic services and disaster response agencies. It may take days for the experts to reach areas affected. The work of first responders as set out in this manual makes the work of the experts more effective.

Lessons have been learnt from the use of the manual and the implementation of its recommendations. Its usefulness and appropriateness have been confirmed, but scientific and technical developments in the field of mass fatality management suggested that an update was necessary.

Work to update this manual, initiated by the World Health Organization and the International Committee of the Red Cross, began in 2015. The International Federation of Red Cross and Red Crescent Societies and the Pan American Health Organization again played a key role in revising the manual and Interpol was consulted extensively to ensure that all manuals on the management of dead bodies were in alignment. Professor Stephen Cordner, from the Victorian Institute of Forensic Medicine, oversaw the editing of this second edition.

This new edition of the manual retains the spirit and purpose of the original publication and recognizes the valuable contribution of first responders in managing the dead in disasters. The manual provides simple, practical and useful guidance for this difficult yet essential task.

  1. Introduction

This manual has two aims: first, to promote the proper and dignified management of dead bodies and, second, to facilitate their identification. Following many disasters, and certainly larger ones, the retrieval and immediate management of dead bodies is done by local authorities, organizations and communities, residents and volunteers. This is because forensic experts may not arrive for some days, or even longer; and in some contexts, there are no forensic experts at all. Consequently, this manual focuses on practical recommendations for those who are on the spot or are able to respond in the immediate aftermath of a disaster – i.e. first responders.

The early work of first responders in managing the dead protects the dignity of the dead. The proper recovery of bodies involves:

  • allocation of a unique code to each body,

  • taking photographs and recording data about each body as soon as possible,

  • placing each body in a body bag, and - the orderly temporary storage of the bodies.

These steps in the early management of the dead go a long way to protecting their dignity. They help to ensure the traceability of the bodies and thus avoid their loss. But more is needed if the bodies are to be identified:

  • a list of the missing must be created, and - information about those on the list must be gathered.

Provided all these steps are taken, the foundations have been laid for later efforts by forensic experts to enable the formal identification of the dead. Implementing all these measures early on also increases the number of dead bodies identified even if a forensic response is not possible. The proper management of the dead also includes acknowledgement and assistance to their bereaved families, friends and communities.

The manual does not provide a comprehensive framework for forensic investigation and does not replace the need for specialist forensic identification of victims. However, if the recommendations in the manual are not followed, identification of dead bodies in significant numbers will not occur. For example, many people nowadays believe that DNA technology alone suffices for identification. However, it is necessary to implement all the recommendations of this manual before any unique identifying method (whether fingerprints,

DNA or dental examination) can be used effectively following disasters (see Annex 8).
Immediately after a disaster there is little time to read guidelines, so this manual dedicates one chapter to each key task and uses bullet-points for brevity and clarity. Local coordinators can easily copy and distribute the relevant chapters to individuals responsible for specific tasks, such as body recovery.

The manual also includes material to assist planners and managers to prepare for future disasters and to carry out training of first responders.

In summary, what is set out in this manual is an immediate response for managing the dead following a disaster. This response is:

  • considerate of the dignity of the dead;

  • respectful of the bereaved;

  • realistic about logistical and human resource constraints;

  • as effective and efficient as possible in ensuring the traceability and identification of the dead;

  • a preparation for the next and necessary step, namely a proper and graduated operation to identify as many of the remaining unidentified bodies as possible. If available, this will involve forensic experts who will rely on the results of the work initiated by first responders.

The length and scope of the immediate response will vary according to the size, context and type of disaster.

Close communication and coordination between those responsible for the immediate disaster response – e.g. first responders, some international organizations such as the International Committee of the Red Cross (ICRC), the World Health Organization (WHO), the United Nations (UN) – and those responsible for disaster victim identification (DVI)2 (usually police and forensic experts applying Interpol DVI principles) is mandatory, and should be pursued as soon as possible, and ideally, even before disaster strikes.

If this approach is taken, an orderly, graduated response to the identification of as many bodies as possible can be realized. Throughout the manual the terms “dead bodies”, “the deceased” or “the dead” are used, instead of the more respectful and technically correct term “human remains”, because the former are less ambiguous for readers. The term “body part” is used to refer to tissue that is recognizably human but is less than a whole body; body parts are treated in the same manner as the whole body.