Disaster Mortuary Services

Background

Among the consequences of disaster is loss of human life. In fact, elevated levels of mortality define the declaration of a public health emergency in much of the world for a number of reasons: (a) the burgeoning world population; (b) the migration to hazard-prone areas such as coastal and seismic zones; (c) the encroachment of humans on zoonotic disease (diseases that can be transmitted from other vertebrate animals to humans) reservoirs; (d) the increasing risk of severe pandemic influenza; and (e) the emergence, following the end of the Cold War, of terrorism combined with ready availability of weapons of mass destruction, which together increase the risk of large-scale fatality incidents. A trend toward an increase in high-mortality natural hazards events is already evident. Between 2000 and 2008, the number of occurrences of disaster incidents involving more than 1,000 deaths increased more than 50% over the entire decade of the 1990s.

Death is a significant vital event associated with strong and distinctive cultural practices that assist the living to cope with the loss of loved ones. The manner of disposing of human remains (for example burial or cremation), the specific rituals surrounding preparation of the body, the timing of this process, and the specific social events associated with the mourning or grieving process vary dramatically within and across societies often shaped by religious and ethnic group membership.

At the same time, disasters often disrupt society's capacity to care for its dead. For the living, the most important aspect of mortuary operations is to identify remains and if possible return these to families. In the extreme case, such as the recent Haitian earthquake, most of the dead were interred in mass graves unceremoniously. The bodies, if not retrieved by loved ones from the place of death, were transported in collection trucks to mass graves more than walking distance from Port au Prince where the majority of deaths occurred. On the other hand, good lessons for fatality management emerged from Thailand's handling of fatalities resulting from the Indian Ocean Tsunami of 2004, where innovation and flexibility resulted in a high level of identification and return of remains to families. An understanding of the process and determinants of successful fatality management can reduce the trauma experienced by the living. Also important is the need to care for mortuary operations workers, who are at increased risk of secondary trauma.

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