Last responders: Disaster morgue tech

Lalynn Pecha, a magnetic resonance imaging technician, was at work at Grand View Hospital in Sellersville, Pa., when her phone rang early in September, just after Hurricane Katrina slammed the Gulf Coast. The commander of her Disaster Mortuary Operational Response Team was calling, and Pecha was to report to Gulfport, Miss., to a temporary morgue set up to identify the dead.

Calls like that go out any time the number of disaster casualties overwhelms local forensic or mortuary resources.

DMORTs and DPMUs
DMORTs are traveling morgues, complete with medical examiners, coroners, pathologists, forensic anthropologists, funeral directors, medical records technicians and transcribers, fingerprint specialists, forensic odontologists, dental assistants, X-ray technicians, and mental health specialists, plus security and investigative officers and support staff.

DMORTs are under the National Disaster Medical System, part of the Operations Branch of FEMA’s Response Division. There are 10 DMORTs, one for each FEMA region.

Team members are compensated as temporary federal employees for their duty time. Most take leaves of absence from their regular jobs, but like National Guard soldiers, DMORT members are given job security. Patricia Kaufmann, M.D., commander of DMORT Region iii, for instance, is a Johnson & Johnson research physician. (A small group of DMORT members is now routinely deployed in advance of situations where mass fatalities might result from terror attack, such as State of the Union addresses, papal visits or Olympic Games.)

The technological marvels the teams work in are called Disaster Portable Morgue Units, and they’re deployable by rail, truck or air. Each of the two dpmus contains more than 10,000 individual items, from routine medical gear like exam tables, forceps, scalpels and hemostats, to digital dental X-ray devices and full-body X-ray machines, as well as a full complement of office computers, faxes, and forms.

Since the DMORTS’ formation in 1993, the teams have responded to about 20 incidents, from cemetery floods and plane crashes to train derailments and terror attacks. On Sept. 11, 2001, four DMORTs were dispatched to Ground Zero, three to the Pentagon and one to the Somerset County, Pa., crash site of United Airlines Flight 93.

Katrina was different: All 10 DMORTs were assigned to the Gulf Coast, as were both dpmus, one to Gulfport, the other to an empty warehouse in St. Gabriel, La.

“That’s unprecedented,” says Kaufmann, who’d previously worked the crash of Flight 93; the 2002 Walker County, Ga., crematorium incident; and the 2003 Providence, R.I., night club fire.

Death is wet
Kaufmann was a veteran, but Katrina was Pecha’s first deployment. Outside the morgue, 22 refrigerated tractor-trailers were parked shoulder-to-shoulder. The bodies were inside the trucks, in black bags, also shoulder-to-shoulder.

Film critic Roger Ebert says every movie scene depicting a morgue uses dripping or running water on the sound track. Katrina provided enough real water to make artificial moisture unnecessary. At St. Gabriel, heavy-gauge plastic was spread over the warehouse floor to insulate the facility against the damp.

Air-conditioned tents were then erected for each station. The dental exam area, for example, was about 14 by 45 feet and included three post-mortem bays so teams of three or four dentists each could work simultaneously.

There was a lot to do. Katrina killed more than 1,250 people, nearly 850 of whom were taken to St. Gabriel. There seemed to be no end to the body bags, and remains were being found two months after the storm.

DMORTs operate under a regimented protocol that’s capable of processing up to 140 bodies a day. The remains are first cleaned and decontaminated with a chlorine solution and assigned a number and a folder. Then a forensic pathologist examines, photographs and X-rays the body. Personal items such as jewelry are inventoried. Fingerprints are taken, when body condition permits.

Forensic professionals work 12-hour shifts, from 7 till 7, and ideally rotate in and out of the disaster site every two weeks. A strong camaraderie also helps deflect the gravity of the job.

“We prefer working in teams of four, so one person can take a break without interrupting the identification process,” says Brian Chrz, d.d.s., a Perry, Okla., forensic odontologist, who previously worked Ground Zero and the 1995 Murrah Federal Building bombing in Oklahoma City.

Identification expertise
Body identification in Katrina’s aftermath was complicated by the poor condition of many corpses, some left for days or weeks in foul flood waters. Visual identification was frequently impossible.

Pathologists therefore seek potential identifiers like tattoos, scars or surgical implants. Pacemakers and orthopedic devices are particularly useful; newer ones have serial numbers that can be tracked through manufacturer records.

“We examine the bodies inside and out looking for any clues that will help us determine who this person is,” says Kaufmann.Autopsies are sometimes necessary, but DMORT autopsies are different from routine forensic proceedings, because the primary DMORT focus is on positive identification, not on determining cause of death.

“We usually know how they died,” Kaufmann says.

Forensic anthropologists can create profiles of the remains based on skeletal assessment of such things as age, gender, ancestry and stature.

“We’re trained to identify bone fragments, what you get in plane crashes,” says Mercyhurst College forensic anthro­pologist Dennis Dirkmaat, one of the first DMORT volunteers in 1994. “Even with X-rays, it can be hard for a pathologist to determine which bone it is. Sometimes, we can feel a fragment and know that it’s, say, a right proximal humerus. Pathologists are not trained to do that.”

Forensic anthropologists now use technology to augment their fingers. Computer programs (such the University of Tennessee’s Fordisc <http://web.utk.edu/~anthrop/facpubs.html>) help classify unknown skeletal remains based on measurements, which is valuable when there is significant decomposition.

To the teeth
Each dpmu has a dental station, where odontologists record dental characteristics. Dental records are the traditional gold standard of forensic identification.

A new technology here is digital imaging, which eliminates the need for conventional film X-rays. Instead, images are transferred directly into computer storage and can be viewed immediately on monitors, enabling easier, faster ante-mortem and post-mortem comparison. Following a 1999 Amtrak derailment near Bourbonnais, Ill., identification of a Japanese victim was facilitated by Internet transmission of dental radiographs from Japan to DMORT odontologists at the scene.

In New Orleans, however, the comparison process was aggravated by the almost total absence of ante-mortem dental X-rays, missing or destroyed by the storm. Normally, a DMORT unit called the Family Assistance Center collects ante-mortem records from dental offices. facs also serve as buffers between morgue operations and those searching for lost family members.

“Usually, families come in and report someone missing, or there will be a list like a flight manifest we can work from,” Chrz says.

After Katrina, many New Orleans dental offices were flooded like everything else, and everyone, including dentists, was displaced. Initially, there was no one even to report who was missing. Even where dental records survived the storm intact, dental offices were closed, and dentists and office staff nowhere to be found.

“This time we had to find the dentists first, something we’ve never had to do before,” says Kaufmann.

Mitochondrial DNA (MTDNA) analysis is another new technology in the DMORT arsenal for identifying and reassociating remains. As with dental identification, mtdna requires post-mortem samples to compare to ante-mortem or family reference samples. DMORT dna specialists are trained to collect DNA samples from family and victims.

After passing through all the stations, the remains are returned to the trucks to await formal identification, at which time the body is embalmed, then released for final disposition.

Life in a disaster morgue
The turmoil in the first days following the storm invited a strange paradox at the DMORT camp in Gulfport: The convoy of refrigerated trucks brought in to store the bodies served also as temporary housing for the living.

“When we first arrived, we slept in cars or inside the trucks that had been brought in to house the bodies,” says Richard A. Weems, D.D.S., a DMORT odontologist and director of clinical operations at the University of Alabama School of Dentistry. During the first few days, he says, the teams had to endure scant food supplies, no running water or electricity, shortages of fuel, and a lack of a communication infrastructure.

While DMORT’s needs, including mess tents, were soon met by FEMA and units of the Mississippi National Guard, some DMORT professionals were surprised that ndms decided to establish the Gulfport operation squarely in the disaster area, presenting an unnecessary hardship for personnel whose jobs are already inherently stressful.
“The storm didn’t affect the entire state of Mississippi, so why not just move the operation and bring the bodies out, and be comfortable?”

Dirkmaat wonders. “Working in a morgue 12 hours a day is stressful enough. Why make people sleep on a cot with 30 other people in an elementary school classroom?”