MASS DISASTERS MEAN TWO THINGS: MULTIPLE DEATHS AND DMORT DEPLOYMENT.

The call comes anytime jetliners go down, de-orbiting shuttles disintegrate, terrorists raze skyscrapers, or killer hurricanes roar ashore.

David R. Senn, DDS, a member of the Bexar County, TX, Forensic Dental Team, was in Colorado when his call came on Saturday, August 27, 2005, 48 hours before Katrina made landfall. The commander of the Region VI Disaster Mortuary Operational Response Team (DMORT) was calling. Katrina was a monster, growing to a Category 5 hurricane on the Saffir Simpson scale, and headed straight for New Orleans. Destruction and death was certain.

Senn, a veteran forensic DMORT odontologist, was to report to Baton Rouge, LA, where a temporary morgue was being set up in an empty brick warehouse in nearby St. Gabriel, a Louisiana town of 6,000, once home to a leper colony. There would be bodies to identify. Senn altered his plans, caught the next plane back home to San Antonio, cleared his teaching schedule, collected his DMORT grab-and-go bag containing enough gear, clothing, and personal items to last about two weeks, and was in Dallas on Sunday, where his team assembled before caravanning 370 miles overnight to Baton Rouge, arriving at 3 A.M. Monday, August 29, just as Katrina began pounding the Gulf coast.

“We took 30 people from Dallas to Baton Rouge, including the DMORT Region VI commander, deputy commander, and administrative officer,” said Senn, a diplomat of the American Board of Forensic Odontology (DABFO). Another deputy commander lived in Baton Rouge and was already on the job. Region VI covers Texas, Oklahoma, New Mexico, Arkansas, and Louisiana.

Last Responders
The National Funeral Directors Association (NFDA) is credited with conceiving the concept of DMORT in the early 1980s. NFDA was concerned at the time about lack of standards handling the dead in mass casualty events. Protocols needed to be imposed on a process that had none. It was also soon apparent that the services of outside forensic professionals would be necessary to augment local resources during disaster response. The NFDA subsequently purchased the components of the first portable morgue, called a Disaster Portable Morgue Unit (DPMU).

DMORTs and DPMUs are now part of the National Disaster Medical System (NDMS), a section of Operations Branch of the Federal Emergency Management Agency’s (FEMA) Response Division. NDMS determines when to activate, which DMORTS to deploy, and where the DPMUs are to be dispatched - usually any incident in which the number of casualties overwhelms local forensic or mortuary resources. The country is divided into ten DMORT regions, geographically similar to the ten Federal Emergency Management Agency (FEMA) regions.

In 1997, the Aviation Disaster Family Assistance Act was signed into law in response to several aircraft accidents. The Act directed the National Transportation Safety Board (NTSB) to coordinate federal resources to identify victims. The NTSB then signed an agreement with NDMS to provide DMORT support in such cases. In 1998, a DMORT team specializing in bio-chemical fatalities was created in response to increasing concern for the release of weapons of mass destruction by terrorists.

The DMORT idea has rooted. A small group of DMORT members is now routinely deployed in advance of situations where mass fatalities might result from terror attack, such as presidential state-of-the-union addresses, papal visits, or Olympic Games.

Since their 1993 formation, DMORTs have responded to about twenty incidents, from cemetery floods and plane crashes to train derailments and terror attacks. Senn, for instance, was part of the team called to attempt dental identification at the 2001 World Trade Center disaster and again at the 2003 STS-107 Columbia crash.

DMORTs usually cover disaster incidents in their own area, although four DMORTs were dispatched to New York City following September 11, three to Washington, D.C., and one to Somerset County, PA. Katrina was even more unusual. All ten teams were mobilized to the Gulf Coast.

“That’s unprecedented,” said Patricia Kaufmann, MD, commander of DMORT Region III (Pennsylvania, Maryland, Washington DC, Delaware, Virginia, and West Virginia). Still, the nationwide DMORT response to the Gulf Coast was scarcely enough. Remains were still being recovered seven weeks after the storm. Brian Chrz, DDS, DABFO, a Perry, OK, forensic odontologist said six weeks after the storm DMORTs were using dental resources wherever they could find them.

“We used military and public health dentists if they were available,” he said.

License to Heal
During emergency response, DMORTs work under the direction of local authorities, providing technical assistance in recovering, identifying, and processing the deceased. DMORTs are truly traveling morgues - composed of medical examiners, coroners, pathologists, forensic anthropologists, funeral directors, medical records technicians and transcribers, fingerprint specialists, forensic odontologists, dental assistants, X-ray technicians, mental health specialists, as well as computer professionals, administrative support staff, and security andinvestigative officers.

DMORT members are required to maintain appropriate certification and licenses within their discipline, but when teams are activated customary regional licensing issues are suspended and all professional licenses and certification are legally valid in all 50 states. Team members are compensated for duty time by the federal government as temporary federal employees. Most take leave of absence from their regular jobs. Like National Guard personnel, DMORT members are given job security.