Written by Sergeant Ronda Montgomery & Ryan M. Rezzelle   

A full-scale deployment training operation in the summer of 2012 tested and prepared the KCRMORG team for events in the future.

Countless scenarios — such as public health emergencies, tornado destruction, or hazardous chemical accidents - could result in a mass-fatality event. Now, the Kansas City Metropolitan Area (a bi-state region comprised of 119 cities and nine counties in Kansas and Missouri) has a new asset in its arsenal to help with the response of large-scale emergency incidents.

Currently, the local medical examiner/coroner (ME/C) is the sole legal authority to conduct victim identification, determine the manner and cause of death, and manage death certification—regardless of the size of the event.

A mass-fatality event is not defined by a specific number of deaths, but instead by the capabilities of a local jurisdiction being overwhelmed by the number of deaths at hand. This may happen quickly, depending on the size of the jurisdiction and access to the personnel or equipment necessary to recover, identify, and reunite decedents with their loved ones. In an effort to plan for the worst (but always hoping for the best), the Kansas City Regional Mortuary Operational Response Group (KCRMORG) was developed to assist the impacted ME/C and provide for an integrated response to a mass-fatality incident. Envisioned and set into motion by its commander, Mike Henderson, chief investigator for the Jackson County (Mo.) Medical Examiner’s Office, its mission is “…to provide the personnel and resources to facilitate an organized and effective response to mass-fatality events.”

Henderson’s vision was built off of his experiences with a federal-level program with the same mission, the Disaster Mortuary Operational Response Teams (DMORTs). Based on these experiences and the knowledge that the National Disaster Medical System prefers that local resources be used before the federal team is deployed, he began advocating for a metro area resource in case of emergency. In spite of Henderson’s knowledge, experience, and enthusiasm, support for a regional program was difficult to cultivate.

Then, an emergency of the worst kind struck. Joplin, Mo. was devastated by a powerful tornado on May 22, 2011. With no local, regional, or state assets available to perform the identification of the 158 people killed in the F5 tornado, DMORT was requested and responded to Joplin.

After Joplin, attitudes toward mass-fatality events changed dramatically.

Federal grants and local funding paved the way for the establishment of KCRMORG. After nearly five years of pre-planning and planning, the KCRMORG is now equipped with the necessary components of a portable morgue and family assistance center. All of the equipment is housed in a custom 53-ft. refrigerated trailer that is maintained by the Jackson County Medical Examiner’s Office.

Structured in accordance with NIMS/ICS (National Incident Management System/Incident Command System) principles, KCRMORG’s top leadership includes a commander and deputy commander who oversee various section chiefs, including administrative chief, chief medical officer, forensics chief, logistics chief, mental health chief, planning chief, safety chief, security chief, and training chief. A public information officer is also designated for any interaction with the media.

KCRMORG team members, comprised of Kansas City Metropolitan Area agency personnel, allow the KCRMORG to utilize local and regional resources with the capability to recover, transport, process and forensically identify decedents of a mass-fatality event occurring in the Kansas City Metropolitan Area. Team members are trained in the functional areas of site recovery of victims, morgue operations, and working with the team Victim Information Center. KCRMORG operates under standard operating procedures, modeled after federal DMORT protocols, that provide a comprehensive reference that describes the standard approach to mass-fatality management.

Those agencies involved with KCRMORG authorize their appropriately qualified and trained personnel to participate on and deploy with KCRMORG, as available, throughout the Kansas City Metropolitan Area, including the nine counties that fall within the Mid-America Regional Council (MARC) region. MARC has been instrumental in assistance with grant management and operational coordination.

There are multiple requirements for participation, including immunizations, completion of several Incident Command System classes, and general team orientation and training. Once approved, each member is under the operational control of the KCRMORG commander or designee, but remains administratively attached to their home agency.

By using the personnel from a variety of regional agencies, KCRMORG is a force multiplier in the absence of or prior to the arrival of the state or federal DMORT support.

When the Need Arises

If an impacted jurisdiction’s ME/C determines a need for KCRMORG assistance, requests for activation are made in conjunction with the impacted jurisdiction’s Emergency Management Director and funneled through the appropriate regional mutual aid coordinator. These coordinators will in turn contact the KCRMORG commander and request activation of KCRMORG. The commander dispatches an initial assessment team to the scene to determine resource and personnel needs. From there, a call-down to KCRMORG members can be initiated.

Local authorities and officials are aware of the high expectations of victims’ family members (and, by extension, the general public, politicians, and the media) concerning identification and morgue operations. Therefore, standard operating procedures were created to ensure a thorough and efficient victim-identification process, designed to minimize errors. These procedures are based on federal guidelines as well as the years of experience by the members of the KCRMORG team.

When the call comes in, a pre-deployment assessment team is immediately dispatched to the site to make estimations as to numbers of staff needed and potential obstacles and assets that can be used to facilitate the mission. Following the initial assessment group, team members are contacted and deployed along with the KCRMORG equipment, via the 53-ft. refrigerated trailer, to make this group fully functional in their mission of identifying the deceased.

Upon the arrival of KCRMORG staff, building the mobile morgue commences. This is a critical step as each deployment presents a unique structural configuration dependent on the disaster and the facility provided for the actual morgue operations. Ideally, any facility chosen for the mobile morgue will be equipped with running water, power, HVAC, restrooms, and a loading dock.

As with any mass-fatality event, maintaining security is a must as family members seek confirmation regarding their loved ones, the media seek leads, looters seek valuables, and the general public just plain gets curious. For liability, safety, and security concerns, access to the morgue is controlled by the KCRMORG security team. Authorized KCRMORG personnel are badged and a list of members is provided to the security team at each event. The teams work with local, state, or federal law enforcement to provide 24-hour security in and around the facility. Only authorized personnel are allowed in or around the mobile morgue. To assist in identification of on-site personnel, each team member must also sign in and out.

The morgue flow-plan and any specific needs of the ME/C will determine the basic floor plan of the morgue. However, it has the full forensic and identification capabilities, including:

  • Admitting
  • X-ray
  • Assessment pathology
  • Personal effects and photography
  • Dental
  • Anthropology
  • Fingerprints
  • DNA
  • Exit and re-bag
  • Embalming and casketing
  • Personal protective equipment (PPE) gown/de-gown and disposal

Integrity is of Utmost Importance

The location, collection, and recovery of decedents and other pertinent materials from an incident site requires a standard approach to ensure appropriate documentation and tracking. KCRMORG personnel can conduct and assist in the numbering and protection of decedents and additional scene activities that could impact morgue operations. Special consideration is made for contaminated recovery sites: decedents and evidence at such a site must be decontaminated prior to entry into morgue operations.

The decedents are documented appropriately at the recovery site and transported to the mobile morgue in a professional and dignified manner, often with a police escort. To ensure accountability, transportation logs are maintained for all decedents transported in this process. The mobile morgue is where the decedents are processed by forensic specialists to confirm identification and to conduct a medicolegal exam for determination of cause and manner of death.

All individuals directly involved with the deceased need protection from blood-borne and aerosol-transmissible pathogens. Therefore, to protect their eyes, skin, and mucous membranes, all individuals present during the body handling and examination wear appropriate PPE. This includes an impervious gown or long-sleeved Tyvek suit with impervious apron, a surgical cap, mask, gloves, shoe covers, and eye protection in the form of goggles or a face shield. As individuals may encounter dangerous pathogens during any stage of the exam, it is necessary the PPE be worn at all times.

Admitting Station: Upon the arrival of the deceased, individuals within morgue operations called “trackers” are assigned to take custody of one set of remains at a time in the Admitting Station of the morgue. There, the remains are assigned a Morgue Reference Number (MRN) as an internal tracking number. One single tracker is assigned to each victim from entrance into admitting through discharge from the morgue area. Trackers, as well as each section chief, are responsible for making sure the MRN on the decedent is the same as the assigned paperwork packet throughout the process.

X-ray Section: Upon completion in the Admitting Station, the trackers proceed to the X-ray Section of the morgue, where unopened body transport bags are x-rayed prior to the examination to ensure there are no obvious hazards such as a firearm or sharp object within the clothing of the deceased. All findings are noted, and x-rays are saved for review by the various doctors and pathologists working in the morgue.

Assessment & Pathology Section: The remains then proceed to the Assessment/Pathology Section. There, all clothing and personal effects are documented, and an examination is conducted that includes assessment of all trauma and associated injuries. With specific permission of the medical examiner or coroner in charge, implants located may be removed in an effort to obtain serial numbers on the implants that may help determine the possible identity.

Personal Effects Station & Photography Section: In the next area of the mobile morgue, a full inventory of all personal effects removed from the transport bag is completed. The items are photographed, logged, packaged, and properly labeled with the MRN assigned to the decedent.

Dental Section: The decedents are also examined by forensic dentists in the Dental Section. There, the section chief conducts a complete dental examination of the remains that includes dental charting and x-rays. Forensic odontologists and their staff, trained in the proper handling, examination, and evaluation of dental evidence, are consulted in the efforts to make dental identifications.

Anthropology Section: A full anthropological examination is completed within this section of the morgue. This can be especially beneficial for fragmented and partial remains. Anthropologists can evaluate bone and bone fragments to yield possible sex, age, race, and stature, as well as possible unique identifying aspects of the skeletal structure.

Fingerprinting Section: When there is sufficient non-traumatized skin on the surfaces of the hands of the decedents, the Fingerprinting Section will make every effort to collect fingerprints to aid in identification. The condition of the skin determines what procedure is performed to recover fingerprints, varying from ink and a print pad to using silicone-based casting materials. If possible, a ten-print card is completed, with any missing digits documented appropriately. The prints are then turned over to the appropriate law enforcement agency for further examination and possible identification.

DNA Section: As another means of identification, the DNA Section of the morgue collects genetic material for potential use in the identification of the deceased. DNA collected from remains can be compared against DNA databases, secondary standards from items believed to belong to the deceased (provided by family), or to DNA of family members themselves (collected by the Victim Information Center). In the DNA Section, a buccal swab and bone sample are preferred for recovery; however, the type of samples collected will be dictated by the condition of the remains.

Exit/Re-Bag Section: In the final station within the functional morgue, the tracker verifies and inventories the deceased and any personal effects against the paperwork. All items are placed in a new, clean body bag labeled on the outside with the appropriate MRN.

Victim Information Center (VIC) and Information Resource Center (IRC): Running concurrently to all other operations, VIC supports the mission in the collection of antemortem data, including DNA reference samples (secondary known DNA and family member DNA). The VIC interviews the next of kin and collects antemortem information. As this process moves forward, VIC members may also be requested to provide information to the next of kin and assist with death notifications. Anything that is learned by the VIC is transferred to the IRC. In the IRC, staff is responsible for matching postmortem and antemortem information, and providing that information to the ME/C.

The antemortem information sought by the VIC includes photographs, medical, dental, hospital, and surgical records, as well as other essential vital statistics from the next of kin. When matched at the IRC with the postmortem information garnered from the morgue, it serves as a contributing factor in the possible positive identification of the deceased. The proper positive identification is necessary for the formal notification of next of kin and the issuance of death certificates.

A loved one may presume a physical body that they are presented with is that of a loved one based solely on physical characteristics. However, in the face of tragedy and trauma, visual identification of a victim can frequently be subject to error. True confirmatory identification is based upon methods including:

  • Fingerprints (including fingerprints, handprints, toe prints, and footprints, if indicated)
  • Odontology
  • Radiology
  • DNA analysis
  • Permanently installed medical devices with recorded serial numbers
  • Distinctive physical characteristics (i.e. ears, scars, moles, tattoos) may be used for positive identification in very unique circumstances

The documentation of the identification, the cause and manner of death, and final disposition are required by law and used for vital statistics and the initiation of probate. The death certificate is the legal instrument for this process, and the local ME/C is responsible for all legal documentation pertaining to death certification.

After the Dust Settles

What goes up must come down. Therefore, demobilization commences when morgue operations have ceased. A standard process is used to ensure the morgue site is cleaned, the mobile morgue is packed, and a complete morgue inventory is completed so that re-supply requests can be submitted. This process includes several steps from general clean up to the removal of biohazard waste.

After-action reports (AAR) are critical for documenting the course of deployment. AARs assist in the future planning and response, indicate lessons learned, and may be useful in legal challenges to the identification process. The KCRMORG training officer is responsible for compiling notes indicating challenges, changes to the SOPs, unique circumstances, or other pertinent information. No later than one month after the deployment of the KCRMORG ends, the final AAR is provided to the KCRMORG commander to review for future planning and training.

Testing the Theory

Even the best preparation may lead to failure if adequate time is not invested for proper planning, training, and practice. That is why in the late summer of 2012, the KCRMORG put their theory to the test, conducting a full-scale deployment training operation in eastern Jackson County, Mo. After reviewing the final AAR, Commander Mike Henderson said, “I believe we have demonstrated our abilities, to ourselves and others in our region, that have surpassed all expectations of our team in such a short time.” So impressive was this training exercise, the KCRMORG has been asked to be a model for the State of Missouri in mass-fatality response.

The primary mission of the Kansas City Regional Mortuary Operational Response Group remains to serve the nine county MARC region, the home region of the team.

About the Authors

Sergeant Ronda Montgomery has served with the Jackson County (Mo.) Sheriff’s Office since 1994. She holds a bachelor’s degree in Criminal Justice from the University of Central Missouri. Throughout her career, Montgomery has been a field deputy, field training officer, off-duty coordinator, grant writer, and currently serves as the Public Information Officer for the sheriff’s office as well as the Kansas City Regional Mortuary Operational Response Group.

Ryan M. Rezzelle is the supervisor of the Crime Scene Investigation Section for the Johnson County (Kan.) Sheriff’s Office Criminalistics Laboratory. He holds a Master of Forensic Sciences degree from The George Washington University and two Bachelor degrees from the University of Maryland. Ryan has been a CSI for 13 years and holds Level III certification as a Senior Crime Scene Analyst through the International Association for Identification (IAI). Ryan is also the CSI Section Coordinator for the Midwest Association of Forensic Scientists.

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