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Mass Fatality Planning

Federal, state, and local agencies are preparing for mass fatality events; this requires participation and collaboration at all levels within agencies and organizations.  The Office of the Chief Medical Examiner (OCME) has developed the following documents to assist localities in planning for mass fatality events.

Mass fatality events may present as an increase in the number of natural deaths due to a natural disease process such as pandemic influenza or Severe Acute Respiratory Syndrome (SARS) in which case the deaths are due to a natural disease process occurring under natural or non-suspicious circumstances.  Management of these deaths is the primary responsibility of the locality in which they occur, with the OCME providing information and guidance.

Mass fatality events due to unnatural causes, for example, bioterrorism agents such as anthrax, smallpox, Ebola or other biological weapon of mass destruction are homicides due to a biological bullet and, as such, come under the primary jurisdiction of the OCME for management and disposition.  Events such as hurricane, flood, earthquake, tsunami, and other “natural” but catastrophic events result in deaths due to accidental causes and circumstances and are also medical examiner cases.  Terrorist attacks such as the World Trade Center, Pentagon, and Shanksville, Pennsylvania plane crashes and deaths due to arson related forest fires are all homicides while the deaths of the associated terrorists are suicides.  All of the foregoing unnatural deaths come under the primary jurisdiction of the OCME.  Once it is apparent that the deaths are due to a naturally occurring disease as opposed to a catastrophic event of nature, terrorism, or deliberate man-made act of destruction, then localities can plan on how to manage the deaths locally as the primary manager in the first instance and how to work with the OCME as the primary manager of the unnatural deaths in the second instance.

For information on mass fatality events in Virginia, the Guidelines for Managing a Mass Fatality Event presents an overview of the OCME’s role in mass fatality events with an all-hazards approach, describing how and when a locality should report deaths to a Medical Examiner, and how a locality should manage human remains during a mass fatality event. 

Individuals who want to learn more about the OCME’s involvement with natural death events, including pandemic flu, are referred to the OCME: Flu Issues Powerpoint presentation in which they will learn about what natural deaths are the OCME’s jurisdiction, our missions, our role in protecting the public’s health, and our collaborations with partners.  The presentation includes basic information for localities on the management of human remains during a mass fatality event due to natural disease.  

Planning for Pandemic Influenza Fatalities

Local authorities are currently planning how to manage an increase in natural deaths due to a pandemic influenza event in the Commonwealth of Virginia.  It is an undeniable fact that if a pandemic were to arrive, citizens will succumb to the disease or related secondary causes.  Local medical facilities, first responders, funeral directors, and many others need to prepare for managing the possibly high numbers of additional deaths during a pandemic.  The Managing Pandemic Influenza Fatality Events brochure contains an overview of what localities need to plan for during a pandemic event including signing and filing death certificates, handling human remains, and storage considerations.  Additionally, the OCME has prepared pandemic flu death estimates derived from VDH projections and CDC’s FluAid 2.0 software and presented by Planning Districts, Virginia Department of Emergency Management Regions , and by Virginia State Police Divisions.  While these numbers are estimates, they provide local authorities with an idea of how many deaths they might see in their locality and encourage collaboration with other districts/regions to manage fatalities.  While pandemic flu deaths would be natural deaths, the protocol for pronouncing the death, signing the death certificate, and handling the remains would not differ from that of seasonal flu, except that there would be higher numbers.  For a review of the protocol for managing pandemic flu deaths, interested readers may review the Flowchart for In-Hospital Pandemic Flu Deaths or the Flowchart for Out-of-Hospital Pandemic Flu Deaths

Additional information on Pandemic Flu is available at the following website:

All of the below files are contained in the above summary but have been separated out for your reading convenience. These files require the free Adobe Acrobat Reader adobe icon.

The following file is a PowerPoint presentation:


Medical Examiner District Offices:

Central District: 804-786-3174
Northern District: 703-764-4640
Tidewater District: 757-683-8366
Western District: 540-561-6615

Last Updated: 01-10-2012

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