Flu reports: We're not ready
by ICFA General Counsel Robert M. Fells, Esq.
The two-day Fatality Management Pandemic Influenza Working Group Conference held in March at Fort Monroe in Hampton, Virginia, resulted in the recent publication of four white papers available at www.icfa.org/government.htm
, the ICFA Web page. The conference was coordinated by NORTHCOM, the Joint Task Force Civil Support and the Department of Health and Human Services. The purpose of the event was to "bring members of the mortuary affairs community and other related subject matter experts within the federal, state, local and private sectors to focus on this potential challenge and help shape the way ahead with their recommendations."
The ICFA was represented by Past President Bob Gordon Sr., CCFE, and General Counsel Bob Fells. Other private sector organizations participating included the National Funeral Directors Association, the Cremation Association of North America, Service Corporation International, Batesville Casket and Matthews International. (See the May Washington Report for details.)
The goal of the conference was to publish white papers outlining recommendations and then disseminate those papers to a wider audience in government and the private sector. For discussion purposes only, conference participants were told to make the following assumptions: The number of individuals expected to perish during a pandemic influenza event in the U.S. may be between 5 percent to 7 percent of the infected population (the infected population estimated to be 25 percent) or 3,612,500 to 5,057,500. This death toll would be in addition to the usual mortality rate of 2.4 million people annually.
Coping with an influenza pandemic Each of the four papers covers a separate aspect of coping with a pandemic influenza attack. The title of each paper describes its subject matter: Morgue Operations, Identification and Command and Control of Mass Fatalities Resulting from a Pandemic Influenza Event in the United States;
Scene Operations, to Include Identification and Medico-Legal Investigation Protocols and Command and Control of Mass Fatalities;
The Provision of Family Assistance and Behaviorial Health Services in the Management of Mass Fatalities; and
Funeral Services and Final Disposition of Mass Fatalities.
The fourth paper may be of the most interest to funeral homes, cemeteries and crematories in that it explores several key issues such as: What are the overall limitations of the disposition system?
Are regulatory systems equipped to handle the demands of interstate licensure?
What is the extent of this comprehensive economic impact?
Is there a clear distinction of key stakeholders and their respective roles?
How are the respect and dignity of the deceased and surviving families maintained?
Among the top concerns expressed in managing mass fatalities is the following observation: "Funeral service personnel, suppliers and other mortuary service operations do not have priority access to resources. The ability to respond effectively to a pandemic event is completely dependent upon the availability of critical resources (vaccine, fuel, utilities, labor, raw materials, transportation, security, communication bandwidth, etc.)... State pandemic influenza plans must be adapted and/or modified to classify mortuary services personnel as 'first responders' and address resource, logistics and funding concerns."
With respect to reciprocal licensing on an emergency basis, the white paper observed: "States differ in requirements for licensing of funeral directors, embalmers, cemetery and crematory operators. Additionally, managing mortuary operations within a unionized workforce may require additional negotiations during an emergency... State Emergency Management Assistance Compacts (EMACs) should be modified to include reciprocal licensing of mortuary services personnel. State pandemic influenza plans must be developed, adapted and/or modified to address regulatory issues, including pre-adoption of necessary legislation."
The ICFA Government and Legal Affairs Committee recently concurred on a policy statement for use by state associations that urges the prompt amendment of state laws to enable the appropriate licensing agency to issue immediate temporary licenses to funeral directors, embalmers and crematory operators who are validly licensed in other states. The ICFA Executive Committee is considering the recommendation as of this writing.
The white paper's executive summary concluded with the following recommendation: "The collective insight of gathered experts through model simulation, brainstorming and peer critique/inquiry reveals a distinct misalignment between current government disaster planning and the realities of mass fatality due to pandemic conditions. It is clear that the National Response Plan Emergency Support Function (ESF) #8 lacks the depth and breadth necessary when facing a potentially dire tragedy of such immense proportion. An ESF so geared to medical services and preventing loss of life only acts as a disservice when morgue operations, body disposition, identification and all multifaceted peripheral operations are inadequately addressed. Further, it is recommended that an optimum integration of the issues identified during this collaboration be formed into actionable plans, with the utmost consideration being given to an ESF dedicated to mass fatality response."