069. London Mass Fatality Plan Main Body

LONDON MASS FATALITY PLAN

March 2007

Version 2

PROLOGUE Dealing with the consequences of mass fatality incidents requires the dedication of numerous agencies. These agencies are committed to ensuring that the deceased and the bereaved receive sensitive and dignified treatment, in accordance with the ideals projected in the quotes below:

“Show me the manner in which a nation or community cares for its dead and I will measure with mathematical exactness the tender sympathies of its people, their respect for the laws of the land and their loyalty to high ideals.” (Gladstone, William, 1871)

“All persons involved with the bereaved will be mindful of the following recommendations: • • • •

Provision of honest and accurate information at all times and at every stage Respect for the deceased and the bereaved A sympathetic and caring approach throughout The avoidance of mistaken identification.” (Clarke, Lord Justice, 2001, para 34:1)

“The care with which our dead are treated is a mark of how civilised a society we are. Much goes on for understandable reasons behind closed doors. For this reason there is a special responsibility placed on those entrusted with this work and the authorities that supervise it to ensure that the bodies of the dead are treated with the utmost care and respect. That is what bereaved and loved ones are entitled to expect and what society at large demands.” (Haddon-Cave, Charles, 2000) Representing the Marchioness Action Group

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London Mass Fatality Plan Version 2

Acknowledgements

ACKNOWLEDGEMENTS The London Mass Fatality Plan has been made possible through the efforts of the London Resilience Partnership. The London Resilience Team is especially grateful to the belowlisted organisations for their advice and assistance, without which this document would not have been possible: Association of Chief Police Officers (ACPO) ACPO Major Disaster Advisory Team (MDAT) British Transport Police (BTP) Cabinet Office - Emergency Planning College City of London Police (CoLP) De Boer Environment Agency (EA) Health & Safety Executive (HSE) Health Protection Agency (HPA) HM Coroners in London and the Home Counties HM Coroner to the Royal Household Home Office Mass Fatalities Team Home Office CBRN Team Human Tissue Authority (HTA) Interpol Local Authorities in London and the Home Counties London Mass Fatality Working Group Metropolitan Police Service (MPS) Military – London District National Health Service (NHS) Royal College of Pathologists Society and College of Radiographers Thames Water and all partner agencies not so far mentioned but represented on the London Regional Resilience Forum.

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Executive Summary

EXECUTIVE SUMMARY Focus

Reference

Activation of the Plan:

Section 2.1

The London Mass Fatality Plan may be invoked when an incident occurs in London which is likely to overwhelm existing procedures for managing fatalities. The plan may also be activated in response to an incident overseas which calls for the identification and repatriation of large numbers of UK nationals. Activation Cascade: On recognising the need for the London Mass Fatality Plan the police or relevant Local Authority(s) will notify the Coroner and contact the London Resilience Team (LRT). The LRT contact the relevant Coroner(s) and other personnel necessary to make-up the Mass Fatality Co-ordination Group.

Section 2.3 Diagram 2.1

The Mass Fatality Co-ordination Group: The Mass Fatality Co-ordination Group, as the name suggests, coordinates the implementation of the plan and will:

Section 2.16

identify – by reference to section 5 – the most appropriate level of implementation of this plan to be called in response to the nature, Section 5 scale, and complexity of the incident i.e. 1. Local: whereby it is possible to utilise existing mortuary infrastructure with only minor enhancement or modification 2. Regional: the nature and/or extent of the incident calls for the use of a Designated Disaster Mortuary within the existing mortuary infrastructure of London 3. National: the demands of the incident have exceeded local and regional capability and assistance is requested from the Home Office in the guise of the National Emergency Mortuary Arrangements (NEMA) (see Appendix B) identify – by reference to section 5 of this plan – the most appropriate form of disaster mortuary to be used in the response to the nature, scale, and complexity of the incident identify – by reference to Appendices A & B of this plan – the most appropriate location for the establishment of the mortuary (dependent on the required tier of response) manage any applications made in respect of the National Emergency Mortuary Arrangements (NEMA) oversee and the supply and construction of the NEMA in relation to operational requirements and contractual timelines

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Section 5.7 Appendix A Section 5.11 Appendix B

Section 5

Appendix A Appendix B

London Mass Fatality Plan Version 2

Executive Summary

act as a liaison and co-ordination forum in respect of: o

victim recovery issues (with particular focus on those issues affecting the reception of deceased victims within the mortuary)

o

identification processes within the mortuary (and by associated support services)

o

Family Liaison issues relative to the processes within the mortuary

o

financial issues

o

the work within the mortuary (through regular liaison with the Mortuary Management Team)

The Mortuary Management Team: Section 5 The principle responsibilities of the Mortuary Management Team are focused on the effective operation of the mortuary (regardless of its nature or type). The responsibilities of this team thus include: overall supervision of mortuary procedures constant assessment of the workings of the mortuary to identify and address any problems the day-to-day operational management of the mortuary the co-ordination of supplies, equipment, services and staff the briefing to family members regarding viewing arrangements (to be arranged via the Family Liaison Co-ordinator) liaison with the police Media Liaison Officer, government departments and press offices, with regard to the progress of the identification process and other relevant issues (controlled by the Senior Identification Manager) the recording of any information which may be relevant for the purpose of any subsequent debriefing (see section 18)

Mortuary Procedures: The mortuary procedures produced in this plan reflect those tried and tested methods approved by ACPO and the police Major Disaster Advisory Team (MDAT).

Section 6

Mortuary Equipment: Details of national mortuary stockpiles and their locations are contained in the National Emergency Mortuary Arrangements.

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Appendix B

London Mass Fatality Plan Version 2

Table of Contents

CONTENTS SECTION 1 – OVERVIEW

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Introduction ............................................................................................................. 10 Command and Control ............................................................................................ 11 Audience ................................................................................................................. 11 Scope of the Plan.................................................................................................... 11 Tiers of Implementation........................................................................................... 12 Purpose................................................................................................................... 13 Overarching Principles ............................................................................................ 13 Reviewing the Plan ................................................................................................. 14 Security Classification ............................................................................................. 14 SECTION 2 – ACTIVATION AND MANAGEMENT OF THE PLAN

15

Activation of the London Mass Fatality Plan ........................................................... 15 Activation Cascade ................................................................................................. 15 ‘Presiding’ or ‘Incident Coroner’ .............................................................................. 15 ‘Lead Coroner’ Principle.......................................................................................... 15 ‘Lead Local Authority’ Principle ............................................................................... 16 The Mass Fatality Co-ordination Group .................................................................. 17 SECTION 3 – ROLES AND RESPONSIBILITIES OF ORGANISATIONS IN THE MASS FATALITY CO-ORDINATION GROUP

20

HM Coroner............................................................................................................. 20 Supervising Forensic Pathologist............................................................................ 21 The Local Authority ................................................................................................. 21 The Police Service .................................................................................................. 23 The London Resilience Team ................................................................................. 25 SECTION 4 – DISASTER VICTIM IDENTIFICATION

26

Reasons for Identification ....................................................................................... 26 The Identification Commission ................................................................................ 26 The Inquest ............................................................................................................. 29 SECTION 5 – THE MORTUARY

30

Purpose ................................................................................................................... 30 The Mortuary and Implementation of this Plan ....................................................... 30 Local............................................................................................................ 30 Regional (Designated Disaster Mortuary) ................................................... 31 National (National Emergency Mortuary Arrangements)............................. 31 Disaster Mortuary.................................................................................................... 31 The Single Mortuary Principle ................................................................................. 31 Unsuitable Facilities ................................................................................................ 32 Holding Audit Area .................................................................................................. 33 Local Authority Mutual Aid ...................................................................................... 33 The Mortuary Management Team........................................................................... 33 Facilities at the Mortuary ......................................................................................... 34 Catering................................................................................................................... 35 Office and Technical Equipment ............................................................................. 35 Waste Disposal ....................................................................................................... 36 Security ................................................................................................................... 36

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SECTION 6 – MORTUARY PROCEDURES

37

Arrival and Registration........................................................................................... 37 Storage.................................................................................................................... 37 External Examination and Photography .................................................................. 38 Swabbing, Cleaning and Photographing the Deceased.......................................... 39 Radiography............................................................................................................ 39 Oral Radiography .................................................................................................... 40 Fingerprints ............................................................................................................. 40 DeoxyriboNucleic Acid (DNA) ................................................................................. 40 Taking of Samples and Removal of Human Remains............................................. 41 Fluoroscopy............................................................................................................. 41 Odontology.............................................................................................................. 41 Anthropology ........................................................................................................... 41 Re-bagging.............................................................................................................. 42 Embalming ............................................................................................................. 42 Release of the Deceased to the Relatives .............................................................. 42 Unclaimed Deceased Victims ................................................................................. 42 Deceased Victims to be Repatriated Abroad .......................................................... 43 The National Body Identification Number................................................................ 43 Property................................................................................................................... 43 Disposal of Personal Property................................................................................. 43 Evidence ................................................................................................................. 43 Evidence of Terrorist Incidents................................................................................ 44 Evidence (Non-Medical).......................................................................................... 44 Medical Evidence .................................................................................................... 44 Storage of Evidence................................................................................................ 44 Deceased Victim Documentation: ACPO Victim Label Booklet .............................. 44 Deceased Victim Documentation: Interpol Disaster Victim Identification Booklet ... 45 Deceased Victim Documentation: Victim Profile Check List ................................... 45 Deceased Victim Documentation: Overview of Use................................................ 45 Deceased Victim Documentation: Options.............................................................. 46 Evidential Disclosure............................................................................................... 46 Confidentiality Considerations................................................................................. 46 Non-Family Visits to the Mortuary ........................................................................... 47 SECTION 7 – FAMILY VIEWING

48

Family Viewing Area ............................................................................................... 48 Environmental Conditions of the Family Viewing Area............................................ 48 Religious Needs Specific to the Viewing Process ................................................... 48 Ritual Hand Washing .............................................................................................. 49 Additional Requirements ......................................................................................... 50 Medical Aid.............................................................................................................. 50 SECTION 8 – RELIGIOUS AND CULTURAL ISSUES

51

Buddhist .................................................................................................................. 51 Chinese (Confucianism, Taoism, Astrology and Christianity) ................................. 51 Christians ................................................................................................................ 51 Christian Scientists.................................................................................................. 51 Church of Jesus Christ of Latter Day Saints (Mormons) ......................................... 51 Hindus ..................................................................................................................... 51 Humanist ................................................................................................................. 52 Jain.......................................................................................................................... 52 Jehovah Witness..................................................................................................... 52

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Jews ........................................................................................................................ 52 Muslim..................................................................................................................... 53 Sikh ......................................................................................................................... 53 SECTION 9 – ROLES AND RESPONSIBILITIES OF ORGANISATIONS

55

The London Resilience Team ................................................................................. 55 The Local Authority ................................................................................................. 55 The Coroners Officer............................................................................................... 55 Mortuary Professions .............................................................................................. 56 The Police ............................................................................................................... 57 Mortuary Resources Manager................................................................................. 63 The Salvation Army................................................................................................. 63 National Health Service........................................................................................... 64 Human Tissue Authority.......................................................................................... 64 Health and Safety Executive ................................................................................... 64 Military..................................................................................................................... 64 Private Sector and Others ....................................................................................... 65 SECTION 10 – HEALTH AND SAFETY

66

Fire Safety............................................................................................................... 66 Radiation Safety...................................................................................................... 66 First Aid ................................................................................................................... 66 SECTION 11 – WELFARE

68

Police Family Liaison Officers ................................................................................. 69 Religious and Cultural Issues.................................................................................. 70 The Survivor Reception Centre ............................................................................... 70 Family and Friends Reception Centres ................................................................... 70 Humanitarian Assistance Centre............................................................................. 71 The Staff Welfare .................................................................................................... 71 SECTION 12 – COMMUNICATIONS AND MEDIA POLICY

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SECTION 13 – SITE CLEARANCE

73

Rescue and Recovery ............................................................................................. 73 Recovering Deceased Victims ................................................................................ 73 Holding Audit Area .................................................................................................. 74 Site Preservation (Investigation) ............................................................................. 74 Site Stabilisation Stage ........................................................................................... 74 Site Clearance Stage .............................................................................................. 75 Transport to the Mortuary........................................................................................ 75 SECTION 14 – CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR (CBRN)

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SECTION 15 – INTERNATIONAL DIMENSION

77

Interpol .................................................................................................................... 77 Foreign and Commonwealth Office......................................................................... 77 Death Certification................................................................................................... 77 SECTION 16 – DECOMMISSIONING AND CLOSURE

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SECTION 17 – GUIDANCE ON DEALING WITH COSTS ASSOCIATED WITH AN EMERGENCY MORTUARY

79

Introduction ............................................................................................................. 79 Types of Costs Likely To Be Incurred ..................................................................... 79 Responsibilities for Payment and Recovery of Costs ............................................. 79 Authorisation of Expenditure ................................................................................... 80 Recoverability of Costs ........................................................................................... 80 Summary................................................................................................................. 81 SECTION 18 – DEBRIEFING

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THE LONDON MASS FATALITY PLAN

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Section 1

SECTION 1 - OVERVIEW INTRODUCTION 1.1

The London Mass Fatality Plan (LMFP) has been produced by the London Resilience Team (LRT) under the auspices of the London Mass Fatality Working Group (LMFWG) to the London Regional Resilience Forum (LRRF). This plan was agreed by the London Regional Resilience Forum (LRRF) in January 2007.

1.2

The plan is primarily designed to supplement existing multi-agency emergency preparedness arrangements in London. It is focused on facilitating the response to a ‘sudden impact’ event or ‘emergency’ (see paragraph 1.17) which involves mass fatality. It may not, however, be entirely appropriate for use in the response to all ‘rising tide’ incidents (see paragraph 1.18). Due to the nature of the challenges they represent, such incidents may be the subject of separate plans already in existence. Nonetheless, consideration may be given to the implementation of distinct elements of this plan in support of other arrangements where it is felt to be appropriate e.g. the deployment of storage elements of the Emergency Mortuary.

1.3

An emergency is defined by the Civil Contingencies Act, 2004 as: ‘an event or situation which threatens serious damage to human welfare in a place in the UK; an event or situation which threatens serious damage to the environment of a place in the UK; or, war, or terrorism, which threatens serious damage to the security of the UK.’ Additionally, to constitute an emergency, an event or situation must also pose a considerable test for an organisation’s ability to perform its functions.

1.4

This plan is designed to negate or mitigate the possibility that the magnitude and complexity of the incident or emergency would overwhelm the emergency services and those other agencies involved in the response.

1.5

Since its inception in June 2004, the plan has been successfully implemented to handle victims of the Asian Tsunami in 2004 and during the operational response to the bombings of London in July 2005. The plan has been updated as a consequence of lessons learnt through those deployments and to interact with and complement the National Emergency Mortuary Arrangements (NEMA) introduced by the Home Office in June 2006.

1.6

Where appropriate it is important that this regional response plan is read in conjunction with existing emergency procedures and guidance contained in: a) the National Emergency Mortuary Arrangements (NEMA) - ‘Supplementing the Local Response’ - Home Office, 2006 (see Appendix B) b) the London Emergency Services Liaison Panel (LESLP) Emergency Procedures Manual - Version 6 - July 2004 c) ‘Emergency Preparedness’ - Home Office 2005 d) ‘Guidance on Dealing with Fatalities in Emergencies’ - Home Office / Cabinet Office, 2004 e) the Association of Chief Police Officers (ACPO) Emergency Procedures Manual – ACPO 2002 f)

the London Strategic Emergency Plan - London Resilience Team, 2005

g) the London Command and Control Protocol - London Resilience Team, 2006 h) the London Recovery Management Protocol - London Resilience Team, 2006

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i)

the London Humanitarian Assistance Centre Plan - London Resilience Team, 2006

j)

the London Site Clearance Plan - London Resilience Team, 2003 1

k) The Needs of Faith Communities in Major Emergencies: Some Guidelines – Home Office, 2005. COMMAND AND CONTROL 1.7

Emergency response is based on the emergency services’ system of Gold, Silver and Bronze command. A brief explanation of the command framework is offered in the following text.

1.8

Strategic Level – ‘Gold’ - The Gold level is responsible for formulating strategy and commanding resources but delegates all tactical decisions to Silver.

1.9

Tactical Level – ‘Silver’ - The purpose of the tactical level is to ensure that the actions taken by the operational level are co-ordinated, coherent and integrated in order to achieve maximum effectiveness and efficiency.

1.10

Operational Level – ‘Bronze’ - The level at which the management of immediate practical work is undertaken at site(s) of the emergency or other affected areas.

AUDIENCE 1.11

This document is intended for tactical (SILVER) and operational (BRONZE) representatives of all agencies within the London Resilience Partnership who would have a role to play in the management of large-scale human fatality following an incident or emergency in London.

1.12

Strategic (GOLD) representatives should refer to London’s Generic Regional Response Plan (GRRP) currently referred to as the London Strategic Emergency Plan (SEP).

SCOPE OF THE PLAN 1.13

The London Mass Fatality Plan has been produced in response to the requirements of the UK Capabilities Programme and, in particular, the programme’s stated planning aim which is ‘to ensure that a robust infrastructure of response is in place to deal rapidly, effectively and flexibly with the consequences of civil devastation and widespread disaster inflicted as a result of conventional or non-conventional disruptive activity.’

1.14

The plan is designed to provide tactical options and guidance to all agencies responding to an incident involving mass fatality. In addition, it provides detailed information that is designed to assist in the administration of a broad range of operational matters allied to the management of the deceased.

1.15

An incident such as that mentioned in paragraph 1.14 may be referred to as a ‘Mass Fatality Incident’. A ‘Mass Fatality Incident’ is any incident in which the number of fatalities is greater than normal local arrangements can manage.

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Under review and development.

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Section 1

1.16

Thus, the scale of any incident to which this plan may be applied will be such that normal operations are not possible. Such incidents may include both ‘Sudden Impact’ and ‘Emerging’/’Rising Tide’ events.

1.17

Sudden Impact events – Immediate impact ‘emergency’ events or situations are those that occur with little or no prior warning. The effects are usually felt right away and include: Accidental – transport, public place incidents and collapse of structures Natural – floods and storms Terrorism – explosions, fire and physical attack Hazardous – Chemical, Biological, Radiological & Nuclear (CBRN) 2 .

1.18

Emerging or ‘Rising Tide’ incidents – As the name suggests, these incidents provide some degree of warning prior to their impact and include: Outbreaks – epidemics, pandemics Extreme weather conditions – heat, cold.

1.19

Both types of event may be considered to be a ‘Major Incident’ and may fall within the scope of this plan. It should be noted, however, that due to the nature of the challenges represented by ‘rising tide’ incidents, such incidents may be the subject of separate plans already in existence. Nonetheless, consideration may be given to the implantation of distinct elements of this plan in support of other arrangement where it is felt to be appropriate e.g. the deployment of storage elements of the Emergency Mortuary (see also paragraph 1.2). The London Emergency Services Liaison Panel (LESLP) Major Incident Procedure Manual defines the criteria to be used by the emergency services for declaring a ‘Major Incident’.

TIERS OF IMPLEMENTATION 1.20

Depending on the scale and nature of the relevant incident there may be a requirement for this plan to be implemented on one of three possible levels: i. Local: whereby it is possible to utilise existing mortuary infrastructure with only minor enhancement or modification ii. Regional: the nature and/or extent of the incident calls for the use of a Designated Disaster Mortuary within the existing mortuary infrastructure of London (see Appendix A) iii. National: the demands of the incident have exceeded local and regional capability and assistance is requested from the Home Office in the guise of the National Emergency Mortuary Arrangements (NEMA) (see Appendix B).

1.21

For the purposes of this plan each of London’s eight Coroners has identified a designated mortuary within the area of their jurisdiction (see Appendix A).

1.22

When implementing this plan it should be borne in mind that any one event could involve a mixture of features. The response may need, therefore, to address a single event that impacts over a wide area or, alternatively, several events that occur simultaneously in any number of locations.

2

Subject to current national planning projects.

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Section 1

PURPOSE 1.23

Generally, the London Mass Fatality Plan (LMFP) supplements existing Emergency Procedures which provide for an integrated emergency response to an incident in London. The plan provides additional options for dealing with incidents involving large numbers of human fatalities. It may also be used to cater for the response to an incident overseas which calls for the identification and repatriation of large numbers of UK nationals.

1.24

Specifically, the plan details arrangements for the provision of suitable mortuary facilities as well as offering advice and guidance aimed at facilitating: an appreciation of the definition and purpose of available mortuary types effective coronial management structures effective co-ordination of the local authority lead an understanding of the roles and responsibilities of relevant organisations and key individual roles therein successful management of the mortuary and the procedures therein an understanding of the structures that exist to assist in the identification of disaster victims an appreciation of religious and cultural issues relative to the management of the deceased insight into the international dimensions of mass fatality incidents knowledge of property and evidence management procedures an awareness of complementary plans and protocols available for use by all relevant agencies.

OVERARCHING PRINCIPLES 1.25

In meeting these aims it is important to recognise and support the principles to emerge from the Public Inquiry into the Identification of Victims following Transport Accidents in March 2001. Generally referred to as Lord Justice Clarke’s recommendations (of which they form a part), there are four key principles which should underpin any mass fatality plan. They are: the provision of honest and, as far as possible, accurate information at all times and at every stage respect for the deceased and the bereaved a sympathetic and caring approach throughout; and the avoidance of mistaken identity.

1.26

In addition, the response provided will need to: prioritise care for the living over the management of the deceased, and be mindful of the needs and concerns of the bereaved.

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Section 1

REVIEWING THE PLAN 1.27

In developing this plan the London Resilience Team (LRT) made wide use of learning emanating from post-incident debriefs, public inquiries, associated reports and relevant exercises. The content of this plan has been designed to reflect known best practice from throughout the world.

1.28

The LRT is conscious, however, that things move on and is therefore committed to the continual review and improvement of the plan. As such this plan must remain an evolving document. In practice, this means that the LRT will actively monitor the content of the plan against contemporary good practice and issue important amendments as required.

1.29

The plan has been designed in the format of a loose-leaf four-ring binder to facilitate the inclusion of any such amendments by you, the user. In addition to this ongoing review process the LRT will formally re-examine the plan for accuracy and bearing not later than every two years from the date of last publication (where practicable).

SECURITY CLASSIFICATION 1.30

The main part of this plan is unrestricted and may be shared with relevant interested parties. Some appendices, however, are marked as ‘Restricted’ and should, therefore, not be released to agencies outside of the London Resilience Partnership without the authority of the London Resilience Team.

1.31

The London Resilience Team can be contacted on telephone: 020 7217 3666 (24hrs).

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Section 2

SECTION 2 – ACTIVATION AND MANAGEMENT OF THE PLAN ACTIVATION OF THE LONDON MASS FATALITY PLAN 2.1

The London Mass Fatality Plan, or part(s) thereof, may be invoked when an incident occurs in London which is likely to overwhelm existing procedures for managing fatalities. The plan, or any component part, may also be activated in response to an incident overseas which calls for the identification and repatriation of large numbers of UK nationals.

2.2

Regardless of its nature, it is generally accepted that either the emergency services or appropriately placed London Local Authority will be the first of the agencies to be alerted to an incident requiring the implementation of the plan.

ACTIVATION CASCADE 2.3

On recognising the need for the London Mass Fatality Plan the police or relevant Local Authority(s) will notify the Coroner and contact the London Resilience Team (LRT). The LRT will then contact the relevant Coroner(s) and other personnel necessary to make-up the Mass Fatality Co-ordination Group (see section 2.16 for further details). This process is demonstrated by the model that follows:

Diagram 2.1: Activation cascade Police or LA to notify the Coroner and inform the LRT Duty Director (via the LRT Duty Officer) Tel: 020 7217 3666 (24/7 answer-machine which gives the number of the on call LRT Duty Officer)

HM Coroner invokes the London Mass Fatality Plan

LRT contacts HM Coroner to seek authority to call out the London Mass Fatality Co-ordination Group

‘PRESIDING’ OR ‘INCIDENT CORONER’ 2.4

The plan may be activated by any HM Coroner in London. In doing so that Coroner accepts the responsibilities of the presiding or ‘Incident Coroner’. The remit of this role may be influenced by the ‘Lead Coroner’ Principle outlined below.

‘LEAD CORONER’ PRINCIPLE 2.5

In the event of a multi-sited incident - or one which transcends coronial jurisdictions it may be considered appropriate for the relevant Coroners to agree which of their number will preside in the position of ‘Lead Coroner’. The Lead Coroner may then act on behalf of all the Coroners concerned in the incident.

2.6

Once known, the Incident or Lead Coroner will convene and chair the Mass Fatality Co-ordination Group (see paragraph 2.16 below).

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2.7

Section 2

It may be possible for an individual other then the Incident or Lead Coroner to Chair the group. The identity of the Chair in such circumstances must be agreed by both the Coroner and Gold.

‘LEAD LOCAL AUTHORITY’ PRINCIPLE 2.8

The Lead Local Authority Principle provides a framework for the management of chosen mortuary facilities which: may be remote from the site(s) of any incident, and is within the borough boundaries of a local authority other than that (or those) directly affected by the incident(s).

2.9

The principle can be applied in relation to three separate scenarios within the remit of this plan: the use of designated mortuaries the use of emergency mortuaries; and the related application of the Lead Coroner Principle. These scenarios are described below.

2.10

The Use of Designated Mortuaries (see section 5.7): in the event of a chosen ‘designated mortuary’ being outside the borough boundary of the local authority directly affected by an incident (Local Authority ‘A’): the local authority in whose area the mortuary is located (Local Authority ‘B’) will staff, equip and manage the facility on behalf of the authority affected by the incident (Local Authority ‘A’); but the local authority in whose borough boundary the incident took place (Local Authority ‘A’) will be responsible for all reasonable costs incurred in respect of running the mortuary for this purpose.

2.11

The Use of Emergency Mortuaries (see section 5.11): in the event of an activation of the National Emergency Mortuary Arrangements (NEMA) it is possible that the site chosen for the emergency mortuary (a mortuary comprising a temporary demountable structure) will lie outside the borough boundary of the local authority directly affected by an incident (Local Authority ‘A’).

2.12

In such circumstances the emergency mortuary may be staffed, equipped and managed by either local authority (‘A’ or ‘B’ mentioned above). The ‘Lead’ Local Authority, however, will always be the local authority directly affected by an incident (Local Authority ‘A’) regardless of which authority actually manages the mortuary.

2.13

The decision as to which authority manages the mortuary should be the subject of early discussion between the local authorities concerned. In reaching this decision, due regard should be taken of the Coroners view in relation to those aspects of the Lead Coroner Principle mentioned below.

2.14

Lead Coroner Principle: by reference to paragraph 2.5 above, it can be seen that in the event of a multi-sited incident - or one which transcends coronial jurisdictions - it may be considered appropriate for the relevant Coroners to agree which of their number will preside in the position of ‘Lead Coroner’. In such circumstances, it may be felt appropriate for the choice of Lead Local Authority to reflect the day-to-day partnerships between a Local Authority and associated Coroner.

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2.15

Section 2

Each Local Authority affected by an incident may either choose to sit on the Mass Fatality Co-ordinating Group or be represented by the Lead Local Authority.

THE MASS FATALITY CO-ORDINATION GROUP 2.16

Purpose: The Mass Fatality Co-ordination Group, as the name suggests, coordinates the implementation of the plan and will: identify – by reference to section 5 – the most appropriate level of implementation of this plan relative to the nature, scale, and complexity of the incident i.e. o

Local: whereby it is possible to utilise existing mortuary infrastructure with only minor enhancement or modification

o

Regional: the nature and/or extent of the incident calls for the use of a Designated Disaster Mortuary within the existing mortuary infrastructure of London (see Appendix A)

o

National: the demands of the incident have exceeded local and regional capability and assistance is requested from the Home Office in the guise of the National Emergency Mortuary Arrangements (NEMA) (see Appendix B)

identify – by reference to section 5 of this plan – the most appropriate form of disaster mortuary to be used in the response to the nature, scale, and complexity of the incident identify – by reference to Appendices A & B of this plan – the most appropriate location for the establishment of the mortuary (dependent on the required tier of response) manage any applications made in respect of the National Emergency Mortuary Arrangements (NEMA) oversee and the supply and construction of the NEMA in relation to operational requirements and contractual timelines act as a liaison and co-ordination forum in respect of:

2.17

o

victim recovery issues (with particular focus on those issues affecting the reception of deceased victims within the mortuary)

o

identification processes within the mortuary (and by associated support services)

o

Family Liaison issues relative to the processes within the mortuary

o

financial issues

o

the work within the mortuary (through regular liaison with the Mortuary Management Team) (see section 5.29)

Core Membership: The Mass Fatality Co-ordination Group’s core membership* comprises the following individuals or their chosen deputy: the presiding Incident or Lead Coroner (Chair) the designated Supervising Forensic Pathologist the Senior Investigating Officer (SIO) (police) the Senior Identification Manager (SIM) (police)

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the Mortuary Facilities Manager (usually appointed by the Local Authority) a strategic representative from the Local or ‘Lead’ Local Authority a representative of the London Resilience Team (LRT)/Government Liaison Team. *For a visual representation of this membership see Diagram 2.2 below.

2.18

Complementary membership: In addition the following individuals and organisations may be considered for membership of the group (as and when appropriate): all other Coroner(s) with jurisdictional responsibility within the confines of the incident footprint (if different to the Incident or Lead Coroner) subject-matter advisors from: o

the police

o

the London Resilience Team

o

the Home Office Mass Fatalities Unit

o

Kellogg Brown and Root (KBR)

o

London District (military)

the Mortuary Operations Manager (police) the Family Liaison Co-ordinator (police) the Welfare Co-ordinator the Family Viewing Co-ordinator the Disposal Co-ordinator the Disaster Site Recovery Manager the Logistics Support Manager the Media Liaison Officer. 2.19

This list is not exhaustive and other members may be subsequently identified as being necessary to the purpose of the MFCG. Beyond the core membership, it is not intended that members listed here will be required to attend all meetings of the group but may be called on to attend as and when required.

2.20

Whilst it may not possible for every member of the group to be present at each relevant meeting, their advice should be sought before a decision is made on the placement of any disaster mortuary facilities.

2.21

Administrative support for the Mass Fatality Co-ordination Group will be provided by the relevant Local Authority.

2.22

A written record must be made of all decisions made by the Mass Fatality Coordination Group. If practical all meetings will be minuted.

2.23

The roles performed by both the organisations and individuals concerned in the group are illustrated at Diagram 2.2 on the page that follows.

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Diagram 2.2 - Mass Fatality Co-ordination Group - Core Membership

HM Coroner

Administration Support (Local Authority/LRT)

Chair Operation Support * Casualty Bureau Manager

Mortuary Facilities Manager

Supervising Forensic Pathologist

(Usually appointed by Local Authority

Family Liaison Coordinator

Victim Recovery Team Leader

Senior Identification Manager

Strategic Local Authority Representative (Local or agreed Lead)

Mortuary Operations Manager

LRT Representative

London Resilience Team Advice/Support Government Liaison Team

* Attendance may be required for update purposes. Other complementary members may attend as required.

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SECTION 3 - ROLES AND RESPONSIBILITIES OF ORGANISATIONS IN THE MASS FATALITY CO-ORDINATION GROUP 3 HM CORONER 3.1

Coroners are independent judicial officers whose appointment and duties are regulated by law. They inquire into certain kinds of death set out in the Coroners Act 1988, s 8(1), namely those which the coroner has reasonable cause to suspect (a) are violent or unnatural, (b) are sudden, of unknown cause, or (c) occur in prison. The death may result from a major disaster and for a particular coroner to have jurisdiction, it does not matter where the death occurred (even outside the UK). Jurisdiction is established as consequence of ‘where the body now is’.

3.2

Only the Coroner can authorise procedures relating to the deceased and human remains in circumstances outlined above. Thus, in the event of a disaster it is only the Coroner who can authorise the moving of deceased victims and/or human remains at or from the associated scene(s).

3.3

In addition, it is only the Coroner who can authorise: a post-mortem examination of a dead person the taking of forensic samples or specimens for analysis the retention of forensic samples or specimens for further investigation, and the release of the deceased and residual human tissue 4 to the bereaved or their agent.

3.4

It may be important to note that in exercising the authorities above the Coroner assumes control and possession of the deceased: at no time does the Coroner take on ownership of the deceased.

3.5

As the Coroner has statutory responsibility for the identification of disaster victims, in London, he or she will: chair the Mass Fatality Co-ordination Group (where appropriate) appoint: o

a Supervising Forensic Pathologist (see paragraph 3.8)

o

all necessary remaining pathologists

o

all necessary Forensic Odontologists (see paragraph 9.23)

o

all necessary Forensic Anthropologists (see paragraph 9.12)

o

all necessary Forensic Archaeologists (see paragraph 9.18)

assign responsibilities to relevant Coroners Officers (see paragraph 9.4) convene and chair an Identification Commission (see paragraph 4.6) in consultation with the Supervising Forensic Pathologist and Senior Identification Manager (SIM) (see paragraph 3.24), determine the identification criteria to be used as well as the extent of any post-mortem examination in the circumstances of the particular incident

3

Including individual and linked roles where appropriate Residual Human Tissue (RHT) and its proper means of disposal will be defined and subject to policies agreed by the Mass Fatality Coordination Group 4

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authorises the type and the taking of DNA samples for identification purposes liaise with the Senior Identification Manager (SIM) and the chosen forensic service provider to: o

ensure that a policy of random sampling of DNA is in place (if appropriate)

o

validate the DNA identification process

in consultation with the Senior Identification Manager (SIM) and the Senior Investigating Officer (SIO), will decide the strategy for recovering the deceased, human remains and residual human tissue from the scene(s) along with the Senior Identification Manager (SIM), liaise with the Family Liaison Co-ordinator to discuss meeting with bereaved families so as to explain relevant forensic and identification processes open, conduct and close all relevant Inquests issue all relevant disposal certificates. 3.6

The Coroner may wish to visit the scene(s) of the incident along with the Supervising Forensic Pathologist.

3.7

In consultation with the membership of the Mass Fatality Co-ordination Group the Coroner will also decide on the appropriate level of mortuary provision to the specific incident i.e. local, regional or national (see section 2.16).

SUPERVISING FORENSIC PATHOLOGIST 3.8

The Supervising Forensic Pathologist works closely alongside the Coroner in determining the extent of any post-mortem examinations which are to be undertaken. In addition, he/she will supervise the authorised post-mortem and identification examination procedures.

3.9

At the behest of the Coroner, the Supervising Forensic Pathologist may appoint other pathologists to work within the mortuary. Whilst these pathologists are so engaged the Supervising Forensic Pathologist will be responsible for their supervision.

3.10

In conjunction with the Mortuary Facilities Manager, the Supervising Forensic Pathologist will arrange for the provision of adequate levels of appropriately skilled staff to fulfil functions within the mortuary.

3.11

Along with the Senior Identification Manager (SIM), the Supervising Forensic Pathologist will liaise with the Family Liaison Co-ordinator in order to discuss meeting with bereaved families with a view to explaining relevant forensic and identification procedures.

THE LOCAL AUTHORITY 3.12

The Local Authority is responsible for establishing and equipping those mortuaries which are required in circumstances to which this plan applies. If so required this duty can be performed by utilising the principles of ‘mutual aid’ (see section 5.26) and/or calling on pan-London arrangements made available through this plan.

3.13

The Local Authority is responsible for alerting social services, the Environment Agency and calling on support from Faith Leaders and the Voluntary Sector to assist in welfare provision for family and friends of the deceased (see also the Multi-Faith Plan).

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3.14

Social Services will liaise with the police Family Liaison Co-ordinator to assess the need for trauma support staff and other tangible support for families and friends who view the deceased and/or need to deal with funeral arrangements.

3.15

The Local Authority will usually appoint and support a Mortuary Facilities Manager (see paragraph 3.18). This appointment may be achieved by utilising the principles of ‘mutual aid’ (see section 5.6).

3.16

The Local Authority within whose area the mortuary is situated (unless otherwise agreed) will assist in matters relating to: the management of all sub-contracted services (unless stated as otherwise in agreements contained within the National Emergency Mortuary Arrangements) public health Health & Safety hazardous waste collection the management of effluent discharges in consultation with the water service utility provider and the Environment Agency refuse collection cleaning and road-sweeping the provision of garden and landscaping services the upkeep and appearance of all public areas within the mortuary.

Mortuary Facilities Manager 3.17

The Mortuary Facilities Manager will be an experienced Mortuary Manager usually appointed by the Local Authority. If pragmatic to do so, the Mortuary Facilities Manager may be appointed by the relevant health authority (or Cribbs Ltd. for the East London area).

3.18

The specific responsibilities of the Mortuary Facilities Manager include: liaison with the Human Tissue Authority (HTA) to arrange for any necessary licensing of the venue (if appropriate) to ensure proper logistical support to all areas of the mortuary facility in conjunction with the Mortuary Operations Manager (see paragraph 3.29) – to oversee all relevant staffing requirements within the mortuary in conjunction with the Mortuary Operations Manager – to ensure appropriate consideration of all staff welfare issues to ensure that a qualified First-Aider is on site and available at all times of operation in conjunction with the Supervising Forensic Pathologist (see section 3.8) - to ensure appropriate consideration and enforcement of all relevant Health and Safety legislation working with the Supervising Forensic Pathologist and the Mortuary Operations Manager - to ensure the application of all appropriate hygiene practices (including wet/dry area discipline)

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to manage the provision, use and stockpiling of Personal Protective Equipment (PPE), stationary, office supplies and mortuary staff refreshments to ensure the proper handling, storage and disposal of clinical waste the supervision of the cleaning of all parts of the mortuary facility to arrange and supervise the decommissioning of the mortuary facility (including ensuring that all necessary cleansing and repairs are undertaken in advance). THE POLICE SERVICE 3.19

The police service is responsible for investigating the incident, tracing missing persons, victim recovery and identification (as and when appropriate).

3.20

The police service accepts responsibility for managing the reception and documentation of the deceased arriving at the mortuary as well as the gathering of physical evidence of both crime and victim identification (Section 6).

3.21

The police will provide for the security of any mortuary site unless other satisfactory arrangements are in place or agreed.

Gold 3.22

The Overall Incident Commander or police ‘Gold’ will chair the Strategic Coordination Group and will appoint both the Senior Investigating Officer (SIO) and the Senior Identification Manager (SIM).

Senior Investigating Officer (SIO) 3.23

The Senior Investigating Officer (SIO) leads the investigation into any relevant criminal activity (including terrorism) or culpability issues.

Senior Identification Manager (SIM) 3.24

The Senior Identification Manager (SIM) acts on behalf of the SIO (and to the satisfaction of the Coroner) in leading the investigation into the identification of the deceased.

3.25

The Senior Identification Manager (SIM) has overall responsibility for all police officers and staff involved in all aspects of the identification process. In order to achieve his/her primary function the SIM will also have overall responsibility for the following aspects of the identification process: Victim Recovery Mortuary Documentation Casualty Bureau Family Liaison.

3.26

The SIM will assist the Coroner in establishing an Identification Commission (see section 4.6). In order to facilitate this process the SIM will work in conjunction with the Coroner and Senior Investigating Officer (see above) to develop an Identification Strategy.

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3.27

The SIM will, in consultation with the Coroner and the Senior Investigating Officer (SIO), develop a Recovery Strategy. This will establish when and how deceased victims and human remains are to be removed from the scene(s) and transported to the mortuary.

3.28

In consultation with both the Coroner and the chosen forensic service provider, will ensure that a policy of random sampling of DNA is in place (if appropriate) to validate the DNA identification process.

Mortuary Operations Manager 3.29

The Mortuary Operations Manager is responsible to the SIM and is responsible for the implementation of this plan relative to: obtaining, seizing and retaining evidence and personal property at the mortuary ensuring continuity of evidence through correct and systematic management (including the deceased, human remains and residual human tissue which has arrived at or been seized at the mortuary) the correct completion of all relevant post-mortem documentation (including its delivery of to the Mortuary Documentation Officer – see section 9.51).

3.30

Further, the Mortuary Operations Manager is responsible for: the direct supervision and support of all police mortuary teams liaison with the Mortuary Facilities Manager to ensure that wet/dry area discipline is adhered to and that health and safety risk assessments are being observed.

3.31

The Mortuary Operations Manager is a member of the Mortuary Management Team (see section 5.28).

Family Liaison Co-ordinator (FLC) 3.32

The Family Liaison Co-ordinator (FLC) is to act on behalf of the SIM relative to: the functions of family liaison the availability and deployment of Family Liaison Officers (FLOs) (especially in complex cases with multiple deployments) the co-ordination of information arising from multiple FLO deployments the skills, knowledge and experience of the FLO team in terms of culture, lifestyle and diversity issues.

3.33

The FLC also acts in support for the Family Liaison Officers by: monitoring workloads maintaining a register of contact details of appropriate organisations/lay people/professional consultants to assist them in their role providing a networking point for FLOs requiring advice from other FLOs who have experience in dealing with particular scenarios acting as a channel for welfare, occupational health, defusing support promoting/facilitating mutual FLO peer group support

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monitoring mandatory attendance at the Welfare/Occupational Health Department acting as an independent channel for FLO debriefing to draw out good practice liaising nationally to share and gather good practice for implementation within his/her own force area. THE LONDON RESILIENCE TEAM 3.34

The Duty Director or a chosen representative will attend all meetings of the Mass Fatality Co-ordination Group in order to: represent the interests of the Government Office for London form a link to the Government Liaison Team at the Strategic Co-ordination Centre act as a conduit between the Mass Fatalities Co-ordination Group and HM Government / Ministers specific to issues concerning the mass fatality process assist in establishing funding agreements between the relevant Local Authority, HM Government and all relevant third parties advise on other relevant LRRF plans that may be pertinent to the aims of the MFCG.

END NOTE 3.35

Details of additional responsibilities of these and all other agencies involved in the plan can be found at Section 9.

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SECTION 4 – DISASTER VICTIM IDENTIFICATION REASONS FOR IDENTIFICATION 4.1

In police terms, Interpol Resolution AGN/65/Res/13 (1996) (see Appendix H) recognises that for legal, religious, cultural and other reasons, human beings have the right not to lose their identity after death, and that the identification of victims is of importance for police investigations.

4.2

Additional calls for the identification of the deceased lie in: a statutory requirement – s. 8 (1) Coroners Act, 1988 (see the Statutory Framework at provided at Appendix I) ethical and humanitarian needs relative to the provision of information to surviving family members fact of death in a particular individual to be reported for official, statistical and legal purposes administrative and ceremonial purposes in respect of burial or cremation the need to provide information regarding any claims for life insurance, contracts, survivors’ pensions and other related financial matters the need to allow the legal process to proceed with a firm knowledge of the identify of the deceased the need to facilitate enquiries into criminal or suspicious deaths the need to issue a death certificate to comply with the resolution of the Interpol Standing Committee on Disaster Victim Identification (see above).

4.3

Disaster Victim Identification (DVI), normally the responsibility of the police, is a difficult and demanding exercise which can only be brought to a successful conclusion if properly planned and which, of necessity, has to involve the active participation of many other agencies. It is, however, only one aspect of dealing with disasters which will always vary considerably in scale and effect.

4.4

The ultimate aim of all Disaster Victim Identification operations must always be to establish the identity, without error, of every victim by comparing and matching accurate ante-mortem (AM) and post-mortem (PM) data.

4.5

The Identification Commission is a group representing all aspects of the DVI process which is set up to consider ante-mortem data and post-mortem data in order to determine the identity of each of the deceased to the satisfaction of the Coroner.

THE IDENTIFICATION COMMISSION 4.6

The Coroner should assume responsibility for establishing an Identification Commission (a term that is in standard use in Interpol countries).

4.7

In general the Coroner should chair the Commission but there may be, however, cases where this is not appropriate. In such cases it should be for the Coroner to decide who should take the chair.

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4.8

The purpose of the Identification Commission is to identify all the deceased and human remains. It directs procedures and scrutinises all evidence relating to identity, so as to enable the Coroner to make decisions regarding their release.

4.9

It is essential that all matters relating to establishing the identity of victims are closely controlled and regularly reviewed. To facilitate this policy the following should be utilised: the position of Senior Identification Manager (SIM) (see section 3.24) the Identification Commission itself the Post-Mortem Team the Ante-Mortem Team.

4.10

Sitting at regular intervals the full Identification Commission will examine each prospective identification against the evidence presented by the Post- and AnteMortem teams until all victims have been identified or enquiries exhausted. The meetings are not intended to replace the usual liaison between the various teams working both within and outside the mortuary.

4.11

The Identification Commission should meet regularly and comprise the following core members: the Coroner the Senior Identification Manager (SIM) or representative the Supervising Forensic Pathologist an Administrative Officer.

4.12

In addition, it may be appropriate to invite assistance from: additional pathologists / forensic pathologists the Odontologist the fingerprint expert(s) the Ante-Mortem Co-ordinator (see section 9.32) the Family Liaison Co-ordinator the Mortuary Documentation Officer the Mortuary Operations Manager (see section 3.29) other specialists as appropriate independent advisor(s).

4.13

The use of identification methods will vary according to the nature of the incident and must be agreed, in the first instance, by the ‘Presiding’ or ‘Incident Coroner’.

4.14

Identification may be classed into three categories in order of importance. Whilst it’s contents are not exhaustive, the list below provides the groupings from which identification evidence may be drawn:

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Primary Factors Fingerprints Odontology DNA X-ray (in certain circumstances) Unique medical identifier. Note: One feature could be regarded as sufficient in isolation but it would be highly desirable to have at least one secondary item to prevent any suggestion of identification evidence being confused. Secondary Factors Distinctive deformity or medical condition Marks, scars and tattoos Blood grouping Physical disease X-ray Jewellery Distinctive clothing Personal effects. Note: A minimum of three such features might normally be required to confirm identity. Assistance Only Clothing Photographic Body location (at the time of recovery) Visual Description Facial Mapping Note: These characteristics are not generally regarded as sufficient in their own right but may support primary or secondary features. Dependent on circumstances, Facial Mapping may sometimes amount to at least a secondary feature. 4.15

Where the deceased are severely disrupted it will be for the Coroner to decide whether any small identified remains amount to a ‘body’ for jurisdictional purposes.

4.16

Whilst the general principle has been that only ‘that part of a body which by itself is inconsistent with life’ can, in law, amount to a body, it is submitted that this is naïve in the context of mass fatalities. It is suggested that where there is clear independent evidence that a death of a particular person(s) has occurred, then any fragmented remains that are identified should be treated as a body.

4.17

A principle function of the Identification Commission is to set criteria by which identification of the deceased is established. On reviewing all the available

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identification evidence, the Coroner will decide whether there is sufficient certainty to allow the release of the deceased. 4.18

Whilst the deceased will normally be released to the next of kin or their agent as soon as identity is certain, the process may be delayed if the deceased are disrupted and fragmented remains are to be separately identified and reunited. In cases such as this, families should be given three options relative to the restoration of their loved one(s): to wait until all remains are recovered and identified to hold a funeral of the remains in their possession but be informed when and if further remains are identified to hold a funeral or dispose of the remains in their possession with no further contact being made.

THE INQUEST 4.19

HM Coroner has a duty to hold an inquest if: there is reason to suspect that someone has died a violent or unnatural death, or has died a sudden death of which the cause is unknown, or has died in prison or in any other place, has died in such circumstances as to require an inquest under any other Act (section 8(1) Coroner’s Act 1988).

4.20

The inquest is usually opened within a few days of the death when evidence is given as to identification, the brief circumstances of the death, and the cause of death. The inquest is then adjourned to allow for any enquires and investigations to be completed.

4.21

Once all the evidence has been obtained, a full inquest hearing is usually held. The purpose of the Inquest is to confirm identity and determine when, where and how the deceased came by their death. However, if there is to be a prosecution for certain offences or there is to be a public inquiry, the inquest will be adjourned and may or may not be resumed.

4.22

At the conclusion of the coroner’s proceedings, the Registrar of Deaths will be notified so that a death certificate can then be issued.

4.23

The Coroner has no automatic power or duty to investigate the deaths of persons who are assumed to have died but whose bodies cannot be found. However, in such circumstances, the Coroner may apply to the Secretary of State for permission to hold an inquest under s.15 Coroners Act 1988.

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SECTION 5 – THE MORTUARY PURPOSE 5.1

The purpose of a mortuary is: to establish identity, through careful examination of the deceased and associated property in order to obtain evidence which can be matched with data obtained by the Ante-Mortem Team and the Casualty Bureau to facilitate the establishment of the precise cause of death through proper examination of the deceased by pathologists to facilitate the collection of evidence of crime: not only in the cause of death but by examination of clothing and other exhibits recovered from the deceased e.g. bomb fragments to allow for the preservation and recording of personal effects of the deceased to provide facilities for the preparation of deceased victims for release to family members by reconstructive techniques where necessary (embalming may be appropriate in some cases - particularly in the case of repatriation overseas).

5.2

The mortuary will play a central part in the collection of evidence. The police will work within the mortuary for documentation purposes and work in close liaison with the Casualty Bureau as well as all Ante Mortem Teams.

THE MORTUARY AND IMPLEMENTATION OF THIS PLAN 5.3

By reference to paragraph 2.16 (reproduced below) it can be seen that the London Mass Fatality Plan can implemented one of three possible levels: Local: whereby it is possible to utilise existing mortuary infrastructure with only minor enhancement or modification Regional: the nature and/or extent of the incident calls for the use of a Designated Disaster Mortuary within the existing mortuary infrastructure of London (see Appendix A) National: the demands of the incident have exceeded local and regional capability and assistance is requested from the Home Office in the guise of the National Emergency Mortuary Arrangements (NEMA) (see Appendix B)

Local: 5.4

As stated above, the implementation of the plan at the local level will utilise those mortuaries already in existence within the infrastructure of London. In such circumstances the relevant Local Authority may provide a Public Mortuary for use as a disaster mortuary.

5.5

This facility may, in fact, be provided by either the Local Authority or the local Health Authority (or Cribbs Ltd. in the East London area). Regardless of its source, however, the mortuary holds the deceased for the purposes of identification, post mortem examination and storage prior to their return to the bereaved.

5.6

Should it be that the demands of an incident exceed the capabilities of the local mortuary the Coroner may decide to invoke the regional tier of the plan by making use of the relevant Designated Disaster Mortuary.

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Regional: Designated Disaster Mortuary 5.7

Once again, by reference to the paragraph above, it can be seen that should the nature and/or extent of the incident call for it, the use of designated, enhanced facilities within the existing mortuary infrastructure of London may be necessary.

5.8

It has been agreed with each of the London Coroners (responsible for nominating a disaster mortuary) and London Local Authority Chief Executives (responsible for providing it) that the most suitable mortuary in each Coroner’s area, be nominated as a single ‘Designated Disaster Mortuary’ (see Appendix A for details).

5.9

In the event of an incident to which this plan refers, HM Coroner will liaise with the local authority responsible for providing the relevant ‘Designated Disaster Mortuary’ in order to ensure that arrangements are in place for it to be used operationally.

5.10

Each ‘Designated Disaster Mortuary’ (see Appendix A) has an agreed maximum capacity but, in the event of this capacity being exceeded, the National Emergency Mortuary Arrangements (see Appendix B) may be appropriate for use.

National: National Emergency Mortuary Arrangements (NEMA) 5.11

Should it be that the demands of an incident exceed the capabilities of the regional plan i.e. the Designated Disaster Mortuary, the Coroner may decide to invoke the national tier of the plan by making a request for an Emergency Mortuary via the National Emergency Mortuary Arrangements (see Appendix B for full details).

5.12

The National Emergency Mortuary Arrangements (NEMA) form the basis of HM Government’s programme of central assistance to supplement existing local and regional plans. The arrangements which can be offered as part of that central assistance package include: a temporary demountable structure(s) acting as an ‘Emergency Mortuary(s)’ stockpiles of general mortuary equipment chilled storage for use at an incident site specialist radiographic equipment; and the UK Disaster Victim Identification Team (UK-DVI).

5.13

Full details of the concept of operation for this national capability programme can be found at Appendix B.

DISASTER MORTUARY 5.14

The phrase ‘disaster mortuary’ should be taken as a generic term loosely describing any mortuary which is being utilised as such in the response to a disaster. The term may, thus, apply to the facilities known as the ‘Designated Disaster Mortuary’ or the ‘Emergency Mortuary’.

THE SINGLE MORTUARY PRINCIPLE 5.15

Deaths at the Scene: All deceased victims and human remains from a disaster scene must be taken to a single mortuary. In the event of a multi-sited incident it may be appropriate to dedicate a single mortuary (or independent access to the mortuary along with associated separate storage) for the deceased from each scene. This requirement is necessary because:

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the nature of the incident could cause a quantity of human remains greater than the sum of victims involved (this would require a single mortuary so as to ensure that all such human remains are gathered in one place for subsequent identification and repatriation) procedures for examining and identifying disrupted deceased victims require a great deal of space the use of multiple mortuaries would increase the burden on the communications system which would already be under great strain during a disaster there will be intense media interest which will require a high degree of security and co-ordination containment of the incident and associated security problems would be made more difficult if more than one mortuary was in use simultaneously the use of multiple mortuaries would require significantly higher staffing levels in terms of the identification team the use of multiple mortuaries would lead to scattering of vital identification information the use of multiple mortuaries may cause unnecessary distress to the bereaved in the event of the need to attend viewings at several different mortuaries the use of a single mortuary minimises the impact on the existing mortuary infrastructure in London allowing for the continuity of business in the capital. 5.16

Deaths Elsewhere: Victims who, as a result of the disaster, die en route to or at the hospital will be moved to the disaster mortuary and managed by that facility’s staff.

UNSUITABLE FACILITIES 5.17

Hospital Mortuaries: The National Health Service (NHS) hospital mortuary caters for persons who die in hospital and has post mortem and storage facilities. As a general principle it is recommended that hospital mortuaries are NOT used as Designated Disaster Mortuaries unless the number of fatalities involved is manageable and well within the capabilities of the particular hospital facility. Hospital mortuaries are not generally suited to use as a disaster mortuary because: the access and egress requirements of large numbers of vehicles carrying the deceased victims to such a mortuary may interfere with the ability of ambulances to access/egress the hospital large numbers of deceased victims arriving at the hospital mortuary might overwhelm the capacity of the facility which might: o

necessitate the use of a second or third mortuary

o

seriously disrupt the routine work of that mortuary for periods of several days or weeks

a hospital mortuary is usually ill-equipped and ill-suited to deal deceased victims from a major disaster which may be disrupted, burnt, or may have undergone decomposition (there may also be many more mutilated human remains than intact deceased victims which would create a need for disproportionately large storage facilities)

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the deceased may need to undergo extensive radiological examinations, and this would be difficult for overstretched hospital radiology departments to bear. 5.18

Non-designated Public Mortuaries: For similar reasons to those stated above it is undesirable to use a non-designated public mortuary as a disaster mortuary but this will depend on the number of deceased victims and on the storage capacity of the relevant public mortuary.

5.19

It should be realised that a major disaster could totally monopolise the facilities of the public mortuary (including the storage and office space) for several months. This would cause severe disruption of the mortuary’s day-to-day operations during the period of the major disaster investigation.

5.20

It may not be practical to move those deceased already in place in a public mortuary in order to accommodate incoming mass fatality victims.

5.21

The physical attributes of many existing mortuaries may affect their ability to deliver evidential continuity and care for the families of the victims.

5.22

In addition, public mortuaries are usually located centrally in urban areas which may pose problems of security, traffic congestion and potential intrusion by the media.

5.23

Private Mortuaries: Private Mortuaries are maintained by the private undertaking sector. Although they may have post mortem facilities they are mainly used for storage of deceased prior to burial or cremation (see, however, paragraph 3.17).

HOLDING AUDIT AREA 5.24

The Holding Audit Area (previously known as the Body Holding Area) is a designated area for containing the deceased victims in one place, at or near to the scene, prior to transportation to the mortuary. This area should not be confused with a mortuary and no post-mortem procedures or examinations will take place at this point. The Holding Audit Area is both designated and managed by the police.

LOCAL AUTHORITY MUTUAL AID 5.25

Each Coroner in London has designated a mortuary to use in response to a mass fatality incident within their jurisdiction (the Designated Disaster Mortuary).

5.26

In addition, the London Resilience Team has brokered a ‘Mutual Aid’ agreement so that in the event of a mortuary being used as part of the ‘local’ tier response (described earlier in this plan), a Designated Disaster Mortuary would supply resources, if need be, to other responding Local Authorities within the same Coroners jurisdictional area.

5.27

This mutual aid agreement was signed off by the London Local Authority Working Group meeting of May 2004.

THE MORTUARY MANAGEMENT TEAM 5.28

The principle responsibilities of the Mortuary Management Team are focused on the effective operation of the mortuary (regardless of its nature or type). The responsibilities of this team thus include: overall supervision of mortuary procedures

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constant assessment of the workings of the mortuary to identify and address any problems the day-to-day operational management of the mortuary the co-ordination of supplies, equipment, services and staff the briefing to family members regarding viewing arrangements (to be arranged via the Family Liaison Co-ordinator) liaison with the police Media Liaison Officer, government departments and press offices, with regard to the progress of the identification process and other relevant issues (controlled by the Senior Identification Manager) the recording of any information which may be relevant for the purpose of any subsequent debriefing (see section 18). 5.29

A written record must be made of all decisions made by the Mortuary Management Team. If practical all meetings will be minuted.

5.30

The Chair of the Mortuary Management Team will decide on the frequency of the teams meetings.

5.31

Membership of the team will include: Senior Identification Manager (or deputy) Mortuary Documentation Officer Mortuary Facilities Manager Mortuary Operations Manager Supervising Forensic Pathologist Coroner’s Officer Ante-Mortem Co-ordinator Resources Manager Health & Safety Co-ordinator (see section 10) Senior Radiographer / Radiation Protection Supervisor specialist advisers (as required).

5.32

Should the Emergency Mortuary be set up it will be advisable for a liaison representative from the designated site to attend Management Team meetings. This will be particularly useful in the initial stages of the process.

5.33

When an Emergency Mortuary is situated on Ministry of Defence property the relevant military Commanding Officer will designate a Liaison Officer to attend the team’s meetings.

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rest area a designated smoking area. 5.35

Operational areas will have heating and air conditioning in place to ensure the optimum temperature relative to working practices.

CATERING 5.36

Catering arrangements will be put in place at the mortuary for the supply of hot food for the staff. If this catering is not provided on a 24 hour basis there will be facilities for staff to store and cook food. If necessary, food lockers should be provided.

5.37

Arrangements will include the provision of an area for staff to safely consume food.

5.38

Under no circumstances will food or drinks be consumed in the wet area of the disaster mortuary.

OFFICE AND TECHNICAL EQUIPMENT 5.39

The Resources Manager, in liaison with the Mortuary Facilities Manager, will take on responsibility for arranging the supply and placement of the following:

Electricity 240-volt mains electricity with sufficient 13 amp sockets will be required in all areas. Portable electric equipment used in the mortuary (such as electric saws) will be used with power-breaking devices. An Emergency Power Supply (EPS) will be made available. It is particularly important that the body storage area and refrigeration for evidence and specimens is kept at a constant temperature. Consideration should be given for such facilities to be alarmed in case the temperature changes to the detriment of effective storage of the deceased/evidence. Water Running water will be required at tables / benches used for: o

washing the deceased

o

Post Mortems examinations

o

organ cutting and examination

o

embalming.

Hot and cold running water will be required in other areas of the mortuary: o

toilets

o

shower and washing facilities

o

catering

o

cleaning.

Waste water will either be tanked and removed from the site or discharged into the local sewerage system as deemed to be appropriate.

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Telecommunications o

telephone and fax lines will be required

o

the use of mobile phones should be discouraged in the mortuary facility as such systems are not secure and can be monitored by the media

o

due to Health and Safety requirements, mobile phones (whether switched on or off) will not be permitted within the wet area of the mortuary.

Surveying & Engineering o

support office accommodation where possible (including structural advice).

IT equipment It will be necessary for a computer link to be made between the disaster mortuary and the HOLMES II Casualty Bureau database. The provision of this service lies with the Metropolitan Police Service. Other IT services will be provided by the local authority or police service as is seen to be appropriate to the surrounding circumstances and needs. 5.40

The Mortuary Resources Manager will also arrange and supply other office equipment and accommodation services which may be required.

WASTE DISPOSAL 5.41

It is important to maintain tight control of the handling, packaging and disposal of clinical waste from the wet area of the mortuary. The Mortuary Facilities Manager will thus appoint a member of the mortuary staff to supervise the disposal of clinical waste.

5.42

Yellow clinical waste containers will be required from the Local Authority. The request should be made by the Mortuary Facilities Manager.

5.43

Appropriate ’sharps’ containers will be required for the disposal of needles, syringes etc.

5.44

Black plastic refuse bags should be used for domestic waste and disposed of separately and in accordance with existing Local Authority policy.

SECURITY 5.45

The Mortuary Management Team will arrange with the police and the Local Authority to supply security at the disaster mortuary site. The Local Authority may use private sector services for certain security tasks such as perimeter patrols. Security personnel supplied by the Local Authority must be licensed by the Security Industry Authority (SIA).

5.46

The Mortuary Operations Manager will be in charge of security arrangements. If the disaster mortuary is on a military site security will be arranged in co-operation with the Military Liaison Officer.

5.47

Consideration should be given for an Air Exclusion Zone to be arranged over the disaster mortuary to discourage attempts at filming the facility from the air.

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SECTION 6 – MORTUARY PROCEDURES NOTE: The following procedures are presented in a linear sequence so as to aid their assimilation by the reader. It is important to note, however, that real life events do not always sustain such a rigid approach. Varying degrees of flexibility may be required, therefore, in the operational application of the process described below. ARRIVAL & REGISTRATION 6.1

Deceased victims and human remains may be recovered from places other than the scene of the incident e.g. hospitals and other mortuaries. All deceased victims, human remains and residual human tissue should be transferred to a single mortuary where the process of identification and examination will take place. On arrival at the mortuary details will be recorded using the Disaster Victim Identification (DVI) forms or the Victim Profile Forms (VPF) as appropriate (see sections 6.82 to 6.97).

6.2

Great care should be taken to ensure there is no cross contamination of forensic evidence in the event of the incident resulting in multiple crime scenes. The methodical recovery of human remains from the disaster site is vital to the mortuary process.

6.3

In the event of the deceased coming to the mortuary from such multiple sites (especially the scenes of terrorist activity) it may be appropriate to arrange for their reception and storage to be aligned to the relevant site i.e. one reception area and one storage area to be provided at a rate of one per site. In such circumstances all effort should be made to prevent commingling of the deceased, human remains or residual human tissue.

6.4

On their arrival body bags must be inspected to ensure that the ACPO Victim Label Booklet accompanies the body bag and its number corresponds with the attendant paperwork received from the scene.

6.5

So as not to interfere with the integrity of evidence, it is imperative that no body bags are opened at this stage unless authorised by the SIO/SIM.

6.6

So as to ensure evidential continuity, the Body Reception Officer (see section 9.35) must complete and manage all relevant documentation in accordance with policy and instructions.

6.7

The Body Reception Officer will ensure that personal property (unless enclosed within the body bag) does not come into the mortuary.

6.8

On their arrival, consideration should be given to examining the deceased by means of a radiological scan. This will ensure that there are no munitions attached to the deceased. A visual search for such munitions should have been made, however, prior to the deceased being removed from the scene.

STORAGE 6.9

Whenever deceased victims or human remains are not undergoing any part of the mortuary process they must be securely stored in the mortuary’s refrigerated storage areas for safeguarding.

6.10

In order to prevent commingling and cross-contamination, the deceased victims must always be stored separately from each other.

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6.11

Refrigerated storage within the mortuary should be constructed or organised into two distinct sections: one section for storage of the deceased prior to a post-mortem and the other for those who have undergone post-mortem procedure. Should the provision of distinct areas not be possible, the same distinction can be made through the use of different coloured body bags or distinctive labelling attached to the bag.

6.12

Every effort must be made for deceased victims and/or human remains to be stored and handled in accordance with all known faith issues (see section 8)

EXTERNAL EXAMINATION & PHOTOGRAPHY (STRIP AND SEARCH) 6.13

As each body bag is opened the deceased and/or human remains should be placed on a mortuary tray.

6.14

If the contents of a body bag are severely disrupted it maybe necessary for the remains to be kept in the original body bag throughout the process of examination / post mortem (see section 6.52 in regard to the re-bagging of the deceased).

6.15

At this stage (before any further work is undertaken) photographs should be taken of the deceased victim, whilst clothed, to show the front, rear and side profiles. The unique body identifier number should be clearly visible in all photographs. A digital photograph should also be taken and attached to the Body File.

6.16

All jewellery, wallets, documents, etc. should then be removed from the deceased and the details recorded on the Disaster Victim Identification (DVI) form or the Victim Profile Forms (VPF) as appropriate (see sections 6.82 to 6.97).

6.17

Close attention should be paid to obtaining detailed descriptions of jewellery or other body adornments (particularly if engraved with an inscription or jewellers mark) as such details can greatly assist in the identification of the deceased.

6.18

All jewellery and other property ascribed to the deceased should be photographed and passed to the Post Mortem Team Exhibits Officer who will place the items into a property bag bearing the body number. The Team Exhibits Officer will complete a property label in respect of each item of property recovered.

6.19

Each item of such property will be given an exhibit number in accordance with the following configuration: Eight (8) figure Body Number / Post Mortem Team Exhibit Officer’s initials / sequential number, e.g.

60012345 / KG / 123 6.20

In addition the Post Mortem Team Exhibits Officer will make an entry describing the property in an Exhibits Register. There will be at least one Exhibit Register per body bag (i.e. an Exhibit Register must not be used for more than one body bag).

6.21

The Post Mortem Team Exhibits Officer will ensure that a self-adhesive identification/barcode sticker from the victim recovery documentation is affixed to every completed property label.

6.22

An additional digitally produced photo must be taken of each item of property and attached to the outside of the sealed property bag so as to save any future need to open and re-seal the bag in order to check it’s contents.

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6.23

If any item of property is damaged or contaminated/bloodstained brief details will be shown on the property label. If the item is wet or damp it may not be appropriate for it to be sealed in a plastic property bag. The Post Mortem Team Exhibits Officer will be responsible for deciding the correct way of sealing and storing such items.

6.24

The deceased victim should be stripped of all clothing and their details (size, colour, make etc.) recorded on the Disaster Victim Identification (DVI) or Victim Profile Form (VPF) as appropriate.

6.25

The clothing and personal effects should be placed into appropriate packaging, labelled with the unique body reference number and sealed.

6.26

The clothing may be stored within the mortuary until the contents are returned to family or destroyed. Clothing should be photographed before final disposal in this way.

6.27

The Post Mortem Team Exhibits Officer will formally hand over all items recovered during examination and post-mortem (along with the relevant Exhibits Register) to the Mortuary Exhibits Officer who will then be responsible for their appropriate storage.

SWABBING, CLEANING AND THE PHOTOGRAPHING THE BODY 6.28

All deceased victims will always need to be washed. It is imperative, however, that before this is done, due consideration should be given to the taking of external body samples/swabs etc. Such swabs and samples will be of particular concern in the case of terrorist offences. The SIO or SIM will advise as to whether such swabs are necessary.

6.29

A purpose of washing the deceased is to expose any distinguishing marks or scars on the body. After washing, therefore, a physical description of such marks and scars will be recorded on the Disaster Victim Identification (DVI) or Victim Profile Form (VPF) as appropriate.

6.30

Once the deceased has been washed, the appropriate documentation should be completed and the deceased should again be photographed showing his/her front and back. Each photograph must clearly show the relevant body number so as to assist with evidential audit trails.

RADIOGRAPHY 6.31

Additional fluoroscopy or radiography of identifying features may be required as determined by the Supervising Forensic Pathologist, Odontologist or Anthropologist. The Association of Forensic Radiographers will be able to facilitate the supply of qualified staff for radiography, either directly or via the UKDVI forensic staff arrangements maintained as part of the National Emergency Mortuary Arrangements (NEMA).

6.32

Traditional radiography is both time-consuming and cumbersome in terms of photographic development. The process requires the presence of dangerous chemicals and component elements on the site of the mortuary. In order to save the need to address the numerous Health and Safety issues brought about by the presence of such materials, digital radiography will be used in the post mortem process.

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6.33

In addition, digital radiography offers benefits in the time savings relative to image development and enhancement (instant) as well as being far easier to disseminate for investigative consultation. Digital (electronic storage media) images can be communicated by email and thus, if so required, be despatched to any destination throughout the world in a matter of seconds. The same distribution of traditional radiography products could take days. This time-saving feature of digital radiography has the potential to afford significant benefits to the speed of any pertinent forensic investigation.

6.34

Radiography should be used to establish physical features not visible to the naked eye such as medical plates, physical irregularities, healed fractures and unique bone structure. All such discoverable features have the potential to assist with the identification process.

6.35

Radiography can protect mortuary staff by exposing dangerous items concealed within the deceased (munitions, shrapnel etc.).

6.36

If, during radiography, items are discovered within a deceased victim or human remains which may be considered to be evidence (e.g. munitions or shrapnel) this information should be documented and the Supervising Forensic Pathologist and Mortuary Documentation Officer informed.

ORAL RADIOGRAPHY 6.37

Digital dental radiography will be performed as part of the odontological examination. Provision should be made for the use of relevant oral radiography equipment in the design of the mortuary (see Odontology section at paragraph 6.49)

FINGERPRINTS 6.38

Fingerprints (fingers, hands, toes and feet) should be taken and processed according to policy and instruction. Details of any missing fingers and toes should be documented on the Disaster Victim Identification (DVI) or Victim Profile form (VPF) as appropriate.

6.39

The deceased should not be disfigured or mutilated in any way in order to obtain fingerprints (see section 1.25).

DEOXYRIBONUCLEIC ACID (DNA) 6.40

It is for the Senior Identification Manager and Coroner to liaise with the forensic science service provider to agree an appropriate strategy for the collection, profiling and matching of ante-mortem and post-mortem samples for DNA analysis.

6.41

The overarching aim will be to ensure that, where appropriate, deceased victims and human remains are identified and re-united using the most suitable and effective scientific methods available. The process must be undertaken in a way that is legal, proportionate, accountable and necessary whilst ensuring integrity and continuity throughout.

6.42

It may be considered appropriate to establish scientific facilities at the mortuary for the purpose of examining DNA.

6.43

It is for the Senior Identification Manager to consider arrangements for the forensic scientific service provider to appoint a Liaison Officer within the mortuary.

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TAKING OF SAMPLES AND REMOVAL OF HUMAN REMAINS 5 6.44

The methods used for establishing the identity of the deceased should, wherever possible, avoid any unnecessary invasive procedures or disfigurement or mutilation. Body parts will not be removed for the purposes of identification except where it is necessary to do so.

6.45

All requests for specific forensic procedures regarding the deceased or human remains (including the taking of samples, organs, limbs etc) must be made to the Coroner.

6.46

Should the Coroner give authority regarding the taking of samples or human remains, such authority will be in writing with copies retained by the Coroner and SIM as appropriate.

FLUOROSCOPY 6.47

Fluoroscopy is an imaging technique commonly used to obtain real-time images of the internal structures of the deceased victim through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an x-ray source and fluorescent screen between which a patient is placed. However, modern fluoroscopes couple the screen to an x-ray image intensifier and CCD video camera allowing the images to be played and recorded on a monitor for immediate review.

6.48

In the context of the mortuary process, fluoroscopy is especially useful for identifying the presence of foreign matter within the deceased or human remains and identifying any threats to staff safety in real-time. In addition, the use of fluoroscopy allows for instantaneous identification of matter which may be considered to be evidence. This process might be of particular use following cases of terrorist activity.

ODONTOLOGY 6.49

When required, an Odontologist will undertake the charting of teeth. To aid identification, comparison of the radiography data may be made with the deceased’s dental records which are obtainable from domestic dentist with the assistance of the relevant Family Liaison Officer.

6.50

Authority must be requested from the Coroner prior to the commencement of any invasive procedures which may be required to obtain dental identification data (see section 6.37 above)

ANTHROPOLOGY 6.51

Digital radiography examination in conjunction with anthropology will negate the requirement for invasive procedures in many circumstances. The precise protocol to be followed will be determined by the Coroner in conjunction with the Supervising Forensic Pathologist, Senior Anthropologist and Senior Radiographer.

5

See “The Public Inquiry into the identification of Victims following Major Transport Accident” (The Report of Lord Justice CLARKE). See also the Human Tissue Act 2004.

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RE-BAGGING 6.52

After the identification examination process the human remains will be stored in a fresh body bag. The original body bag should be retained, carefully sealed, packaged, recorded and processed as an exhibit. As such, it should be formally taken into the possession of the Post Mortem Team Exhibits Officer before being passed to the Mortuary Exhibits Officer.

6.53

This is because the original bag will be soiled and contaminated but may be of significant evidential value. The use of colour coded bags at this stage may assist with a system of effective storage of the deceased.

6.54

It is a role of the Body Storage Officers to assist in re-bagging the deceased and human remains.

EMBALMING 6.55

Embalming will not be permitted until written authority is received from the family of the victim or their representative. Only when authorised to do so by the Coroner (on receipt of the family mandate introduced above) may third party, private sector representatives embalm and encoffin the deceased.

6.56

If possible, embalming should only be carried out in accordance with religious and cultural considerations (see section 8).

6.57

Embalming may be required if a deceased victim is to be repatriated abroad.

RELEASE OF DECEASED VICTIMS TO RELATIVES 6.58

When the Coroner is satisfied that a deceased victim can be released to the next-ofkin he/she will authorise the release and complete the appropriate documentation.

6.59

In the event that the deceased are not intact, arrangements will be made in accordance with the wishes of each family which will be ascertained via the relevant Family Liaison Officer (see section 9.4).

6.60

Burial or Cremation Orders are obtained from the Coroner on completion of the Inquest (see section 4.19).

UNCLAIMED DECEASED VICTIMS 6.61

The Coroner will decide the procedures in relation to the deceased that are unclaimed. A deceased victim may go unclaimed if a next of kin cannot be found or in circumstances where a next of kin is, in fact, identified but does not wish to claim the deceased.

6.62

If a deceased victim is unclaimed the Local Authority will arrange for burial or cremation in accordance with their statutory obligation imposed by the Public Health (Control of Diseases) Act, 1984. Any such disposal will be in accordance with any identified faith requirements.

6.63

In circumstances where a next of kin is identified but does not wish to claim the deceased, he or she must still be advised of the time, date and location of any burial or cremation.

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DECEASED VICTIMS TO BE REPATRIATED ABROAD 6.64

When a deceased victim is to be repatriated abroad the Coroner will be required to sign an ‘Out of England’ form (Form 103). This form must bear the National Body Identification Number (see below).

NATIONAL BODY IDENTIFICATION NUMBER 6.65

The National Body Identification Number a unique eight (8) digit identification number which is issued by the National DNA Database. Each number is allocated against a single form within the stocks held by police across the nation.

6.66

This Unique Reference Number (URN) is generally presented as eight (8) digits which are representative of the far larger number issued by DNA Database. The longer number is encoded in an associated bar-code displayed on the ACPO Victim Recovery Labels in use today.

6.67

The ACPO Victim Label (see Appendix E) includes a number of self-adhesive Unique Reference Numbers which are required to be fixed to every document created in relation to the deceased victim or human remains. Copies of the self-adhesive label must also be affixed to the container or packaging for every item of personal property and samples taken from all deceased victims or human remains.

PROPERTY 6.68

Property at the mortuary will be either: personal property of the deceased attached to them; or evidence.

DISPOSAL OF PERSONAL PROPERTY 6.69

Careful consideration should be given to making a decision to clean property without first consulting family members through the Family Liaison Co-ordinator. Certain faiths require that all parts of a deceased victim are buried or cremated and this may include bloodstained clothing. Details of family requirements in respect of property are included on the VPF14 form.

6.70

In addition to ascertaining the wishes of families, the SIM/SIO should also seek advice in relation to any Health and Safety implications in returning unclean items to relatives.

6.71

A photograph of each item should be retained before it is returned.

EVIDENCE 6.72

Evidence will be: items recovered following a terrorist incident items required for other evidential purposes medical evidence.

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EVIDENCE OF TERRORIST INCIDENTS 6.73

Following a terrorist incident it may be decided that any device or item will need to be re-constituted to provide evidence. Examples include: a bomb or other explosive device a vehicle used for a vehicle borne explosive device (car-bomb) a vehicle involved in the incident (the fuselage of an aircraft).

6.74

Fragments of such items maybe recovered at the mortuary and be discovered during radiography or during “Strip and Search” prior to post mortem.

6.75

In terrorist incidents, trained Exhibits Officers from the Metropolitan Police Service Counter Terrorism Command (SO15) will be attached to the mortuary.

6.76

The Metropolitan Police Service Counter Terrorism Command (SO15) will be responsible for the safekeeping of all exhibits recovered following a terrorist incident.

EVIDENCE (Non-Medical) 6.77

Items identified as evidence will be labelled and stored in accordance with the instructions shown at sections 6.13 to 6.27.

6.78

Advice should be sought from the Senior Investigating Officer before any items of evidence are cleaned.

MEDICAL EVIDENCE 6.79

Medical evidence such as samples should be refrigerated or frozen depending on the nature if the item. The Main Exhibits Officer will seek advice on the methods of storage from the scientific service provider.

STORAGE OF EVIDENCE 6.80

All evidence should be securely stored. Access to stored evidence should be controlled. It is the duty of the Mortuary Operations Manager assisted by the Mortuary Duty Officer to ensure the security of evidence.

6.81

It may be necessary for soiled items to be refrigerated. The Mortuary Exhibits Officer will, however, seek advice on the methods of storage from the engaged scientific service provider.

DECEASED VICTIM DOCUMENTATION: ACPO VICTIM LABEL BOOKLET (see Appendix E) 6.82

The ACPO Victim Label Booklet was introduced across the UK in 2004. Its purpose is to ensure a comprehensive and robust system of continuity and record maintenance. It is relevant to the recovery, movement, examination and identification of deceased victims and human remains together with associated property. The content has been designed to be ‘user friendly’ and in a booklet format acceptable to the identification, investigative and judicial processes.

6.83

The booklet incorporates the capability to utilise, if required, the national bar coding system whereby each booklet, and therefore each victim or human remains has a unique national reference number (with the series dedicated only to disaster victim identification). A number of detachable and self-adhesive labels printed within the booklet will be attached, as appropriate, to the deceased victim, the bag containing

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the victim or human remains and all other related articles that require individual but linked identification and continuity. This includes any samples taken from the victim or human remains (see sections 6.17 to 6.24 above). 6.84

The booklet also makes provision for the inclusion of sketches and photographs to assist the continuity and identification process.

6.85

The booklet and its contents have been approved nationally through ACPO Emergency Procedures Committee.

DECEASED VICTIM DOCUMENTATION: INTERPOL DISASTER VICTIM IDENTIFICATION BOOKLET (See Appendix G) 6.86

The police forces of Interpol Member States are committed to utilising the Interpol DVI Booklet as a means of obtaining information relating to the identity of disaster victims when making enquiries abroad. The booklet is split into two halves: yellow Ante-Mortem Forms and pink Post-Mortem Forms. It also contains a template for a comparison report.

6.87

The completion of Ante-Mortem Forms was previously the responsibility of the police Ante-Mortem Team. In most cases this responsibility is now more likely to fall to the police Family Liaison Officers.

6.88

The pink Post-Mortem Forms will be completed in respect of victim recovery, identification etc. It will be completed by personnel from the police Mortuary Documentation Team.

DECEASED VICTIM DOCUMENTATION: VICTIM PROFILE CHECK LIST 6.89

The Victim Profile Check List was introduced to provide a more user friendly, efficient and comprehensive method of recording information in respect of deceased victims and human remains.

6.90

The check list accommodates the processes used in respect of deceased victims and human remains within the mortuary. The content reflects experience of the victim identification process gained within the UK and abroad in recent years. The booklet is designed to replace the pink Post Mortem section of the Interpol DVI Booklet. The checklist highlights fields comparable to the Interpol DVI booklet with the corresponding field number being coloured red.

DECEASED VICTIM DOCUMENTATION: OVERVIEW OF USE 6.91

The particular Victim Label Booklet which is completed at the scene of the incident from where the deceased victim or human remains are recovered initiates the recording of the Disaster Victim Identification process. Those personnel involved in the scene management and victim recovery process complete the relevant sections of the document as part of the associated evidential audit trail.

6.92

The Victim Label Booklet containing the remaining sections travels with the deceased victim or human remains via the ‘Body Holding Area’ or ‘Holding Audit Area’ (if appropriate), to the mortuary. The relevant documentation teams at the mortuary will then complete the remaining sections of the booklet as appropriate alongside associated documentation e.g. the Victim Profile Check List, the Interpol DVI Booklet, Major Incident Room Property Registers etc.

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6.93

All deceased victims and human remains (recovered separately) will be the subject of individual documentary records (as alluded to above). The document type (UK Victim Profile Check List v. Interpol Disaster Victim Identification Booklet) will be dictated by policy relative to each incident. It is important that adequate stockpiles of booklets are maintained together with there being a system in place to obtain further copies if necessary.

6.94

Consideration should be given to the dissemination of information contained within the completed booklets to those other areas involved in any related process i.e. Casualty Bureau, Exhibit/Property Officers, Family Liaison and the Incident Room.

DECEASED VICTIM DOCUMENTATION: OPTIONS 6.95

The form templates within the Interpol Booklet are incompatible with administrative processes maintained internationally and as a result, the use of the UK Victim Profile Check List as a replacement has not been accepted. Therefore, within the UK, the potential number of enquiries abroad relating to victim identification will be a contributing factor as to whether the UK Victim Profile Check List or the Interpol Booklet is the most appropriate documentation to use.

6.96

The Senior Identification Manager will make a policy decision as to which forms are used. If, however, details of the victim need to be sent overseas it may be appropriate to merely to copy across information from the UK Victim Profile Check List onto an Interpol DVI Form.

6.97

Copies of both Interpol DVI and Victim Profile forms are shown in Appendices G and F.

EVIDENTIAL DISCLOSURE 6.98

All documentation created within the mortuary maybe subject to disclosure 6 . The police Disclosure Officer will be attached to the Major Incident Room (MIR). He/she must be advised of all documentation that is created in relation to the incident.

6.99

Consideration should be given for key members of staff to be issued with a hardback book in which to write notes including decisions / rationale etc. These books can then be submitted to the Disclosure Officer on completion of the operation.

6.100 The Mortuary Documentation Officer will liaise with the police Disclosure Officer regarding documentation and other disclosable data created within the mortuary. CONFIDENTIALITY CONSIDERATIONS 6.101 Care should be taken to shred copies of personal or sensitive documentation that are no longer required, particularly items which may identify the deceased. 7 6.102 The Police will ensure that appropriate police documentation is available at the mortuary. 6.103 No person will take any photographic image by any means within the mortuary other than an official photographer authorised by the police.

6 7

Criminal Procedure and Investigation Act 1996 Data Protection Act 1998

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NON-FAMILY VISITS TO THE MORTUARY 6.104 Requests may be received from parties wishing to view the mortuary. The Mortuary Management Team will grant or deny such with this decision being made against the backdrop of their affect on the operational efficiency of the mortuary and the processes therein. 6.105 A log of all visitors will be maintained by the Mortuary Facilities Manager. 6.106 All visits will need to comply with Health and Safety and risk management advice and guidance. 6.107 Visitors will not be permitted to take photographs or other recordings whilst in the mortuary complex.

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SECTION 7 – FAMILY VIEWING FAMILY VIEWING AREA 7.1

Viewing of the deceased traditionally takes place once the deceased has been released to the bereaved. The viewing then takes place at a location chosen by the bereaved and provided by their agent. In extreme circumstances, however, viewing may take place at the mortuary. Should this unusual circumstance become the case, viewing facilities should be made available as soon as practicable. They should be provided in an area which has been specially prepared and, wherever possible, takes into account religious or cultural needs. At the behest of the family, viewings may be arranged via their chosen funeral director at a location other than the disaster mortuary.

7.2

Those families that chose to view their loved ones at the mortuary will gather, with their Family Liaison Officers (FLOs), to be briefed about the procedure when they arrive at the mortuary’s Family Viewing Area.

7.3

As soon as the viewing party is ready to drive to the mortuary a telephone call will be made to the Family Viewing Area Supervisor and the security staff at the mortuary site entrance to warn them of their impending arrival.

7.4

They will travel, with their FLO, in unmarked mini-buses with darkened windows (to prevent media intrusion) to and from the mortuary.

7.5

It is important that their every effort is made to enable their passage through the mortuary security is as speedily as possible.

7.6

The viewing party will be met by appropriate personnel and welcomed into the outer reception room, shown to the seats provided and offered refreshments.

ENVIRONMENTAL CONDITIONS OF THE FAMILY VIEWING AREA 7.7

The décor within the viewing area should be simple and peaceful. Cream and blue are considered to be the most appropriate colours with small arrangements of green shrubs.

7.8

Flowers – cream roses, with labels attached to enable family members to write messages, should be available within the viewing area. These could be left with their loved ones, left in the memorial garden, or taken away with them.

7.9

A Memorial Garden sited near to the viewing area gives family members a quiet place for contemplation and opportunity to compose themselves before leaving the mortuary. The choice of colours of flowers within this area could be contentious to some faith groups but foliage plants with hues of blues and mauves appropriate.

RELIGIOUS AND CULTURAL NEEDS SPECIFIC TO THE VIEWING PROCESS (also see Section 8) 7.10

The following is a brief guide to the major religions and church denominations which may be encountered and their particular requirements. It is important to note that it is preferable for there to be no religious symbols in the viewing area at all rather than risk offence to any group.

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Christian: High Anglican, Roman Catholic, Orthodox may require a crucifix (cross with the figure of Jesus on it) Free Churches (includes Baptist, Methodist, United reformed, Evangelical and The Salvation Army may require a Plain Cross to be present in the viewing area. Jewish: There should be no symbols unless there is a request for the Star of David to be placed in the viewing area. A two handled cup should be available for use in the ritual hand washing process. Muslim: There should be no symbols Hindu: There should be no symbols unless there is a request for ‘Om’ the painted blue and gold disc symbols to be placed in the viewing area. Buddhist: There should be no symbols; however, it is customary for the family to bring incense, fruit, and rice and candles to leave with the deceased. Sikh: There should be no symbols unless there is a request for the Sikh symbol ‘KHANDA’ to be placed in the viewing area. 7.11

Religious and cultural needs will be addressed with the assistance of The Salvation Army personnel present within the viewing area. While consideration should be given to the concerns of those individuals and communities for whom post mortem investigations are unwelcome and where there is a requirement for prompt burial, their needs should not be met at the expense of others who are grieving in equal proportion.

7.12

Viewings are usually restricted to the face, head and hands of the deceased. It should, however, be noted that in some cultures it is acceptable for a close relative to view the whole body of the deceased.

7.13

The Family Viewing Area Supervisor will communicate (prior to the visit to the viewing area) the family wishes for religious and cultural support to The Salvation Army Co-ordinator who will arrange for the appropriate faith leader to be present and ensure that any requests for religious symbols are present.

7.14

The Salvation Army personnel present (who will be ordained ministers) will provide pastoral support to those family members who have not made prior arrangements for a particular faith leader to be present but who, when they arrive to view their loved one, feel it appropriate to be supported in this way.

RITUAL HAND WASHING 7.15

Ritual hand washing is as much a cultural need as a religious requirement, it is important that the ritual hand washing equipment is available for every viewing to ensure that all those who wish to participate are not overlooked.

7.16

The equipment needed is a clear glass bowl with unopened litre bottles of water and new hand towels. It is preferable for the bowl to be empty so that their particular requirements can be observed.

7.17

The Jewish faith use a two handled cup and will facilitate the hand washing process themselves.

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ADDITIONAL REQUIREMENTS 7.18

It may be possible that family members may request for music to be placed while they attend the viewing area and it would be prudent to ensure that a CD player is available should this be requested

7.19

Family members may request locks of hair from the body of their loved one. This could be arranged with prior notification when the mortuary technician can prepare for this in advance. Small clear plastic exhibit containers are ideal for this purpose. Alternatively, some family members may wish to cut the locks of hair themselves. Again, the containers should be made available together with scissors.

MEDICAL AID 7.20

London Ambulance Service will provide a paramedic to the Family Viewing Area during the period when families are visiting the area to ensure that, should a medical emergency arise, there is a trained professional available to provide the highest level of care.

END NOTE 7.21

It is important to note that, in responding to an incident of the type covered by this plan, every effort will be made by the responders to comply with each and every religious and/or cultural requirement. Disasters are, however, extraordinary events and, as such, which may require the responding agencies to carefully consider the needs of religions against the practical demands of the operation.

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SECTION 8 – RELIGIOUS AND CULTURAL ISSUES BUDDHIST 8.1

After death, the body of the deceased may be handled by non-Buddhists. In some cases a monk may perform some additional chanting, but this is not a universal practice. There are no objections to post-mortems.

8.2

Preparation of the body for the funeral is generally left to the undertaker, but in some instances relatives may also wish to be involved. The deceased may be put in a coffin, or wrapped in cloth (sometimes white), or dressed in the deceased’s own clothes. The deceased may be surrounded by candles, flowers, incense, photographs and coloured lights, but this is a matter of individual choice and there are no hard-and-fast rules. The deceased is usually cremated, at a time dependent upon the undertaker and the availability of the crematorium’s facilities.

CHINESE (CONFUCIANISM, TAOISM, ASTROLOGY, CHRISTIANITY) 8.3

After death, undertakers handle the deceased. Some undertakers in areas with long established Chinese populations are accustomed to Chinese needs such as embalming and the deceased being fully dressed in best clothes including shoes and jewellery. In such areas some cemeteries have a Chinese section.

8.4

Burial or cremation may take place a week after the person has died. If the deceased is a child, parents usually do not want to visit the mortuary. A sibling or close relative would be asked to deal with any viewing of the deceased.

CHRISTIANS 8.5

The choice between cremation and burial can either be a matter of personal choice or a denominational requirement. In all cases, the wishes of the deceased’s family, or friends, should be sought if possible. If this cannot be done, then Christians should be buried.

CHRISTIAN SCIENTISTS 8.6

Questions relating to care of the body should be answered by the individual’s partner/ family. In general, Christian Scientists request that, whenever possible, the body of a female should be prepared for burial by a female. The individual’s family should answer questions relating to post mortem examinations.

CHURCH OF JESUS CHRIST OF LATTER-DAY SAINTS (MORMONS) 8.7

The Church takes no position on post mortem examinations. Church or family members will usually arrange for the deceased to be clothed for burial.

8.8

Burial rather than cremation is recommended by the Church, but the final decision is left for the family of the deceased.

HINDUS 8.9

It is preferred if all Hindu bodies can be kept together after death. A deceased Hindu should be placed with the head facing north and the feet south.

8.10

Cleanliness is important and the body can be undressed and cleaned, but the family should be consulted where possible. The arms should be placed to the sides and the legs should be straightened. The face should be pointed upward with eyes closed and the whole body must be covered with white cloth. Any detached body parts must

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be treated with respect as if they were a complete body. Post mortems are permitted, usually with prior agreement of the immediate family. 8.11

When a person dies their body is washed, dressed in new clothes and flowers are placed around it.

8.12

The bereavement in the family lasts a minimum of two weeks during which several rituals are followed. Hindus believe in cremating the body so that the soul is completely free of any attachment to the past physical matter.

HUMANIST 8.13

No specific requirements. The choice between cremation and burial is a personal one, although cremation is more common. Most will want a humanist funeral, and crosses and other religious emblems should be avoided. However, since many humanists believe that when someone dies the needs of the bereaved are more important than their own beliefs, some may wish decisions about their funeral and related matters to be left to their closest relatives.

JAIN 8.14

There are no specific rituals in Jain philosophy for this event. Bodies are always cremated and never buried except for infants. Cremation must be performed as soon as practicable, even within hours if possible, without any pomp. Many Jains still pursue Hindu customs as a family preference. All normal practises of UK undertakers are acceptable if handled with respect. The family normally provide the dress and accessories for the preparation and final placement in the coffin.

JEHOVAH WITNESS 8.15

If a post mortem is required by law, the wishes of an appropriate relative should be ascertained and, if possible, their wishes observed. The dead may be buried or cremated, depending on personal or family preferences and local circumstances.

JEWS 8.16

The prompt and accurate identification of the dead is particularly important for the position of a widow in Jewish law. Post mortems are forbidden unless ordered by the civil authorities. Body parts must be treated with respect and remain with the corpse if possible. When a person dies, eyes should be closed and the jaws tied; fingers should be straight. The body is washed and wrapped in a plain white sheet, and placed with the feet towards the doorway. If possible it should not be left unattended. For men a prayer shawl, tallit, is placed around the body and the fringes on the four corners cut off.

8.17

The Chevra Kadisha (Holy Brotherhood) should be notified immediately after death. They will arrange the funeral, if possible before sunset on the day of death, but will not move the body on the Sabbath. Coffins are plain and wooden (without a Christian cross). Someone remains with the body constantly until the funeral. It is not usual to have floral tributes. Orthodox Jews require burial but Reform and Liberal Jews permit cremation.

8.18

The burial should take place as quickly as possible after death. The body should not be left alone as this is thought to be disrespectful. The body will be washed thoroughly, male bodies by men and female bodies by women. It is then placed in a simple unpolished box with no handles and padding. This is to symbolise that in death all are equal, despite personal wealth.

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MUSLIM 8.19

As a Chaplain, in a death situation you should NEVER touch the body, whether male or female. The safest guideline is also to never touch a family member. The best advice for viewing the deceased after death would be to escort the family in and then stand off to the side, out of the line of sight. You are there to help if needed, not pretend to be part of the family. Try to identify who is the effective leader within the family. That person should be the one approached with practical details, rather than presuming that it would be the next of kin

8.20

Muslim dead should be placed in Holding Audit Areas or temporary mortuaries, and ideally be kept together in a designated area (with male and female bodies separated). Post mortems are acceptable only where necessary for the issue of a death certificate or if required by the coroner.

8.21

Ideally only male Muslims should handle a male body and female Muslims a female body. The body should be laid on a clean surface and covered with a plain cloth, three pieces for a man and five for a woman. The head should be turned on the right shoulder and the face positioned towards Makkah.

8.22

As soon as possible after death the body is given a ritual washing called Ghusl. This is to wash away all sin so the body can meet Allah in a pure state. The deceased is anointed with perfumes and spices and wrapped in white cloth, usually the Ihram clothes used for the Hajj. This ritual is the same for rich and poor, in death, Muslims believe all are equal.

8.23

Muslims try to bury the deceased within 24 hours of death if possible. They believe that the soul departs at the moment of death. The deceased is placed with their head facing the Muslim holy city of Makkah.

8.24

Ritual washing is performed usually by family members or close friends, usually according to the sex of the deceased. The body is wrapped in a shroud of usually simple, white material. Afterwards, salat (prayers) will be said for the deceased.

8.25

Next of Kin or the local Muslim community will make arrangements to prepare the body for burial. Muslims believe in burying their dead and would never cremate a body. Burial takes place quickly, preferably within 24 hours.

SIKH 8.26

The five Ks (5 Ks are five physical symbols worn by Sikhs i.e. underwear ‘kachha; wristband ‘kara’; sword ‘kirpan’ unshorn hair ‘kes’ and comb ‘kanga’) should be left on the dead body, which should, if possible, be cleaned and clothed, in clean garments before being placed in a coffin or on a bier. According to Sikh etiquette, comforting a member of the opposite sex by physical contact should be avoided, unless those involved are closely related. Deliberate expressions of grief or mourning by bereaved relatives are discouraged, though the bereaved will want to seek comfort from the Sikh scriptures. The dead person should always be cremated, with a close relative lighting the funeral pyre or activating the machinery. This may be carried out at any convenient time. The ashes of the deceased may be disposed of through immersion in flowing water or dispersal.

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END NOTE 8.27

It is important to note that, in responding to an incident of the type covered by this plan, every effort will be made by the responders to comply with each and every religious and/or cultural requirement. Disasters are, however, extraordinary events and, as such, which may require the responding agencies to carefully consider the needs of religions against the practical demands of the operation.

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SECTION 9 – ROLES AND RESPONSIBILITIES OF ORGANSIATIONS GOVERNMENTAL STAFF: The London Resilience Team (LRT) 9.1

The London Resilience Team (LRT) will become part of the Government Liaison Team (GLT) which acts as the liaison point between the Strategic Co-ordinating Group (SCG) and HM Government. In addition, the team may act in support of the both the Mass Fatality Co-ordination Group and the Mortuary Management Team.

9.2

The Mass Fatality section of the London Resilience Team is responsible for production and update of the London Mass Fatality Plan.

THE LOCAL AUTHORITY: Administration Assistant(s) 9.3

Assists other mortuary staff through the provision of administrative support including the taking of minutes at all mortuary meetings (may also be provided by the police).

MORTUARY STAFF: The Coroner’s Officer 9.4

The Coroner’s Officer works in support of the Coroner. With appropriate authorisation from the Coroner, the Coroner’s Officer may represent the Coroner in his/her absence.

9.5

He/she will support the Coroner in all their functions and, in particular, may document: the extent of the examination of the deceased the taking of specimens or samples for analysis and examination the retention of material for further examination the release of deceased victims and human remains to the family (including secondary remains) the disposal of deceased victims and human remains (where there are no family or none are known to have an interest).

9.6

The Coroner’s Officer is an acknowledged expert in dealing with procedures following death. Their assistance and advice will be invaluable following an incident which results in mass fatality.

9.7

If circumstances warrant it, a ‘Senior Coroner’s Officer’ maybe appointed to supervise and oversee a team of Coroner’s Officers.

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MORTUARY PROFESSIONS: Anatomical Pathology Technologists 9.8

The technologist will be a professional who will be responsible to the Supervising Forensic Pathologist and who will assist the pathologist with the Post Mortem process.

9.9

In the Autopsy Suite, the technician assists the pathologist, whose role it is to examine the deceased to discover the cause of death. The technician helps the pathologist to examine the deceased and to take samples of tissue for analysis.

9.10

After the examination it is the technician’s job (on the authority of the Coroner) to acceptably reconstitute the deceased and to store the tissue specimens until they are analysed. The technician is also responsible for maintaining the equipment and instruments used.

9.11

Technicians must be able to recognise safety hazards, particularly the risk of infection from those who have died of viral diseases.

Forensic Anthropologist 9.12

Forensic anthropology is the examination of skeletal remains. This examination can be used to first determine if the remains are in fact human. Then the forensic anthropologist can determine the gender, approximate age, physical stature, and likely racial affiliation of the person in life. The examination can also yield approximate time since death, likely cause of death and any identifying illnesses or wounds suffered in life that could leave traces in the bone structure. This information can then be used to help identify the remains.

9.13

The Forensic Anthropologist may be required to assist the Senior Identification Manager in providing primary identification evidence through dental examination of the deceased.

9.14

The Forensic Anthropologist is appointed by the Coroner.

9.15

The Forensic Anthropologist may need an assistant.

Forensic Anthropologists Assistant 9.16

The Forensic Anthropologists Assistant is responsible to the Mortuary Documentation Officer.

9.17

The Forensic Anthropologists Assistant records all matters - as directed by the anthropologist - on the approved post mortem documentation and passes the same into the formal possession of the Mortuary Documentation Officer.

Forensic Archaeologist 9.18

Forensic Archaeology is the application of archaeological methods to forensic (crime scene) work.

9.19

The Forensic Archaeologist combines knowledge of osteology (a branch of anatomy dealing with bones) and human remains with archaeological techniques to help recover finds and provide vital evidence for the investigative team.

9.20

With an osteology background, the Forensic Archaeologist can provide field guidance on the age, sex, and other physical characteristics of human remains.

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Forensic Archaeologists Assistant 9.21

The Forensic Archaeologist’s Assistant is responsible to the Mortuary Documentation Officer.

9.22

The Forensic Archaeologist’s Assistant records all matters - as directed by the archaeologist - on the approved post mortem documentation and passes the same into the formal possession of the Mortuary Documentation Officer.

Forensic Odontologist 9.23

Forensic Odontology (dentistry) is that aspect of dental science, which interacts with the legal justice system. It covers a wide range of activities. Primary among these are the identification of unidentifiable human remains, mass disaster preparedness, and being an effective expert witness, both in the criminal, as well as civil trials.

9.24

The Forensic Odontologist is appointed by the Coroner. He/she may be required to assist the Senior Identification Manager (SIM) in providing primary identification evidence through dental examination of the deceased.

9.25

A Forensic Odontologist is likely to need an assistant.

Forensic Odontologists Assistant 9.26

The Odontologists Assistant is responsible to the Mortuary Documentation Officer.

9.27

The Odontologists Assistant records all matters - as directed by the Odontologist - on the approved post mortem documentation and passes the same into the formal possession of the Mortuary Documentation Officer.

Forensic Radiographer 9.28

Radiography will be deployed in the mortuary as part of the Disaster Victim Identification (DVI) and investigative process. It will be used as requested in support of Forensic Pathology, Anthropology and Odontology (described above).

9.29

The Forensic Radiographer is a qualified UK State registered diagnostic radiographer who has received additional training in forensic and emergency mortuary procedures accredited by the Association of Forensic Radiographers and College of Radiographers. The Forensic Radiographer will work under the direction of the Supervising Forensic Pathologist.

9.30

The Forensic Radiographer will be provided by the Association of Forensic Radiographers upon the request of the Coroner, Supervising Pathologist or via UKDVI arrangements.

THE POLICE Administration Assistant(s) 9.31

Assists other mortuary staff through the provision of administrative support including the taking of minutes at all mortuary meetings (may also be provided by the local authority).

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Ante Mortem Co-ordinator 9.32

The Ante Mortem Co-ordinator, as part of the Ante Mortem Team, is responsible for compiling a file in respect of each person reported missing, believed to have been involved in the incident and not yet accounted for or identified as deceased. This file comprises information for comparison with post mortem data and is compiled for the information of the Coroner.

Ante Mortem Team 9.33

The size of the Ante Mortem Team will depend to a large extent on the number of fatalities but the Ante Mortem Co-ordinator and a nucleus of the team should be activated as soon as practicable to work closely with the Casualty Bureau.

9.34

The functions of the team are to: prepare a list of missing persons believed to have been involved in the disaster obtain evidence of the likelihood that the missing persons were involved prepare a file of evidence for comparison with that from the Post Mortem documentation (this file will be presented to the Coroner for deliberation by the Identification Commission) liaise with the Family Liaison Co-ordinator to inform the next-of-kin when all identifications have been completed (the authority of the Senior Identification Manager will be required) provide a single point of contact for the Family Liaison Co-ordinator and Family Liaison Officers and provide all possible assistance.

Body Reception Officer 9.35

The Body Reception Officer can be either a police officer or an appropriately trained member of police staff and will: supervise the reception of each deceased victim and/or human remains ensuring that: each of the deceased victims/human remains is accompanied by a completed ‘Scene Note’ section of appropriate Disaster Victim Identification documentation (see Appendices E, F and G) which has been completed at the scene and bears matching unique body identifier numbers enter the details of the body bag in the appropriate Mortuary Reception and Post Mortem Log / Register enter the details of the deceased victim/human remains in the Individual Body/Part Movement Log and maintain the log as appropriate maintains the Mortuary Reception and Post Mortem Log / Register (as may be appropriate) ensure that personal property of the deceased does not come into the mortuary (unless carried on the deceased).

9.36

In the event of a multi-sited incident, it may be appropriate to employ a separate Body Reception Officer in respect of each scene. This course of action may be appropriate to ensure that there is no cross-contamination of evidence between any of the relevant scenes.

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Body Storage Officer 9.37

The Body Storage Officer may be a police officer or an appropriately trained member of police staff and: ensures effective and respectful temporary storage of the deceased seizes the original body bag in which the deceased was transported (plus associated labels) and carries out the approved re-bagging process maintains and completes the Body Storage Log / Register liaises with the Viewing Area Supervisor so as to ensure efficacy in the family viewing process (where appropriate) completes the Victim Profile Form 13/13a (record of viewing) liaises with the Coroner’s Officer, Family Liaison Officers and undertakers regarding the release of the deceased maintains the Body Release Log.

9.38

In the event of a multi-sited incident, it may be appropriate to employ a separate Body Storage Officer in respect of each scene. This course of action may be appropriate to ensure that there is no cross-contamination of evidence between any of the relevant scenes.

Body Transit Team 9.39

The Body Transit Team is likely to be made up of police officers who will be responsible to the Body Reception Officer. The team may move deceased victims and human remains around the mortuary as required (for examination, storage and viewing).

9.40

The team will be responsible for the completion of the Body Movement Log in respect of all such actions.

9.41

In the event of a multi-sited incident, it may be appropriate to employ a separate Body Transit Team in respect of each scene. This course of action may be appropriate to ensure that there is no cross-contamination of evidence between any of the relevant scenes.

Family Liaison Officer (FLO) 9.42

The primary function of an FLO is that of an investigator. In performing this role the officer will offer, give and facilitate support with consideration being given to the needs of the family.

9.43

The role involves the day to day management of the partnership with the family in the investigation and close liaison with the SIO/SIM to ensure families are treated appropriately, professionally and with respect to their needs. This may involve working in a variety of situations in very demanding and stressful conditions over sustained periods of time.

9.44

Family Liaison Officers are selected from volunteers who have the appropriate qualities and skills. All FLOs are trained to the accepted ACPO standard before being deployed in cases of mass disaster and, as a consequence, will be conversant with the contents of the ACPO Emergency Procedures Manual.

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Section 9

Family Liaison Officers must not be expected, under any circumstances, to attempt to assume the responsibility of personally counselling a victim’s family whether qualified to do so or not. This does not, however, preclude an FLO from offering sympathy and/or moral support.

Family Viewing Area Supervisor 9.46

The Family Viewing Area Supervisor will be a trained and experienced Family Liaison Co-ordinator (FLC).

9.47

The Family Viewing Area Supervisor reports directly to the Mortuary Operations Manager and has overall responsibility for all the FLOs deployed at the Family Viewing Area in order to facilitate the viewing of the deceased by family members and friends. Responsibilities include: managing the Family Viewing Area liaison with mortuary staff to ensure that the correct deceased victim has been prepared and is ready for viewing at the right place and at the right time (including the completion of Victim Profile Forms VPF 13/13a) ensuring that Family Viewing Area is properly prepared in accordance with the family’s need and, as far as practicable, desires (due account should be taken of the family’s religious and cultural requirements) (see also ‘The Salvation Army’ at section 9.57) the briefing/debriefing of all FLOs visiting the Family Viewing Area ensure that a Paramedic is on stand by, close to the Viewing Area, prior to and during the time of any family viewing facilitating with FLO welfare issues (only those FLOs assigned to the Family Viewing Area) ensuring appropriate logistical support to the Family Viewing Area (in conjunction with the Mortuary Facilities Manager).

Fingerprint Officer 9.48

The Fingerprint Officer is an authorised police employee who is responsible to the Mortuary Documentation Officer and will: obtain fingerprints, hand and/or footprints from the deceased, as directed (ear-prints have previously been used for identification purposes and should also be considered) arrange for the prints to be taken for comparison purposes through liaison with Ante-Mortem Co-ordinator prepare print comparisons for presentation to the Identification Commission and Coroner.

Mortuary Access Controller 9.49

The Mortuary Access Controller is responsible to the Mortuary Duty Officer. He/she controls access and egress to the mortuary by maintaining, or causing to be maintained, a log of all persons who enter and leave the site.

9.50

The Mortuary Access Controller may be required to supervise the issue of passes for people and/or vehicles entering the site.

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Mortuary Documentation Officer 9.51

The Mortuary Documentation Officer is a police officer who is responsible to the Senior Identification Manager. The Mortuary Documentation Officer will: ensure evidential continuity is maintained in respect of each fatality assume responsibility for all aspects of documentation in relation to the post mortem examination of victims liaise with pathologists, odontologists and other specialists engaged in the mortuary to establish what paperwork is created and to agree the correct methods for this to be submitted to Identification Commission collate post mortem data in respect of each victim into a single file for the benefit of the Coroner liaise with the police Disclosure Officer regarding documentation and other disclosable data created within the mortuary. present identification evidence to the Identification Commission as part of the Post Mortem Team supervise any visual identification of the deceased along with the Coroner’s Officer (performed with the authority of the Senior Identification Manager) liaise with the Ante Mortem Co-ordinator regarding identification matters and the release of remains after identification identify areas of responsibility relative to any relevant undertakers.

Mortuary Duty Officer 9.52

The Mortuary Duty Officer is a police officer who is responsible to the Mortuary Operations Manager (see paragraph 3.29) and will: ensure the smooth running of the mortuary (particularly in the absence of the Mortuary Documentation Officer, Mortuary Operations Manager and Mortuary Facilities Manager) ensure that the London Mass Fatality Plan (as it relates to mortuary management) is adhered to at all times. liaise with the mortuary managers to assist with logistical and operational support within the mortuary ensure security of the mortuary assume responsibility for all visitors to the mortuary.

Mortuary Exhibits Officer 9.53

The Mortuary Exhibits Officer is a trained police officer who is responsible to the Mortuary Documentation Officer. He/she will: record details of all property received from the Post Mortem Team Exhibits Officer(s) assume responsibility for property taken from the deceased place copy(s) of property exhibit book in the relevant body file ensure that personal effects are stored securely until disposal ensure continuity of any items identified as evidence

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liaise with his/her counterparts (Scene Exhibits Officer and/or those attached to the Major Incident Room) 8 consult with the Family Liaison Co-ordinator concerning which items of property the relatives wish to be returned in due course (the form VPF14 refers to this process) liaise with the Family Liaison Co-ordinator, the Senior Investigating Officer and funeral directors concerning the cleaning and restoration of property dispose of property according to instructions from the Senior Investigating Officer and the Senior Identification Manager. Mortuary Photographer 9.54

The Mortuary Photographer should be a police authorised photographer and is responsible to the Mortuary Documentation Officer. He/she and will: be responsible for photographing deceased victims and/or human remains: as removed from the body bag, prior to being stripped after clothing (but not jewellery) has been removed 9 after all personal effects removed. take any photographs required by the pathologist and other specialists during the course of their examinations prepare photographs for production in any Inquest or inquiry or for identification purposes as specified by the Identification Commission.

Post Mortem Documentation Officer 9.55

The Post Mortem Documentation Officer is a police officer who is responsible to the Mortuary Documentation Officer and will: supervise the police post mortem teams ensure that the deceased (including personal effects) is photographed before and after removal of clothing (see also the duties of the Mortuary Photographer) record on the DVI/VPF forms details of all items removed or taken from the deceased ensure that property so removed is handed into the possession of the Exhibits Team for recording make notes as directed by the pathologist pass the completed form (including notes) into the possession of the Mortuary Documentation Officer.

8

It will be necessary to record details of items seized and recovered on the HOLMES II Incident Database

9

This photograph should pay particular attention to the jewellery and personal effects. Photographs will always include the body number.

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Post Mortem Team Exhibits Officer 9.56

The Post Mortem Team Exhibits Officer is an appropriately trained police officer who is responsible to the Post Mortem Documentation Officer and will: receive all items of property and/or samples removed from the deceased by the pathologist and/or Post Mortem Team (as appropriate) complete a Major Incident Exhibit Register in respect of all such items, maintaining at least one register for the contents of each body bag examined completes an Exhibit Label in respect of each item of property and/or sample removed from the deceased/human remains and secure them to the appropriate packaging/container ensure that all items of property / exhibits / samples are packaged and stored in accordance with exhibit handling policies ensure that photographs are taken of individual items of property removed from the deceased including an additional digital photograph (see also the Mortuary Photographer) (the digital photograph should be firmly affixed to the outside of the packaging/container to show the contents).

Post Mortem Team Search Officer 9.57

The Post Mortem Team Search Officer is responsible to the Post Mortem Documentation Officer and will: assist the Pathologist and Anatomical Pathology Technologist to systematically remove all items of clothing and property from the deceased victim/human remains search all items of clothing and property removed from the deceased victim/human remains to establish evidence of identification provide an accurate detailed description of all such items, narrating the same to the Team Exhibits Officer where appropriate, assist the Team Exhibits Officer in the packaging of items.

MORTUARY RESOURCES MANAGER 9.58

The Mortuary Resources Manager reports directly to the Mortuary Management Team. He or she may be an employee of the police service or Local Authority and will assist with the supply and set up of the mortuary. He/she assists the Mortuary Managers in the supply of services and equipment. The Mortuary Resources Manager may require an assistant.

THE SALVATION ARMY The Salvation Army Co-ordinator 9.59

The Salvation Army is able to provide trained and experienced officer(s) who are ordained minister(s) to act as The Salvation Army Co-ordinator in the Family Viewing Area. Should this service be considered to be appropriate in the given circumstances of the incident, the co-ordinator may: assist the local authority in ensuring that the Family Viewing Area (FVA) is fit for purpose liaise with the Family Viewing Area Supervisor each day to facilitate the faith needs of family members

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facilitate the faith response within the FVA greet family members when they arrive at the FVA provide emotional, practical and spiritual support to family members ensure that the FVA is appropriate for each family group i.e. the correct number of chairs, drinking glasses water etc. ensure that the faith and cultural needs of family members are met e.g. ritual hand washing liaise with senior faith leaders to identify the most appropriate individual to provide specific faith support be available to provide emotional support to the police and local authority team within the FVA be available to provide support to the multi-agency team within the mortuary facility. NATIONAL HEALTH SERVICE 9.60

The provision of support, staff and equipment as considered to be appropriate.

HUMAN TISSUE AUTHORITY 9.61

The HTA was set up to regulate the removal, storage, use and disposal of human bodies, organs and tissue for a number of Scheduled Purposes – such as research, transplantation, and education and training – set out in the Human Tissue Act 2004 (see also paragraphs 3.17-3.18: the Mortuary Facilities Manager).

HEALTH AND SAFETY EXECUTIVE 9.62

The Health & Safety Executive will usually be the enforcing authority for the regulation of health and safety statutory requirements at the mortuary. The Health and Safety at Work etc Act 1974 and subordinate regulations require employers and the self-employed to ensure that controls are in place to safeguard workers and the public against risk of injury and ill health.

9.63

It is not the role of the HSE to provide Risk Assessments. These should be carried out by all employers and self employed persons at the location, with co-operation and co-ordination between the parties to ensure that safe systems of work have been devised for the protection of all. At the site of a disaster mortuary, particular attention should be paid to controlling the risk of infection.

MILITARY 9.64

The military may be required to provide logistical support to the civil community by way of the Military Aid to Civil Authorities (MACA) protocol already in existence.

9.65

In addition, the military in ‘London District’ stockpile emergency mortuary equipment on behalf of the Home Office (see Appendix B).

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PRIVATE SECTOR AND OTHERS 9.66

The provision of specific advice and support as requested. Examples of such assistance might include: embalming and encoffining assistance with personal property licensed security.

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SECTION 10 – HEALTH AND SAFETY 10.1

Health and Safety at Work legislation requires all employers to follow safe-working practices as far as possible. This applies in the same way to permanent and temporary facilities (such as represented by the types of mortuary referred to in this plan).

10.2

Consideration must be given to the enormous demands placed upon responding staff to a mass fatality incident. Plans must make provision for welfare and psychological support for all staff (see section 11).

10.3

Such support measures might include: the provision of a separate rest area, away from media and from the bereaved monitoring members of staff, who may, because of family bereavement, illness, relationship problems or other similar problems, could be considered to be vulnerable to external factors consideration of any long-term impact on staff (with appropriate monitoring and support initiatives) inclusion of occupational health departments in planning, response and monitoring arrangements.

FIRE SAFETY 10.4

The Local Authority will liaise with the local element of the London Fire Brigade to ensure that the Disaster Mortuary complies with Fire Safety Standards.

10.5

The Local Authority will ensure that there are sufficient: Fire Alarms Fire Signage Fire Blankets Fire Extinguishers Fire Exits.

10.6

The Mortuary Facilities Manager will ensure that fire precautions are maintained.

10.7

All staff at the disaster mortuary should know the correct procedures in the event of a fire.

10.8

Further guidance on fire safety can be found at: Fire Safety Orders

http://www.opsi.gov.uk/si/si2005/20051541.htm

Outdoor Events

http://www.dclg.gov.uk/index.asp?id=1162112

RADIATION SAFETY 10.9

A Radiation Protection Advisor should be appointed to the site. Such advisors are able to recommend safety measures to take in respect of the use of radiography equipment within the mortuary (see http://www.hse.gov.uk/radiation/index.htm for further information and guidance).

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FIRST AID 10.10 First Aid Facilities will be provided at the disaster mortuary. 10.11 A First Aid Room should be provided in a ‘neutral’ area of the mortuary so it is accessible both to both mortuary staff and visitors (such as grieving next-of-kin). 10.12 The Mortuary Facilities Manager will ensure that there is a qualified First Aider on site at all times. 10.13 A fully equipped Paramedic (including defibrillator capacity) must be in attendance in the Family Viewing Area (see Section7) at all times when families are in attendance for viewing purposes.

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SECTION 11 - WELFARE 11.1

This section is not intended to be a comprehensive guide for meeting all the welfare issues pertaining to a major emergency but rather seeks to highlight some of the processes, facilities and agencies that have a role to play in providing such support.

11.2

Those directly involved in the incident may require welfare support at a number of locations and over a long period of time. These may include: receiving hospitals the Survivor Reception Centre the Friends and Family Reception Centre the Humanitarian Assistance Centre Emergency Mortuary Family Viewing Area site visits memorial services anniversaries Inquests.

11.3

The provision of welfare support involves a multiplicity of statutory bodies and voluntary organisations. The following all have a role in providing practical, emotional, psychological or spiritual support to those directly involved in the emergency: Local Authorities voluntary organisations faith communities National Health Service Bereavement Counsellors Interpreters Police Family Liaison Officers (see also paragraph 9.45).

11.4

The level of support to survivors will vary depending upon their individual needs. What is important is that survivors are aware of where they can access support both in the immediate and long term.

11.5

The importance of a Support Helpline, dedicated web site and advice in setting up survivor support groups has been highlighted in recent emergencies.

11.6

Family 10 members and friends of the deceased are likely to be in a state of shock and their reactions will vary considerably in the way in which they respond. They will invariably have an urgent need for accurate information about their loved ones.

10

The term family is used in its widest sense. This may include partners, parents, siblings, children, guardians and others who may have had a direct and close relationship with the deceased victim.

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11.7

HM Coroner is responsible for all issues relating to the deceased until such time as they are released for burial or cremation. Family members will need to have the role of the Coroner and the process of identification explained to them with care and will need to be kept informed about the progress of the investigation.

11.8

It is important that those dealing with the deceased should ensure that family members feel that time and care has been spent dealing with their loved ones as individuals as opposed to ‘anonymous deceased victims’.

11.9

The manner in which family members are dealt with in the immediate aftermath of the disaster will have a direct bearing on their ability to cope with their bereavement in such traumatic circumstances, both in the short and longer term.

11.10 The local authority will lead in co-ordinating both immediate and long term support to survivors, the bereaved and all those directly involved in the emergency. 11.11 The services of the National Health Service (GP’s and Mental Health services) are key to the provision of psychological support in the long term. 11.12 The bereaved will need support through a number of different potentially traumatic processes: providing items for identification viewing of property (if required) viewing of deceased victims (if required) return of deceased victims to family members issue of the Death Certificate return of personal property visit to site of emergency the Inquest other judicial or public inquiries memorial services ongoing support. POLICE FAMILY LIAISON OFFICERS 11.13 The police Senior Identification Manager (SIM) or Senior Investigating Officer (SIO) will appoint Family Liaison Officers (FLOs) as part of their overall strategy. 11.14 The primary role of the Family Liaison Officer is that of investigator. 11.15 Police Family Liaison Officers have a key role in facilitating the provision of support to those who have been directly involved in the emergency (see also paragraph 9.45). 11.16 Family Liaison Officers will assist the SIO and/or SIM throughout the investigation: by acting as a conduit of information between family members and the appointed SIO/SIM and ensuring that each family is treated appropriately, professionally and in accordance with their diverse needs by explaining the mortuary process to the family

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by making arrangements, if appropriate, with family members to view their loved ones by liaising with family members to obtain ante-mortem information i.e. dental records, DNA, Disaster Victim Identification information, lifestyle and family background statements and other information to assist in the investigation/identification process by liaising with Coroner’s Officers, to ensure that consistent and reliable information is provided to family members. RELIGIOUS AND CULTURAL ISSUES 11.17 Every care is taken to attend to religious and cultural needs where possible. The legal requirements of the UK will need to be effectively communicated to the family of the deceased. 11.18 Any area provided for family members and friends to view the deceased will be constructed with proper regard for religious symbolism. This may include the total absence of certain such items. 11.19 The religious cultural and ethical considerations of the main religious faiths and ethnic groups in the UK are included in the Home Office document The Needs of Faith Communities in Major Emergencies: Some Guidelines (2005). THE SURVIVOR RECEPTION CENTRE (SRC) 11.20 The Survivor Reception Centre will provide immediate support to people directly involved in the incident (including those who may have been slightly injured). It will be set up at a location close to the incident and may be used as a first aid point for minor injuries. Survivors are likely to require immediate emotional and practical support. 11.21 The purpose of the SRC is to formally record details of all survivors involved in the incident. Survivors are potential witnesses to the incident and any related inquiry or investigation. The SRC will provide opportunity for them to be interviewed by the police and by any other relevant investigative body e.g. the Rail Accident Investigation Branch (RAIB). It also permits the gathering of information to assist the police in the collation of data (in terms of known survivors) for the Casualty Bureau. 11.22 In transportation incidents the relevant transportation provider may be involved in the welfare response. FAMILY AND FRIENDS RECEPTION CENTRES (FFRC) 11.23 The purpose of the FFRC is to enable those involved in the incident to be reunited with their loved ones. It should be set up as soon as possible after the incident to give and obtain information regarding the whereabouts of individuals involved in the incident. This process may involve family and friends being interviewed by the police so as to enhance the survivor data held by the Casualty Bureau. 11.24 It is possible that more than one FFRC is set up, particularly in transport accidents when an FFRC may be set up at the point of departure or destination as well as close proximity to the incident crash site.

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THE HUMANITARIAN ASSISTANCE CENTRE (HAC) 11.25 The HAC is a facility where bereaved, families, survivors and anyone else directly affected by the incident can receive information and appropriate support from all relevant agencies, without the need for immediate referral elsewhere. It is acknowledged that while the support will take various forms and will require a wide range of services and agencies, the privacy of individuals requiring psycho-social support is of paramount importance. 11.26 The purpose of the HAC is to: act as a focal point for the giving and receiving of information and assistance to anyone directly involved in an emergency to enable those affected to benefit from appropriate information and assistance in a timely and coordinated manner enable the gathering of forensic samples in a timely manner (where appropriate and in order to assist the identification process) offer access to a range of services that will allow affected people to make informed choices according to their needs ensure a seamless multi-agency approach to humanitarian assistance in emergencies that should minimise duplication and avoid gaps. STAFF WELFARE 11.27 Any incident where there have been mass fatalities will place enormous demands upon all those staff involved in the response. There will be a requirement to work for long hours in very difficult circumstances. This work will be very arduous, traumatic and emotional and it is important to ensure that provision is in place to support all those involved in such work. 11.29 Health and Safety at Work legislation requires all employees to follow safe working practices, as far as practicable. While the facilities in an emergency mortuary might be different from those in a permanent facility, the health and safety provision should be of an equal standard. 11.30 It is important to ensure that staff members have appropriate periods away from situations which may prove distressing and traumatic. The provision of therapeutic services (e.g. shoulder massage, chiropody etc) has proved helpful in the past to those working in similar environments. 11.31 It is imperative that due care is given to the long term impact on staff, particularly those working on specialist teams where the accumulative effect may contribute to adverse physiological, psychological and welfare consequences. Occupational health departments have responsibility to ensure that correct procedures are in place to respond appropriately to incidents and that all employees are aware that such processes are in place to support their individual needs. The responsibility of accessing these services lies with the individual, and/or their line manager(s). It is acknowledged, however, that any support given is based upon expert opinion and the unique circumstances affecting the individual.

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SECTION 12 - COMMUNICATIONS AND MEDIA POLICY 12.1

In the event of an incident causing mass fatality in London, existing media and communications plans and protocols will be used. Each individual agency will have a communications strategy in place to appropriately respond to the emergency or incident. Such strategies should include an agreed pan-agency approach to responding to multiple fatalities at both the local and regional level.

12.2

The communications strategies should outline the process for establishing a Media Centre to facilitate the release of accurate and timely information to the general public.

12.3

The media will not be allowed access to the mortuary, to the Humanitarian Assistance Centre or any Friends and Relatives or Survivor Reception Centres.

12.4

In general, all communications must be undertaken with sensitivity. The deceased must be treated with dignity and the needs of the bereaved should be respected.

12.5

The media will receive all information regarding the mass fatality incident only at the Media Centre. A designated local authority Press Officer and/or police Media Liaison Officer will represent the necessary departments. Facts and figures pertaining to the number of fatalities etc. will only be provided to the media when verified and, then, through the use of a single, pre-identified, point of contact. This contact MUST be the only means of communicating these figures.

12.6

Names of the deceased will not be released until their family members have been notified and sufficient time has elapsed to enable them to notify other relatives and loved ones. The identities of the deceased MUST not be released without the expressed authority of the SIM.

12.7

The London Resilience Team provides a useful link between central government and local responders during an emergency, and is well positioned to take a multi-agency and cross-departmental view of an event.

12.8

The London Resilience Team, therefore, will play a key communications role in a mass fatalities incident by: cascading information from central government, liaising with the Lead Government Department, providing advice, guidance and expertise (particularly in relation to London’s regional plans) to local responders and facilitating inter-agency communications within and between the region(s).

12.9

Key stakeholders to be consulted and informed include: Category 1 and 2 responders, the voluntary sector, the faith community, local community groups/leaders and businesses.

12.10 It is essential that Coroners are kept abreast of all developments.

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Section 13

SECTION 13 – SITE CLEARANCE RESCUE AND RECOVERY 13.1

In the immediate aftermath of the incident the emergency services will take the lead role in co-ordinating the efforts of government agencies and departments, local authorities and private companies.

RECOVERING DECEASED VICTIMS 13.2

In the event of an emergency it is possible there will be human remains in the debris. Providing there is no contamination preventing it, all human remains should be recorded at the site or at the rubble sifting area. However, remains identified during the site clearance or rubble-sifting stages will be treated in an identical way to those recovered from the site. All human remains will be conveyed to the relevant disaster mortuary.

13.3

Removal of the deceased should be carried out as expediently as possible given the particular circumstances of the disaster, taking into account the requirement to preserve evidence relating to the identify of the deceased or the criminal inquiry. Early systematic photography of the scene, with grid marking and careful documentation of the position of deceased victims, human remains and personal possessions is essential. Recognising this, the police have a cadre of selected and trained officers responsible for the recovery of disaster victims (Victim Recovery Teams).

13.4

As deceased victims or human remains require continuity in evidence handling the police will arrange and supervise the movement of remains from the scene or Holding Audit Area to the mortuary utilising these teams. This movement of deceased victims and human remains may be regulated and undertaken in phases to avoid mortuary staff becoming overwhelmed by large numbers arriving at the same time.

13.5

Deceased victims should be removed as soon as is practicably possible. Requirements relative to evidence-gathering and weather conditions may, however, influence operational timeframes for this procedure. None of the remains should be removed until HM Coroner has given permission to do so. It is accepted that some deceased victims may have to be moved in the initial rescue efforts, however, every attempt should be made to leave the remaining deceased victims, and their associated property in the position initially found.

13.6

It is possible that HM Coroner, the Supervising Pathologist, the SIM, and other investigating agencies (e.g. Road, Rail, Air or Marine Accident Investigation Branches) may wish to view the deceased victims insitu in order to assist in determining both the cause of the incident and the cause of death.

13.7

Before removal, deceased victims/human remains will be photographed insitu and an ACPO Victim Label booklet completed in every case. This number will remain with the deceased victim/human remains throughout the mortuary procedures until final identification has been achieved. The location from where the deceased victim was removed will also be labelled with corresponding numbers to those on the deceased (see sections 6.83 to 6.98).

13.8

There is a well-documented systematic approach to the recovery of all items including property - from the disaster scene. This effort will be co-ordinated by police search teams.

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13.9

Section 13

Unattached personal effects found on or near the human remains will, after documenting their position and appropriate photography, be placed in a container, and tagged with unique reference numbers and information reflecting the local surroundings.

HOLDING AUDIT AREA 13.10 A Holding Audit Area will be necessary between the site of retrieval and the mortuary. A number of Holding Audit Areas may be necessary. 13.11 At the Holding Audit Area the body bags will be checked to ensure they are securely and correctly labelled. These bags will remain sealed throughout their transfer to the mortuary. No post-mortem procedures or examination will take place at the Holding Audit Area. 13.12 In cases where terrorism is suspected it may be necessary for an examination of the deceased to take place to ensure that there are no live munitions attached. In such circumstances, the advice of the MPS SO15 Counter Terrorism Command should be sought. 13.13 The Holding Audit Area should be: under cover and out of the public view and within the police cordon (for both security and protection purposes) in close proximity to the disaster site secure a flat outdoor area that can be covered with tarpaulins or on which tenting can be erected to ensure that there is no exposure to the elements, or, an indoor facility on the ground floor of a suitable building accessible to vehicles. 13.14 The Holding Audit Area should have controlled access (no access to family members and friends of the deceased or to the media) 13.15 The Holding Audit Area was formerly referred to as the Body Holding Area. SITE PRESERVATION (INVESTIGATION) 13.16 The site may be treated as a designated crime scene. The police are responsible for securing, protecting and preserving such scenes. They are also responsible for the investigation of any crime and obtaining and securing evidence in conjunction with other investigative organisations. SITE STABILISATION STAGE 13.17 The local authority will take the lead on site stabilisation with assistance from: other local authorities (through their own mutual aid agreements), the emergency services, private contractors and government departments/agencies. As the incident progresses towards the site stabilisation phase, the emergency services will need to consider a formal handover to the Local Authority in order to facilitate the authority’s leading role in the return to normality and restoration of the environment. The Health and Safety Executive will give ongoing advice and guidance.

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SITE CLEARANCE STAGE 13.18 As time moves on the site will move into a clearance phase. The relevant Local Authority will lead in this phase supported by relevant government departments and agencies. Calls will be made on non-governmental resources as required. 13.19 Landfill sites and bulk debris examination sites (with suitable back up sites) have been identified for use as part of the London Site Clearance Plan. These sites will need to be made secure areas. TRANSPORT TO THE MORTUARY 13.20 In the event that deceased victims are contaminated expert advice will be sought from the Joint Health Advisory Cell (JHAC) 11 before they are removed from the scene.

11

At the time of going to press, the concept of JHAC is under review. This and future entries regarding JHAC should therefore be read as encompassing the arrangements that come in to replace JHAC. This plan will be revised to reflect those new arrangements in due course.

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SECTION 14 - CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR (CBRN) 14.1

There is currently little guidance about the management of contaminated fatalities following a CBRN incident. As a result, the Home Office is taking forward a programme of work which examines in detail how contaminated fatalities can be safely handled from recovery to disposal. As part of this work, the Home Office is planning to issue guidance on the Safe Handling of Contaminated Fatalities in due course. Until such guidance as this is available, and in the event of a CBRN incident resulting in fatalities, NO decisions or actions should be taken until specific advice is sought from the Joint Heath Advisory Cell (JHAC) (see footnote attached to paragraph 13.20).

14.2

Decontamination may not remove or reduce the hazard completely as deceased victims/human remains may continue to emit fluids or gases after decontamination.

14.3

Advice should be sought from JHAC on: level of personal protective equipment required to handle human remains the benefits of decontamination (if any) a risk assessment of the continuous hazard which may be posed by remains post decontamination any requirement for ongoing detection, identification, monitoring of human remains, or storage facilities in order to detect the presence of new hazards.

14.4

Transportation of remains should not be undertaken until a full risk assessment has been undertaken with JHAC.

14.5

The Coroner, SIM and Supervising Forensic Pathologist should agree with the options available for safe handling and identifying the remains.

14.6

It may not be possible to use certain methods of identification and it may also be impractical to conduct post mortem examinations.

14.7

Guidance should be sought from JHAC on whether vehicles or storage locations for remains may themselves become contaminated and if or how this contamination can be safely managed and/or removed (environment, buildings, and vehicles).

14.8

If decontamination facilities prove difficult it may well be appropriate to consider temporary facilities that could be disposed of after the use.

14.9

It may be necessary to provide temporary cold storage for contaminated remains at, or close to the scene, within the warm/cold zone or until detailed plans can be developed and managed to address the range of issues arising. This should be achieved within 24 hours.

14.10 JHAC and Specialist Risk Assessments will determine where there should be any restrictions in relation to: viewing return to families repatriation, burial and cremation.

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SECTION 15 – INTERNATIONAL DIMENSION 15.1

Many, if not all, disasters will have an international dimension, in the causation, in the location, in the aftermath or in the nationality of victims.

15.2

Provision will need to be made for the repatriation of family members to the UK if the disaster occurs abroad.

15.3

Foreign nationals who die in England and Wales (and thus in London) may be repatriated to their home country for a funeral. In these circumstances the Coroner will need to issue formal documentation authorising the deceased to be taken outside England & Wales.

15.4

There may be special considerations for victims who are to be repatriated abroad e.g. the necessity for embalming prior to transportation. The Foreign and Commonwealth Office (FCO) may be able to advise on the entry requirements for any country relative to the carriage of deceased persons.

INTERPOL 15.5

Interpol recognises that the responsibility for co-ordinating the investigation, recovery and identification of victims will always rest with the ‘host nation’.

15.6

Factors such as geography, capability and the high proportion of victims (also political, religious or cultural reasons) may require a multi-national response.

15.7

If a multi-national response is required, this will be organised by Interpol however, the ‘host nation’ must always agree to any multi-national support effort.

FOREIGN AND COMMONWEALTH OFFICE (FCO) 15.8

The Foreign and Commonwealth Office (FCO) are able to respond and/or assist in fatality incidents involving either foreign nationals who have died or have been killed in the UK or British nationals who have died or been killed whilst overseas.

DEATH CERTIFICATION 15.9

In similar circumstances to those outlined at section 4.22, at the conclusion of the coroner’s proceedings, the Registrar of Deaths will be notified so that a Death Certificate can then be issued. It should be noted, however, that a Coroners Interim Certificate may not be sufficient to satisfy legal procedures overseas.

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SECTION 16 – DECOMMISSIONING AND CLOSURE 16.1

The Coroner, in consultation with the Senior Identification Manager (SIM), will decide when to close the mortuary.

16.2

The Mortuary Management Team will supervise the decommissioning of the disaster mortuary and ensure that the Post Mortem, Body Receiving and the Family Viewing Areas are clear of all waste and hazardous materials and the equipment is left clean.

16.3

It is probable that the following actions will be required: steam clean/disinfect all equipment, floor surfaces and refrigerated units/vehicles that will have been contaminated disposal of the wet area floor covering (as clinical waste) clean the whole floor area of the mortuary building clean all office floors and work surfaces clean all toilets, showers and kitchen/dining areas arrange for clinical waste skips to be removed, and have waste disposal records completed and retained arrange for the return of all contractors and health service equipment.

16.4

Once all equipment has been returned and cleaning carried out, the Mortuary Management Team will formally hand back the premises to its owners.

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Section 17

SECTION 17 – GUIDANCE ON DEALING WITH COSTS ASSOCIATED WITH AN EMERGENCY MORTUARY INTRODUCTION 17.1

Establishment and operation of a disaster mortuary, even for a short period of time, will cost a considerable amount of money. Several different organisations will be involved in the process. It is important therefore, that financial responsibilities are agreed before the mortuary is required to be established.

TYPES OF COSTS LIKELY TO BE INCURRED 17.2

Expenditure associated with the establishment and operation of the disaster mortuary is likely to fall into several categories: the initial construction or adaptation of the premises and any operating costs incidental costs incurred during operation: supplies, catering, telephone and fax charges etc. the professional fees and expenses of those medical and technical staff working within the mortuary the costs of the movement of the deceased to and from the disaster mortuary the costs of police officers time associated with the administration of the disaster mortuary the costs of liaison arrangements incurred by outside agencies displacement of existing arrangements site recovery / reinstatement of routine facilities.

RESPONSIBILITIES FOR PAYMENT AND RECOVERY OF COSTS 17.3

The payment of fees and expenses to people whose evidence will facilitate the conduct of an inquest is the responsibility of the Coroner (Coroners Act 1988, s.26).

17.4

The Coroner is also able to make expenditure in connection with the removal of the deceased to certain places provided for the purpose of making post-mortem examinations (Coroners Act 1988, s.22).

17.5

The Coroner is funded by the ‘relevant council’ (Coroners Act 1988, s.27). The ‘relevant council’ is the council which appoints the Coroner. However, any costs incurred by the Coroner ‘shall be apportioned’ between the authorities whose areas are covered by each Coroner’s jurisdiction.

17.6

If the deceased are found in the jurisdictions of more than one Coroner, the Coroners will decide amongst themselves the appropriate division of costs. This implies that responsibilities for costs will follow the same division.

17.7

The professional fees and expenses of persons, such as pathologists, working within the disaster mortuary are the direct responsibility of the Coroner as it is the Coroner who authorises the work. The costs of removing the deceased to the disaster mortuary are also the Coroner’s responsibility. The Coroner would therefore pay and reclaim these costs from the ‘relevant council’ in the same manner as for any other inquest.

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17.8

The costs of police officers’ time and associated expenditure should be aggregated with other police costs arising from the incident, for example the costs of administering the incident site. The police would then need to make a separate and complete claim for recovery of costs in the normal manner. It is however likely that only claims for costs in excess of normal operating budgets will be recoverable, so again, accurate and complete record-keeping will be vital.

17.9

Other organisations, including local authorities, will incur costs for liaison arrangements with the disaster mortuary, for example, the costs of social workers attending the mortuary with relatives. These are costs that the organisation would expect to incur in the normal performance of its role, but there may be excess costs directly attributable to increased workloads resulting from the disaster which would need to be recovered as detailed below.

AUTHORISATION OF EXPENDITURE 17.10 In practice the costs associated with an disaster mortuary will require authorisation by different people and will be dealt with in different ways: costs associated with the establishment and on-going provision of the facilities will need to be authorised by the authority responsible for provision of the disaster mortuary or persons acting on its behalf costs directly related to the facilitation of the inquests will require authorisation by the Coroner or persons acting on his/her behalf and will fall to the ‘relevant’ district council under the terms of the Coroners Act 1988 costs incurred by the police and other organisations in support of the operation of the mortuary will have to be authorised by the appropriate persons in the organisations incurring them. 17.11 In all cases, those authorising expenditure should have regard to obtaining best value. Whilst it would be unreasonable to expect any sort of prolonged competitive tendering procedure to be followed in an emergency situation, those authorising expenditure must be aware that any payments made may be the subject of future claims and possible legal action. They would be well-advised to record in writing at the time of authorising any expenditure the reasons for the particular decision and any steps taken, such as telephoning more than one supplier that would aid the later justification of their actions. RECOVERABILITY OF COSTS 17.12 Ultimately most costs incurred by the London Authorities in the response to a major disaster should be recoverable. Local authorities and other bodies carry their own insurance which, depending on the nature of the disaster, may cover some or all expenditure. Costs may be recoverable from those judged responsible for the incident or their insurers. 17.13 One way for local authorities to obtain recompense for disaster-related expenditure is by claiming from the Government through grant aid schemes such as the “Bellwin” rules (operated under Section 155 of the Local Government and Housing Act 1989), details of grant rates and thresholds are on the website: http://www.local.odpm.gov.uk/finance/bellwin.htm

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17.14 Whether costs are claimed from insurers, through the courts or from the Government, it is important that clear records are available showing the amounts expended and especially the authorisation for the expenditure. Having agreed procedures before an incident occurs aids the compilation of these records, which may need to be kept for many years until claims are settled. 17.15 The proper authorisation of expenditure will be the key to deciding which organisation will actually bear the costs and be in a position to recover them when responsibility for the disaster and its costs is final determined. SUMMARY 17.16 It is important that all expenditure associated with the disaster mortuary is properly authorised and clearly accounted for. Prior agreement about the responsibilities for costs will aid this process. Proper record-keeping will allow those making the expenditure the best possible opportunity of later reclaiming the costs from insurers, the Government or those judged responsible for the deaths which cause the temporary mortuary to be required.

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Section 18

SECTION 18 – DEBRIEFING 18.1

Debriefing serves a number of different purposes in any operation and fall into three general categories; the ‘hot’ debrief, the operational debrief, and the critical incident stress debrief. Each have some particular characteristics and each can be used either separately or in conjunction with one another, depending on the type of event to be debriefed, staff involved, organisational purpose, amongst a number of variables.

18.2

The immediate post event or ‘hot’ debrief can be used to capture information in fast time in order to promote and enable continuous improvement. Despite the name, it need not only be conducted at the conclusion of the event. It can be held at many distinct stages. For example, shift change, command handover, and operational phase completion will provide opportunities for these debriefs to take place. There are some general principles about a ‘hot’ debrief. It should be conducted before staff go off shift or are deployed to other duties. For this reason it should be short. Unless a traumatic event has occurred, (which is mentioned later), it should focus on immediate events and the suggested process is for the person responsible for first line supervision to ask staff to identify any operational difficulties that presented during the time period. They should also be asked how they overcame these issues. These should be recorded, quality assured by the supervisor, prioritised for action, and passed up the command chain.

18.3

In this way the ‘hot’ debrief can be a means of highlighting emerging themes and addressing potential difficulties before they become embedded in the operational process. High priority issues can be fast tracked to the appropriate command authority for decision and action, whilst other issues can be dealt with as a slowertime process. There should be a means for the information to be reviewed contemporaneously as part of the command support functions.

18.4

The main operational debrief is the next stage up the debriefing process. Generally, operational debriefing is a means of giving the opportunity to staff, involved in any event, to use their experiences in a determination of what took place in any specified aspect of that event. Debriefing ought to be viewed as part of the event process and integral to feeding back results. Debriefing should be seen as routine in all operations, and should, wherever possible, be planned in at the earliest possible opportunity. Debriefing should also be regarded as a vital part of the planning process for future events.

18.5

Operational debriefing is designed to analyse the event and seeks to improve future performance. It will also highlight any significant aspects of the event with a view to dissemination or identification of other work arising from it.

18.6

Its purpose should not be to apportion blame, but to identify the most and least effective aspects of the operation or event. It has many uses and these often determine the structure of the debrief itself.

18.7

The purpose and objectives of any debrief should be carefully agreed beforehand so that all necessary information is gathered and every one of the issues is covered. The debrief can be organised in any number of different ways. The simplest two processes are to divide participants into their functional groups for the debrief, or to divide participants along a timeline of the event.

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18.8

In either case, it should be borne in mind that it is at least as important to identify and repeat, where appropriate, those things that went well, as it is to identify and avoid those things that did not go well. In view of this, equal time should be apportioned to them. It is also useful to get the participants to reflect on what changes they would make in future as a result of their experiences.

18.9

Following this data collection phase, a report is compiled. This report can be used for a number for purposes. Fundamentally, however, the report is used as part of a process of continual improvement. The information gained should be fed back into the operational context as soon as practicable, and should also inform the development of training and doctrine.

18.10 One other important point about the report. It is common organisational practice, following a debrief that identifies areas for improvement, as all will, to restrict the circulation of the report. If the debrief has been conducted with an appropriate focus, i.e. ‘what happened’ as opposed to ‘who did it’, then this reaction should be actively avoided. Not only is it bad practice, but it actively inhibits the process of improvement that should form part of the culture of all modern organisations. 18.11 By applying this focus, the debrief process is the ‘engine room’ of operational practice; driving the process of identifying issues from real operations (or realistic exercises), analysing the results, and disseminating the learning for the benefit of all. 18.12 Both ‘hot’ and operational debriefs should be subject to some organisational policies about possible evidential issues, if the event experienced has the potential to involve future criminal proceedings. The general rule is that, so long as the participants have already made any evidential notes of their involvement prior to its commencement, the debrief can take place. Advice should be sought if any new evidential information arises out of the debrief itself. 18.13 The final debrief type can be broadly referred to as a critical incident stress debrief. This is generally used when staff have been exposed to traumatic events. The purpose of this debrief is to enable participants to talk about what happened and their reactions to it from a personal rather than an operational context. It is often most useful if the suitably trained debriefers are from a similar organisational background, as they will often have some experiences to draw on. This debrief is not for the benefit of the organisation, but for the benefit of those involved in it. It can help them to ‘normalise’ their experiences, feelings and personal responses to what has happened to them. 18.14 Staff conducting these debriefs should be suitably trained and there should be an organisational recognition that, as the purpose is broadly therapeutic, rather than operational, no records will be kept and that staff who were not involved in the event, (even at command level), should not be present. 18.15 Debriefing of operations and events has a number of organisational benefits if appropriately conducted. Fast time information capture and tactical changes can result; organisational learning can be gained and put into practice; and staff welfare can be assisted. It should be part of organisations’ planning for major events and operations, and is an important contribution to organisational effectiveness. As important as a plan for debriefing is that organisations develop a ‘culture of debriefing’ in which operational effectiveness and continuous improvement are seen as every staff member’s business.

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Enquiries to: London Resilience Team 1st Floor, Riverwalk House 157 - 161 Millbank London SW1P 4RR [email protected] www.londonprepared.gov.uk