Every American who lived through the horrific attack on 9/11 knows exactly where they were when the Twin Towers of the World Trade Center collapsed, killing thousands of innocent people. The British will always remember the fear and pain of the 2005 7/7 London bombings, taking the lives of 52 commuters and injuring 700 others. The Chinese will feel the heartache and devastation of the May 2008 Great Sichuan Earthquake for decades to come. The deadly quake caused billions of dollars in damage and the deaths of over 69,000 people and counting.

Unfortunately, mass casualties are a reality. How would your facility handle a mass casualty? Quite often, a Medical Examiner (ME) facility does not have a sufficient plan or facility in place to adequately deal with a mass casualty. Relying on Disaster Mortuary Operational Response Teams (DMORT) or Federal Emergency Management Agency (FEMA) for complete assistance may not be the answer either. For lack of planning, the facility operates in one of two modes, the ostrich or the overachiever. First, the ostrich; the facility is buried so deep in the “sand,” it operates as if it would never deal with a mass casualty. Second, the overachiever; this facility has completely over-planned, which offsets the budget and becomes a tremendous effort to manage. Blending these two scenarios for a level approach is the most effective.

Your facility should be flexible enough to handle a mass casualty event, but without funding more than is necessary. There are various ways to prepare with a limited budget, from retrofit solutions to new construction.

One flexible solution for ME facilities is temporarily stacking or “double-parking” mobile storage racks while triaging the event. Typically, facility cold rooms are designed with racking down each side of the cold room, with a clear center section for free movement of cadaver lifts and transporters. This clear, center aisle can be temporarily filled with a series of knock-down cadaver racks that, when not in use, can be stored elsewhere until needed. When a mass casualty strikes, these mobile racks are quickly assembled and rolled into the center interstitial space of the cooler, utilizing a triage/prioritization method for putting decedents into reverse order in which the case needs to be worked. As the backlog dwindles, the mobile racks can be removed as needed until the cold room is left with the standard, day-to-day setup needed to process cadavers. With this solution, a suite of cold rooms designed for a working capacity of 500 decedents can ramp up to hold 850 when needed.

Temporary, refrigerated units are also a great solution for a mass casualty, if needed. These units can be leased and delivered to your temporary site. With advanced planning or retrofit, many facilities can handle this solution. A clear space directly adjacent to the facility is needed for placement of the refrigeration units. Often this space is a parking lot that will temporarily displace employees, but allow the facility to handle the crisis. Security must be considered for this solution, as for all others. The ideal place for the refrigerated units is out of the general public sight lines. When planning a new facility, this is a consideration when designing the site and location of the building, as well as any fencing and security arrangements necessary for future events.

The temporary, refrigerated units require additional engineering infrastructure, as many units run on generator power. Additional space for placing the generators is necessary. However, by providing additional exterior, electrical power in the size and capacity necessary to support the units, the refrigeration can be handled off building power and supplant the need to have generators, which are loud and sometimes unreliable, depending on the energy source.

A mass casualty plan should be in place at every ME facility in case a crisis would arise. How do you approach your mass casualty plan? Does your facility have the characteristics of the ostrich, the overachiever, or a blended level approach?

Ken Mohr is a Principal and Sr. Forensic Laboratory Planner with Crime Lab Design, which provides full A/E services for forensic and medical examiner facilities.

Susan Halla is a Project Leader with Crime Lab Design.