The way in which we manage fatalities has a direct effect on the living. Although we cannot always prevent the premature loss of life, our actions can help to avoid additional suffering and reduce the likelihood of others being harmed in the future. This can be done by:
- ensuring the respectful treatment of those who have died
- investigating the cause of death
- preventing other accidents or criminality
- protecting public health
- mitigating the mental and physical health effects of bereavement.
This guidance is about preparing for emergencies which result in the deaths of large numbers of people and deals specifically with the management of the fatalities that occur. It seeks to assist agencies that have duties under the Civil Contingencies Act (2004), the Public Health etc. (Scotland) Act (2008) and other legislation. It recommends both preparations that are required now and actions that will be needed immediately following a mass fatality emergency.
The guidance is set within the established principles of Integrated Emergency Management (IEM), as described in Preparing Scotland, and the statutory duties of Category 1 responders. It assumes that these generic arrangements are in place and recognises Local Authorities, NHS Boards and the Police as the agencies most involved in developing and maintaining the additional capabilities that relate specifically to mass fatality emergencies. It complements other national guidance, in particular Responding to Emergencies in Scotland and Care for People.
Two main types of mass fatalities emergencies are distinguished:
- intensive emergencies, which are localised and usually require investigation to assess criminality or negligence and
- extensive emergencies, which are not localised and where the general circumstances of the deaths are often already known, such as widespread natural disaster or illness.
Intensive incidents, such as those due to accident or hostility, typically require the involvement of the Procurator Fiscal and sometimes specialist Disaster Victim Identification (DVI) officers. Forensic pathology may also be needed, changing the mortuary requirements from a place where bodies are stored, to one where post mortem examinations and the collection of evidence is central.
The requirement for Category 1 responders to plan for reasonably foreseeable emergencies of this sort and to have in place appropriate local capacity is covered by this guidance. The role of business continuity and mutual aid arrangements are also noted. The use of specialist body storage facilities and the National Emergency Mortuary Arrangements (NEMA) are set out, including references to the preparations that Category 1 responders should make to incorporate these in their overall response.
Pandemic influenza is given as an example of an extensive emergency, and the roles of planners and responders are discussed by considering various stages in the provision of care for deceased. These include:
- collection of the body from the home of the deceased or from a hospital
- storage of the body
- mortuary provision
- registration of the death
- funeral director services
- religious observances
- burial or cremation arrangements.
There is a need for Regional Resilience Partnerships (RRPs) to assess and plan for the large number of additional deaths possible during an influenza pandemic. This includes determining the correct combination of measures to increase both capacity and rates of throughput in the various stages of this process. The importance of having effective business continuity management for all parts of the response is stressed, as is the need for RRPs to be able to maintain logistical oversight and to intervene to prevent potential problems. This function is complicated as some of the agencies involved are non-statutory, with commercial interests or with dependencies on voluntary and lay members. It is recognised that the oversight of such a response will be less familiar to some Category 1 responders; however management of services in this way will be essential to make the best use of available resources and may be of lasting benefit to those who have been bereaved.
Note on the legal status of guidance:
The guidance is not prescriptive and should be read in conjunction with any relevant legislation. This guidance is not, and is not meant to be, a comprehensive description of applicable legislation or of any legal obligations. If you are in any doubt about any legal obligations which are contained in applicable legislation or otherwise, you are advised to seek your own independent legal advice.