|
RESCUE. Miraculously, some do. One such is
Dr. Wineland who is found wandering, covered with dust and ash completely
dazed. He has somehow survived and has, himself, dragged clear a number of
now-nameless children, some still alive – some not. Asked to come back later
to TUNA to receive an award for his meritorious service, he declines, never
able to see such a sight again. After this event, he will retire to his farm
in Wyoming.
|
|
Casualties. Later, much later, when the smoke clears
and the dust settles, the scoreboard which once counted free-throws, dunks
and bank-shots, now counts casualties -Sixty-Seven Dead . . . One hundred Eighty-Five Injured – men,
women and children.
|
|
RESPONSE. They say that every
disaster is first local, and I guess that’s true, but this one rapidly turns
into a state and national event. First on the scene are the local police
followed by every member of the volunteer fire department. Officer Bill
Gannon is first to grasp the magnitude of this calamity and, remembering his
ICS training, immediately assumes the role of Incident Commander, a role he
soon surrenders to Fire Chief, "Bull" McCaffrey.
Cotton County EMA, which
was monitoring the gathering tornadic event on weather radios, is notified by
Incident Command that great numbers of fire-rescue personnel are going to be
needed ASAP, PDQ, instanter, stat, rattle-dags. As EMA calls out rescue
personnel from nearby fire departments and rescue squads; Likewise, EMA has
calls, through the Regional Law Enforcement Taskforce for every police
officer available in the county to establish a perimeter. Fire squads
extinguish the remaining blaze that soon burns out when the gas company
closes off the gas line.
The building must first
cool before rescuers can take the time to cut through the rubble of
smoldering, crumbled concrete and steel to find survivors.
Volunteers begin to arrive
and assist (some, of course, injuring themselves.) Ambulances requested
through EMA, draw near and start taking away those who can be saved.
Some can – but many can’t.
They will first head for the nearby County General Hospital, a 25-bed primary
care hospital that notifies ADPH to activate AIMS to take the surge.
Various hospitals in the
State come on-line and notify the State Trauma System and AIMS that they can
receive incoming. The Trauma System guides EMS personnel with casualties to
some-distant hospitals. At the end of
days, the scene of what can best be described as a ”Skyfall” witnesses a veritable “alphabet-soup” of agencies
summoned to perform their various tasks.
|
|
SMORT. One such agency
carries the designation State Mortuary Operational Response Team, SMORT.
Remember Coroner Quincy? There is no possible way that he, the local coroner,
can begin to even locate and identify the decedents, let alone prepare them
for release to their soon-to-be grieving families. Thus, a volunteer
organization which started with funeral home directors and other mortuary
personnel is alerted by EMA – SMORT formed by funeral directors and personnel
just a time such as this.
Quincy is acquainted with
SMORT through his training with the Coroners’ Association. He remembers that
SMORT is composed of funeral directors, funeral employees, coroners, other
trained personnel, as well as administrative support staff, and security
personnel; And it has a number of responsibilities under the direction of the
Coroner whom they assist. These responsibilities include:
•provision of temporary morgue facilities
• victim identification,
•Decedent processing and preparation for disposition of remains to
funeral home directors at the request of families.
SMORT has available to it
personnel that can provide additional services such as forensic dental
pathology and forensic anthropology to aid in identification of remains. It
works closely, He learns, with the Funeral Home Director’s Association,
Alabama Board of Funeral Service, the Alabama Department of Forensic Science
and ADPH as well as with local coroners/medical examiners.
SMORT is patterned after
the federal Disaster Mortuary Operational Response Team (DMORT), which is
administered since 2007 by HHS, National Disaster Medical System (NDMS.) Like
DMORT, SMORT has a two-part process that utilizes a sophisticated computer program
for matching physical characteristics.
If necessary, the families of the decedents provide as much
information about their loved one as possible: medical or dental records,
X-rays, fingerprints, photos or descriptions of tattoos, clothing and
jewelry; blood type information and objects that may contain the decedents’
DNA, such as hair or a toothbrush.
SMORT provides or procures
hot/cold running water, electricity, HVAC, adequate and secure drainage,
parking, communications, and security. An ideal temporary morgue established
within a building would need 5000-8000 ft2.
The information gathered,
called antemortem, or "before death" information, is entered into a
computer program called VIP (Victim Identification Profile), which is capable
of assimilating 800 different item categories, including graphics,
photographs and x-rays. As forensic scientists (pathologists,
anthropologists, odontologists) examine the recovered remains, they enter
their findings - called postmortem data—into VIP.
Coroner Quincy is aware that this mass
casualty event could be determined to be of national importance or might
exceed the capacity of even SMORT. That being the case, DMORT could be
activated to assist, by HHS at the request of ADPH or through AEMA through
EMAC, Interstate Mutual Aid overseen by FEMA.
|
|
SMORT ADMIN. Coroner Quincy
knows that SMORT is administered by the Cullman County EMA where Phyllis
Little is the Director and Kelly Allen is her Deputy. Doug Williams, a
funeral director in Cullman is the statewide SMORT Commander. It utilizes
only volunteers, but receives certain funding through ADPH from ASPR. Tim
Hatch oversees the grant.
SMORT has 50 personnel
divided into 5 regional teams of ten persons. It has five large inflatable
tents, three mobile units and three refrigerated trucks. All will be needed
at this scene.
“Funeral home.” That has
an ominous ring to it doesn’t it. Yet, funeral homes in the State of Alabama
are about to be busy. Sixty-seven Alabama children and adults are lost is
less than one minute.
|
|
ONE THE WAY. One such student is
Johnny Butler, lost in the melee’. Like hundreds of other families, the
worried Butler family hears the news and drive quickly to the scene, clogging
the highway. And like all loved ones, they want to find out whether their son
is alive . . . or not. Only time and
work, a lot of work, will tell.
|
|
VIC. When the Butlers
arrive at the scene, they find a policeman and tell him who they are and ask
if there is any information on Johnny Butler. The Red Cross, called by EMA and in
coordination with a branch of SMORT called the Family Assistance Center or
FAC, has established a temporary place for families and friends to go. This
is the Victim Information Center (VIC.) At the VIC, which has been hastily
located at the municipal auditorium; the family finds many other worried and
concerned families, some food, some organization and what little information
there is.
The municipal auditorium
is close to the scene, perhaps too close. Bearing that in mind, EMA, in
coordination with the FAC, establish a Center, the Family Assistance Center,
at New Bethlehem, a local United Methodist church which is on the other side
of town and unharmed by the monster-storm.
|
|
FAC. FAC staff are
trained to activate quickly the Center following the event as they have here.
Over the next few days, they will provide critical and secondary services to
the 5 to 7 expected family members of each of the victims. The FAC will
partner with a number of sister agencies and will at all times maintain a
high degree of sensitivity and respect for both the family and the lost loved
one. Perhaps most importantly, the FAC will provide a place of security and
serenity away from the prying eyes of the media and the gawkers. None such
will be allowed in FAC at any time, not on my watch any way.
In the end, the FAC will be the families’ life-line to information as
it becomes available, to sanity, and will begin to build the bridge to coping
with what is to come.
|
|
Fac services. Staff of the FAC will assist
SMORT in identifying victims through conducting antemortem interviews, will
provide comfort and assistance to families, and will refer family members for
spiritual or psychological counseling, medical assistance, and material
needs.
|
|
FAC STAFF. The SMORT staff
consists of the County Coroner/Medical Examiner who is the Incident
Commander, the SMORT Commander, the FAC Executive Director (FACED) and Deputy
Director, the Chief of Professional Personnel (ChoPPs,) Family Assistance
Representatives (FARs), the Chief of Operations (Ops,) Antemortem
Interviewers (AMIs,) Antemortem Data Entry Personnel (ADEP,) Administrative
Staff (Admin,) and the Chief of Logistics (CoLog).
|
|
FACES OF THE FAC. At the FAC,
families will see these faces: Doug Williams, the SMORT Commander; Debbie
Gaddy, R.N., the Deputy FAC Director; Dr. Bill Morgan, the Autauga County
Baptist Director of Associational Missions and Chief of Professional
Personnel; and your FAC Director. Dr. Morgan supervises the Family Assistance
Representatives, Ruth Harrell, RN, MPH, Chief of Ops supervises the
Antemortem Data Interviewers and the Chief of Logistics who will be FAC’s answer to MSgt. Bilko,
the scrounger who can procure it . . . Just don’t ask him how or where he got
it.
We are currently actively
recruiting a CoLog as well as FARs, AMIs and Admins. Our goal in recruitment
is to fill out the table of organization and equipment (TO&E) with a
racially and culturally diverse team that includes people of different
faiths, genders and disciplines who are best suited for their particular
assignment.
|
|
Optimal FAC (Only) Setup Exclusive of ADFS Facilities. In this event, New Bethlehem was transformed into the FAC with a
number of service areas, all designed to accomplish its two major goals,
taking care of the families and assisting SMORT to identify decedents so that
ultimately, there can take place the sad reunion as the families are assisted
in taking their loved one to their own funeral home.
The service areas include
a reception/screening checkpoint; a waiting area; a large family briefing
room; a place for victim identification services and data entry/computer
operations; and general operations, childcare, staff break, and family
feeding areas.
|
|
Just who is a “family?”
Just who is a “family?” The working definition of victim and family groups is
broad in scope. The Red Cross, National Transportation Safety Board and the
military all define “family” as anyone that the primary victim’s family
considered to be a family member. If other words, if they say they are
“family,” we won’t question that. Of
course, in a disaster of this magnitude, there might have to be limits placed
on the size of these “families.”
Whoever self-define as
“family,” as in this case, they will or may present desperately seeking
information, physical and emotional comfort, hydration, meals, and protection
from media. In fact, though great emotion is not always immediately present
in families, the Butler family appeared dazed or numb. We know that each of
them will gradually go through stages of denial, hope, and then grief and
despair. Our job is simply to be there with them and for them.
At the TURA disaster, we,
the FAC staff find some family members to have irrational beliefs regarding
the survival of their loved ones in face of certain death, which is common
and not abnormal in early stages of the event. We even have a few
individuals, none of the Butler family, though, who experience stress-induced
physical or behavioral symptoms of such severity that we have to refer them
to other providers for urgent and immediate care.
We learned through this that
acute stress symptoms such as confusion, the presence of intrusive memories,
increased anxiety and a sense of disbelief will be present even in some of
those who directly experienced or witnessed the incident.
|
|
CARING FOR FAMILIES. At New Bethlehem, each family had assigned to them a Family
Assistance Representative (FAR) who served as their guide on this perilous
and sad journey. Like all FARs, the Butler Family FAR, Miss Henrietta Mears,
ministered to their needs, helped them procure things they needed and
generally served as their “next friend.” The FARs exuded a sense of safety,
calm, efficiency, community, and connectedness to social support. Above all,
they provided the Butlers and the hundreds of others like them with hope.
Where there is no hope, there is only despair. No one should despair in the
FAC.
|
|
FAC PARTNERS. The Butler
Family has material needs as well as emotional needs. Miss Mears and the FARs
through FAC have many resources upon whom to call should the need arise. EMA
is the gateway, but people services are provided by Red Cross, Salvation
Army, denominational disaster ministries, especially for Alabama’s FAC, The
Alabama Baptist Disaster Relief Ministry consisting of Chaplaincy, child
care, and food service (food supplied either by Red Cross of Salvation Army.)
The Baptists even provide temporary shower units and self-contained clothes
washing trailers.
Most faiths and denominations have on-call clergy who can give
spiritual counseling. EMA can provide mental health/social worker counseling
if need be. All these resources and
more are available to the families through the FAC. And, it’s the FAR’s job
to see that they are connected.
|
|
MENTAL, HEALTH OR SPIRITUAL INTERVENTIONS. If the FAR refers a family member for mental health counseling
through EMA/Red Cross, they may need psychological first aid - comfort care
over and above what our FARs have been trained to give. A family member could
also need crisis intervention support to provide opportunities for family
members to make decisions to regain control of their lives, psychological
education on stress symptoms and coping as well as casualty support such as
connecting with support systems, decision-making on disposition of remains or
spiritual care interventions by Disaster Chaplains or local clergy of the
appropriate faith.
|
|
IDENTIFICATION OF REMAINS. The second, perhaps toughest, task facing the Butler family will be
assisting SMORT through FAC in identifying remains. In this event, we have already witnessed
search and recovery of remains and an assessment by Coroner Quincy of the
condition of the remains.
|
|
IDENTIFICATION OF REMAINS. Some will be easy to identify, some will not. You know, but the
Butler Family does not know, that what has already begun is the
identification process. In this process, forensic experts, if necessary, will
assess the length of time it might take to make a positive ID and what
methods (esp. DNA) will be needed.
|
|
IDENTIFICATION OF
REMAINS. Certainly, involved in the process is antemortem
data collection involving the making of decisions about the release of
remains to the family and receiving information on identification of
common/unidentified corporeal fragments.
Likewise, the Coroner is already working with due deliberate speed to
determine an exact cause or manner of death for each decedent that has been
identified.
|
|
EVERY DECEDENT IS A PERSON. Though Coroner
Quincy, SMORT and the FAC may work through the case of a number of decedents,
we will never forget that each one is a person and will accord them the
dignity they deserve.
|
|
THE ANTEMORTEM INTERVIEW. After the Butler Family became comfortable with their FAR, Henrietta
Mears, also a member of the Alabama Baptist Disaster Response Mission, they
met with an FAC Staffer, Mr. Richard Cavett, an Antemortem Data Interviewer
(AMI) who led them through the delicate process of obtaining data that helped
SMORT, Coroner Quincy and the ADFS Staff identify a young man who was finally
and sadly determined to be Johnny Butler.
Miss Mears walked with them throughout this process. While AMIs move from family to family
gathering information, FARs stay with their family to assist until relieved.
This process is designed to allow the family to tell the staff their story in
a comfortable manner. While, follow-up direct questions are asked according
to a script which ultimately correlates with the ADFS’ form “VIP,” the bulk
of the interview will be the family members’ narrative.
|
|
DATA ENTRY. Behind the scenes
at the FAC and out of view of the grieving families, the antemortem data
which has been collected by AMIs such as Mr. Cavett is entered into a data
collection system set up and installed in the FAC by the IT staff of ADFS. This information is uploaded to the ADFS HQ
in Montgomery where the antemortem data is matched with the post-mortem data.
The goal is to create a putative match. While ADFS suggests the match,
Coroner makes the final call since this is his County and his responsibility.
The system allows the FAC
Ops to query the system periodically for reports on putative matches so that
Coroner Quincy can be constantly informed as to the status of remains since
he must report to the public, the press and most importantly to the families
on the status of identification of victims.
Data released outside a
family is general in nature. Only the data that pertains to a particular
family is released to the family.
General informational sessions are held in the FAC as need when facts
become available. What only family knows, every family knows, except as it
pertains to an identified decedent
|
|
BEGINNING TO WRAP UP. It is now April 30. The victims are identified and Coroner Quincy
makes his rounds notifying each individual family privately. Such is the case with the Butler Family as
Coroner Quincy, assisted by the FAC Director and the Family FAR, Miss Mears,
notifies them of the truth of what they already knew – Johnny was one of the
fatalities.
If one can find good news
in this, it’s that Johnny is intact and ready to be delivered to his family
for burial. There will be many wreaths on the doors of Alabama tonight.
|
|
SAYING. GOODBYE. Henrietta
Mears and the Staff of the FAC begin to bid good-bye to the families as they
have completed the exigent portion of the mission, that being taking care of
families and reuniting them with their loved one. They have assisted the
Butlers with making arrangements with Turner Funeral Home in Luverne to take
Johnny, to make final preparations and to lay him to rest. This scene, too,
is rehearsed over and over again. However, their job is not over.
|
|
SAVING JOHNNY BUTLER. Johnny Butler was one of 67 victims of that end of days at the
University of Rural Alabama, but he was one. To his family, while they
regretted the loss of the other 67, they grieved and grieve the loss of the
one. It is said that “the loss of a loved one turns our life upside down. Our
world as we knew it has changed and those changes require that we in turn
adjust to a new ‘normal.’”
Perhaps it is also true
that one who lives in memory is never really “lost,” but is forever “saved.”
That’s the Mission of SMORT/FAC; Though many are “lost,” all are
saved. It was a great honor to have had a small part in saving Johnny Butler.
|
|
What did we learn AT THE FAC? What did we learn today? We learned that victims’ families must be
identified quickly and given access to information and services that are
victim sensitive and easily accessible. We learned that there is a strong
need for continuous flow of information delivered through regularly scheduled
family briefings and a pro active approach to family issues and requests. We
learned that consistent and equitable support to all victim family groups is
a challenge, but it is important.
Finally, we learned that
the FAC, the “One stop” support center approach, was efficient, provided a
safe haven for families, and helped facilitate the victim identification
process.
Does this sound like a
mission you feel called to accept, a challenge you’d like to take, a set of
memories you’d like to create . . . and share, then . . .
|
|
The FAC wants you! The FAC wants you! You can be a volunteer; I know you can do it. Heck,
if I can run the thing then anybody ought to be able just to take a part in
it. To quote the great philosopher,
“Snoop Dog,” “here’s how you order. . .” Go to:
VOLUNTEER REGISTRATION. Just follow the directions.
•“Unit type” dropdown, click “SMORT”
•“Choose Unit” dropdown, click
–FAC Care Assistant, or
–FAC Data entry-Admin, or
–FAC Interviewer
|
|
|
The end.
|
|
