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Life in a Disaster

Morgue
MASS DISASTERS MEAN TWO THINGS:
MULTIPLE DEATHS AND DMORT DEPLOYMENT.
The call comes anytime jetliners go Last Responders
down, de-orbiting shuttles disinte- DOUGLAS PAGE The National Funeral Directors
grate, terrorists raze skyscrapers, or Association (NFDA) is credited
killer hurricanes roar ashore. with conceiving the concept of
David R. Senn, DDS, a member of the Bexar DMORT in the early 1980s. NFDA was concerned at the
County, TX, Forensic Dental Team, was in Colorado time about lack of standards handling the dead in mass casu-
when his call came on Saturday, August 27, 2005, 48 alty events. Protocols needed to be imposed on a process
hours before Katrina made landfall. The commander of that had none. It was also soon apparent that the services of
the Region VI Disaster Mortuary Operational Response outside forensic professionals would be necessary to aug-
Team (DMORT) was calling. Katrina was a monster, ment local resources during disaster response. The NFDA
growing to a Category 5 hurricane on the Saffir Simpson subsequently purchased the components of the first portable
scale, and headed straight for New Orleans. Destruction morgue, called a Disaster Portable Morgue Unit (DPMU).
and death was certain. DMORTs and DPMUs are now part of the National
Senn, a veteran forensic DMORT odontologist, was Disaster Medical System (NDMS), a section of Operations
to report to Baton Rouge, LA, where a temporary morgue Branch of the Federal Emergency Management Agency’s
was being set up in an empty brick warehouse in nearby (FEMA) Response Division. NDMS determines when to
St. Gabriel, a Louisiana town of 6,000, once home to a activate, which DMORTS to deploy, and where the
leper colony. There would be bodies to identify. Senn DPMUs are to be dispatched - usually any incident in
altered his plans, caught the next which the number of casualties over-
plane back home to San Antonio, Body identification whelms local forensic or mortuary
cleared his teaching schedule, collect- resources. The country is divided into
ed his DMORT grab-and-go bag con- in the aftermath of ten DMORT regions, geographically
taining enough gear, clothing, and similar to the ten Federal Emergency
personal items to last about two Katrina was made Management Agency (FEMA) regions.
weeks, and was in Dallas on Sunday, In 1997, the Aviation Disaster
where his team assembled before car- particularly Family Assistance Act was signed into
avanning 370 miles overnight to law in response to several aircraft acci-
Baton Rouge, arriving at 3 A.M. difficult by the poor dents. The Act directed the National
Monday, August 29, just as Katrina Transportation Safety Board (NTSB)
began pounding the Gulf coast. condition of corpses to coordinate federal resources to iden-
“We took 30 people from tify victims. The NTSB then signed an
Dallas to Baton Rouge, including some left for days if agreement with NDMS to provide
the DMORT Region VI commander, DMORT support in such cases. In
deputy commander, and adminis- not weeks in 1998, a DMORT team specializing in
trative officer,” said Senn, a diplo- bio-chemical fatalities was created in
mat of the American Board of contaminated flood response to increasing concern for the
Forensic Odontology (DABFO). release of weapons of mass destruction
Another deputy commander lived in waters. Visual by terrorists.
Baton Rouge and was already on The DMORT idea has rooted. A
the job. Region VI covers Texas, identification was small group of DMORT members is
Oklahoma, New Mexico, Arkansas, now routinely deployed in advance of
and Louisiana. generally impossible. situations where mass fatalities might

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result from terror attack, such as presidential state-of-the- ray devices and full body X-ray machines, as well as a full
union addresses, papal visits, or Olympic Games. complement of office computers, faxes, and forms - all
Since their 1993 formation, DMORTs have responded accompanied by a team of experts called Red Shirts.
to about twenty incidents, from cemetery floods and plane “All DMORT members are cross-trained to help
crashes to train derailments and terror attacks. Senn, for quell the initial chaos when setting up and getting
instance, was part of the team called to attempt dental iden- started,” Senn said.
tification at the 2001 World Trade Center disaster and Then, as soon as possible, pathologists, anthropolo-
again at the 2003 STS-107 Columbia crash. gists, and odontologists begin the solemn task of examining
DMORTs usually cover disaster incidents in their and documenting victims.
own area, although four DMORTs were dispatched to
New York City following September 11, three to Death is Wet
Washington, D.C., and one to Somerset County, PA. Film critic Roger Ebert says every single movie depicting a
Katrina was even more unusual. All ten teams were morgue uses dripping or running water on the sound track.
mobilized to the Gulf Coast. Katrina provided enough real water to make artificial
“That’s unprecedented,” said Patricia Kaufmann, moisture unnecessary. At St. Gabriel, heavy gauge plastic
MD, commander of DMORT Region III (Pennsylvania, was spread over the warehouse floor to insulate the facil-
Maryland, Washington DC, Delaware, Virginia, and ity against the damp. Then, air-conditioned tents were
West Virginia). erected for each station. The dental exam area, for exam-
Still, the nationwide DMORT response to the Gulf ple, was set up in an area about 14 ft. by 45 ft. housing
Coast was scarcely enough. Remains were still being three post-mortem bays so dental teams of three or four
recovered seven weeks after the storm. Brian Chrz, dentists each could work simultaneously.
DDS, DABFO, a Perry, OK, forensic odontologist said There was much to do. Katrina killed over 1,250
six weeks after the storm DMORTs were using dental people, nearly 850 of whom were taken to St. Gabriel.
resources wherever they could find them. Fourteen more bodies were found the week of October
“We used military and public health dentists if they 14, forty eight days after the storm.
were available,” he said. “We preferred teams of four so one person can take a
break for an hour or two without interrupting the identifi-
License to Heal cation process,” said Chrz, who previously worked the
During emergency response, DMORTs work under the World Trade Center and the 1995 Murrah Federal
direction of local authorities, providing technical assistance Building bombing in Oklahoma City. Chrz also spent time
in recovering, identifying, and processing the deceased. in Thailand following the 2004 Indonesian tsunami.
DMORTs are truly traveling morgues - composed of medical Forensic professionals work 12-hour 7-7 shifts, ideally
examiners, coroners, pathologists, forensic anthropologists, rotating in and out of the disaster site every two weeks.
funeral directors, medical records technicians and tran- Inside, morgue operations are controlled by a regiment-
scribers, fingerprint specialists, forensic odontologists, den- ed protocol, capable of processing up to 140 bodies a day.
tal assistants, X-ray technicians, mental health specialists, The remains, which have been stored in body bags
as well as computer professionals, administrative support in refrigerated trucks, are first cleaned and decontami-
staff, and security and investigative officers. nated with a chlorine solution, assigned a number, fold-
DMORT members are required to maintain appro- er, and escort, before being moved to forensic stations.
priate certification and licenses within their discipline, but A forensic pathologist then examines, photographs,
when teams are activated customary regional licensing and X-rays the body at the first station. Personal items such
issues are suspended and all professional licenses and cer- as jewelry are inventoried. Fingerprints are taken when the
tification are legally valid in all 50 states. Team members condition of the body permits. When prints are not on file,
are compensated for duty time by the federal government FBI agents or local law enforcement may obtain latent
as temporary federal employees. Most take leave of prints from personal belongings in victims’ homes. Body
absence from their regular jobs. Like National Guard per- identification in the aftermath of Katrina was made partic-
sonnel, DMORT members are given job security. ularly difficult by the poor condition of corpses some left
At the same time DMORTs were activated for for days if not weeks in contaminated flood waters. Visual
Katrina, two DPMUs were also ordered south, to provide identification was generally impossible.
temporary mortuary services. FEMA’s Response Division Pathologists also look for other potential identifiers
maintains two of these forensic caches, staged at the two like tattoos, scars, orthopedic devices, and surgical
FEMA Logistics Centers; one in Rockville, MD, the other implants. Pacemakers and orthopedic devices are partic-
in San Jose, CA. Both were deployed for Katrina; one to ularly useful; newer units have serial numbers that can
Gulfport, MS, the other to St. Gabriel. be tracked through manufacturer’s records.
Depending on the incident, DPMUs can be dis- Autopsies are sometimes necessary.
patched by rail, truck, or air. Each unit contains over “We examine the bodies inside and out looking for
10,000 individual items, ranging from exam tables, for- any clues that will help us determine who this person is,”
ceps, scalpels, and hemostats to high tech digital dental X- said Kaufmann, one of several forensic pathologists on

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each team. Kaufmann, a Johnson & Johnson research ante-mortem dental X-rays that were missing or destroyed
physician in her other life, was previously deployed to the by the storm. Normally, a DMORT unit called the Family
crash site of United Airlines Flight 93 on September 11, Assistance Center (FAC) will collect all ante-mortem
2001, the 2002 Walker County, GA, crematorium inci- records from dental offices. FACs also serve as the buffers
dent, and the 2003 Providence, RI, night club fire. between temporary morgue operations and those search-
DMORT autopsies are different than routine forensic ing for lost family members.
proceedings because the primary focus is not on determining “Usually, families will come in and say so and so is
cause of death but rather on finding positive identification. missing, but there will be some sort of list like a flight man-
“In this case, we usually know how they died,” ifest that we can work from,” Chrz said. Hurricanes leave
Kaufmann said. no manifest. In New Orleans, dental offices were flooded
Forensic anthropologists help by creating a profile and everyone, including dentists, was evacuated. Initially
of the remains based on skeletal assessment of such things there was no one even to report who was missing.
as age, sex, ancestry, and stature. “The most difficult job was not actually doing post-
“We’re trained to identify fragments of bones, mortem examination and charting, it was trying to get
which is what you get in plane crashes,” said Mercyhurst enough ante-mortem information together just to find
College forensic anthropologist Dennis Dirkmaat, a out who’s missing,” Chrz said. Even where ante-mortem
diplomat of the American Board of Forensic dental records survived the storm and existed intact, the
Anthropology, and one of the first DMORT volunteers in dental offices were closed and the dentists and office
1994. “Even with X-rays, it’s hard for a pathologist to staff nowhere to be found.
determine what the bone is. Sometimes, we can feel a “First, we have to find the dentists, something we’ve
fragment and know that it’s, say, a right proximal never had to do before,” said Kaufmann, who spent six weeks
humerus. Pathologists are not trained to do that.” in Gulfport, MS, working at the pathology station, then, after
Forensic anthropologists are also adept at reading a short break, was reassigned to the FAC at St. Gabriel.
X-rays to determine bone age. “There is a relationship Kaufmann said the family assistance process can be
between the age of the individual and the amount of lip- emotional because families have to answer detailed questions
ping—lip-like structures sometimes found at the articu- about the missing - describing any tattoos, surgeries, or pre-
lar end of an osteoarthritic bone,” Dirkmaat said. vious bone fractures - all while grieving at the same time.
Forensic anthropologists now use computers to aug- “Sometimes, they’re not even certain there has been
ment their fingers. Programs such as Fordisc (Forensic a death, making it all the more difficult,” she said.
Anthropology Center, University of Tennessee) help clas-
sify unknown skeletal remains based on measurements. Gene Sweep
“These are valuable in cases where you have signifi- Mitochondrial DNA (mtDNA) is another important tool
cant decomposition,” Dirkmaat said. now included in the DMORT arsenal for positive identi-
For the most part, Katrina victims were intact, though fication and reassociation of remains. As with dental
many were badly decomposed after so long in the water. identification, mtDNA requires post-mortem samples to
There were also numerous cemetery remains to deal with. compare to ante-mortem or family reference samples.
“The storm hit cemeteries, too, sometimes destroy- DMORT DNA specialists are trained to collect DNA
ing coffins, so skeletal remains and bone fragments were samples from family and victims.
later found on adjacent properties or on the beach,” “Typically, we like to take it from the same bone,”
Dirkmaat said. Dirkmaat said. “Currently, when possible, we take sam-
ples from the right tibia.”
To the Teeth DMORT uses DNA protocols established by the
The dental examination and digital X-ray station is next, Armed Forces DNA Identification Laboratory, which
where Senn, Chrz, and other odontologists record dental specifies that samples be treated as evidence, requiring
characteristics. Dental records are the traditional gold chain of evidence documents.
standard of forensic identification. Some have questioned whether traditional medical
A new addition here is digital imaging, which elimi- and dental radiographs and fingerprinting are still neces-
nates the need for conventional film-based dental X-rays. sary in light of the accuracy of mtDNA identification tech-
With digital technology, images are transferred directly niques. The answer seems to be that DNA still takes too
into computer storage and can be viewed immediately on long to process and is too expensive to replace the more
computer monitors, enabling easier, faster ante-mortem conventional, if less absolute, forensic methods. After the
and post-mortem comparison. During the 1999 1996 crash of TWA Flight 800, all 230 victims were iden-
Bourbonnais, IL, Amtrak derailment, identification of a tified through DNA, but it took 13 months.
victim from Japan was facilitated by Internet transmission After passing through all the stations, the remains are
of dental radiographs sent from Japan to DMORT odon- properly returned to the refrigerated trucks to await formal
tologists at the crash scene. identification, at which time the body is embalmed either by
In the case of Katrina, however, the comparison DMORT or local morticians - at the choice of the family -
process was aggravated by the almost total absence of then released for final disposition to a funeral home.

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F rensic M A G A Z I N E
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No Place Like Home “DMORT people consider themselves strangely
The turmoil in the first days following the storm invited a lucky in that they actually get to go to disaster sites and
strange paradox at the DMORT camp in Gulfport. The do something useful,” Senn said.
convoy of refrigerated trucks brought in to store unidenti- Training accounts for their efficiency. Dirkmaat, for
fied remains served as temporary housing for the living. instance, teaches forensic anthropology year around.
“When we first arrived, we slept in cars and inside Dirkmaat said DMORT work is not like routine civil
the trucks that had been brought in to house the bod- cases, where you may have a day or two to do a forensic
ies,” said Richard A. Weems, DDS, DABFO, a DMORT examination. “This is more like a MASH unit - the
odontologist and director of clinical operations at the remains come to your table and you have to be quick. In
University of Alabama School of Dentistry. Weems said ten to fifteen minutes, you’re moving the body on to the
during the first few days, the teams had to endure next station,” he said.
Spartan conditions, including scant food supplies, no Senn said being prepared is a matter of being trained
running water or electricity, shortages of fuel, and lack and ready to work as a team, yet remaining flexible enough
of a communication infrastructure. to adjust to whatever the situation presents. When adjust-
While DMORT’s needs were met in fairly short order ment becomes a little more difficult, every DMORT has
by FEMA and units of the Mississippi National Guard, some mental health professionals available to deal with special
were surprised that NDMS decided to establish the Gulfport problems that arise, and every team member has an exit
DMORT operation squarely in the disaster area, presenting interview with the mental health unit.
something of an unnecessary hardship for DMORT person- “DMORT is very attentive to the psychological
nel whose job is already inherently stressful. needs of their members,” Chrz said. Psychiatrists and
“The storm didn’t affect the entire state of psychologists are not only on duty at the site, they keep
Mississippi, so why not just move the operation and bring in regular contact with DMORT members for up to a
the bodies out to you and be comfortable?” Dirkmaat won- year following an incident, looking for signs of unhealthy
dered. “Working in a morgue twelve hours a day is stress- coping mechanisms.
ful enough, why make people sleep on a cot with thirty Team members have evolved their own more infor-
other people in a school room?” mal means of dealing with stress. Many decompress after
Eventually, DMORT moved into air conditioned a shift by hanging out together, sharing experiences - all
tents, and later still into hotels in Biloxi. while keeping a learned eye on each other.
Conditions were similar in St. Gabriel, where dozens of “Many of us have become friends over the years at
DMORT people slept dormitory-style in an unused elemen- previous deployments and training sessions,” Weems said.
tary school and on air mattresses in an unfinished condo unit. Ultimately, the reward of performing a public service
“They house you wherever they can,” Chrz said. well is the greatest bracer. “The work itself is the psycho-
“You might have to sleep in tents.” logical salve that helps us deal with disasters,” Senn said.

The Job as Tonic


Some physicians, dentists, and other forensic professionals are Douglas Page (douglaspage@earthlink.net) writes
drawn to DMORT work in spite of the bleak, austere condi- about science and medicine from Pine Mountain,
tions at disaster scenes. The job itself is the lure, and the tonic. California.

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