DMORTs Meet the Forensic Needs of Mass-Disaster Incidents
By Joyce Williams, RN, BAN

Disaster Mortuary Operational Response Teams (DMORT) were developed to meet the responsibility of victim identification and mortuary services in the event of a mass disaster. They have evolved over the past 10 years and have been instrumental in actively improving the mass fatality incident response in the United States.

The United States government has had a contingency plan for large-scale disasters since World War II but it wasn't until that Richard Nixon issued Executive Order 0, "Assigning Emergency Preparedness Functions to Federal Departments and Agencies."

The Robert T. Stafford Disaster Relief and Emergency Act (P.L. 93-288) provides for a comprehensive emergency management system to ensure a timely and coordinated response. It was designed to improve the haphazard response to mass fatality incidents by revising and broadening the scope of existing disaster plans.

As a result of the Stafford Act, the Federal Response Plan (FRP) was created. The plan describes the basic mechanisms and structure by which the federal governments will mobilize resources and conduct activities to augment state and local response efforts. There are 12 emergency support functions (ESFs) with a primary agency as the lead agency based on criteria and resources within that functional area. Support agencies assist the functional areas in identifying the responsibilities, actions and requirements of the federal departments and agencies involved in the plan. The FRP is organized as a basic plan with appendices, functional annexes and support annexes. ESF No. 8 provides coordinated assistance to supplement state and local resources in response to public health and medical needs. It utilizes the U.S. Department of Health and Human Services (HHS) as the primary agency.

HHS leads, directs, coordinates and integrates the efforts to provide the necessary medical and public health assistance during a disaster. They direct the activation of National Disaster Medical Services (NDMS) and staffing as well as the direct activation and deployment of health and medical personnel, equipment, and supplies. "NDMS is a partnership of federal agencies charged with providing for medical, mental health, and other human services to victims of national catastrophic disasters. The Office of Emergency Preparedness (OEP) in the HHS leads NDMS. The other federal agencies involved are the Department of Defense, the Department of Veteran Affairs and the Federal Emergency Management Agency (FEMA).

The Office of Emergency Preparedness established the National Disaster Medical System to further the ESF No.8 function. There are 16 categories within ESF No. 8. Functional area 16 is Victim Identification and Mortuary Services.

This function, "a critical component of the NDMS, is the Disaster Mortuary Teams,"¹ which assist in the body processing needs that result from a mass fatality incident. Prior to this, in the early s a committee within the National Funeral Directors Association was formed with the specific intent of designing a standard in the event of a mass fatality incident. Funeral directors have long offered comfort and advice to grieving families on behalf of the deceased.²

In , 87 people were murdered in New York City following a fire at the Happy Land Social Club. This was the second large incident where more deaths occurred that could be handled by local resources in just two months. The medical examiner was unprepared to provide for the dead along with their families and approached a group of funeral directors to assist. They were asked to fill a need -- that of delivering the truth with compassion to the families of victims of these horrific tragedies. These volunteers, under the direction of Tom Shepardson, determined a location for the families to meet where information could be gathered to aid in the identification of the victims. Other agencies such as fire, police and mental health were incorporated in these teams.

Communities were not prepared for these mass fatality incidents. The Office of Emergency Preparedness reviewed the FRP, which focused on victims that survived. Shepardson and his team saw a need to provide for the dead as well as the living. He was asked to develop a course specialized in training providers of mass fatality response. It was soon realized that not just one profession could handle all of the aspects of such an event. ³ Multi-faceted teams were organized with forensic practitioners and trained across the country. The teams consisted of citizens representing several medical specialties as well as support personnel and are employed by the Federal Government when activated. A memorandum of agreement with the NDMS and the National Foundation for Mortuary Care was developed. Thus, DMORT was born in .

They were called Disaster Mortuary Response Teams. The teams were private citizens who would respond at a moment's notice to a disaster with the goal of identification of the dead and returning them to their loved ones. DMORT teams work to locate, recover and identify the remains of victims. The teams utilize the identification services of pathology, odontology, latent prints, and anthropology and DNA technology. In addition many support personnel complement the team. The support personnel consist of dental assistants, emergency response personnel, logistics officers, nurses, psychologists, medical investigators administrative personnel and security specialists. DMORT was organized based on a regional concept, with 10 operational areas across the United States.

In TWA 800 crashed in the ocean waters off the coast of Long Island, N.Y. Loved ones demanded better treatment of the victims with the interests of the victims placed ahead of the airlines. They wanted expedient notification of victim identification, return of personal effects, access to information, counselors and a family assistance center on site. It was after this event that Congress became involved, along with the National Transportation Safety Board (NTSB), and passed the Aviation Disaster Family Assistance Act. Families now could expect certain things in the event of major aircraft incidents by coordinating with local, state and airline authorities involved in investigating and managing a disaster.⁴ They are tasked with seven victim support tasks and victim identification by forensic and medical services.

In the name of the organization changed to Disaster Mortuary Operational Response Team.³ DMORT teams had been forged into a cohesive unit of specialized citizens. They worked side-by side caring for the bodies of strangers often reduced to fragments. These forensic experts struggled to find meaning for the families who were grieving and in shock. All members are caregivers treating bodies with compassion and dignity as they are tasked with the identification and care of the victims.

During the past 10 years DMORT has grown to 1,200 members. DMORT provides the following services: mobile morgue operations, the Family Assistance Center, forensic examination and remains identification, DNA acquisition, coordination of release of human remains, data collection and data entry and embalming and casketing just to name a few. The operation continually strives to achieve its objective as it improves the way in which we identify the victims of mass fatalities and return them to their families.

DMORT is a federal agency that only responds when requested.

"Their mission will continue to assist the local authorities during a mass fatality incident."³ Shepardson said, "They provide these communities with the confidence that everything humanly possible is being done to recover, identify and return the victims to their families. DMORT is proud to be an important and credible factor in the process."⁵ DMORT strives to accomplish their intended missions using scientific skills to help people out in their time of need. The future of DMORT promises to further integrate our response in the identification of victims of mass fatality incidents.

Joyce Williams, RN, BAN, is a member of DMORT Region III and responded to United Flight 93 in September . She works as a forensic investigator for the Office of the Chief Medical Examiner for the state of Maryland.

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