Many people work to make our society a safe place to live and do so, directly and indirectly, in a wide variety of roles. We depend on those who clean and maintain our environment, design safer vehicles, buildings and equipment, as well as those who protect us from hostility and respond to emergencies. Almost all of us have a part to play. Unfortunately we cannot always be successful in preventing harm or, in extreme cases, the premature loss of life. But even when this happens there are steps that can be taken and practices put in place to avoid additional suffering by those who remain: providing support for the bereaved, caring for the deceased's body and pregnancy losses appropriately and respectfully, and investigating the circumstances and causes of death so as to minimise the risk of similar adverse circumstances harming others. How we respond to and learn from the deaths of our fellow men and women therefore has a direct effect on the wellbeing of the living, sometimes immediately, when resources are diverted in response to an emergency, and sometimes more gradually as changes take place to ensure increased safety.

This guidance is concerned with preparing for the aftermath of events which result in the deaths of large numbers of people and specifically with the management of the fatalities that have occurred. It seeks to assist agencies which have duties in this area under the Civil Contingencies Act (2004) and other legislation. It recommends both preparations that are required now and actions that will be needed immediately following mass fatality emergencies. It is particularly relevant to the Police, Local Authorities, National Records of Scotland (NRS) and NHS Boards, who, in their various capacities, will be involved with incident scene management, incident investigation, provision of mortuary and pathology services, the registration of the death, and the burial or cremation of the deceased. It also considers some private organisations, funeral directors and faith groups, who will have a significant role during and after a mass fatalities emergency.

The guidance assumes that the established principles of IEM, set out in Preparing Scotland, are being applied and does not repeat generic advice that is available elsewhere and will be familiar to most readers. References to some of the most important information sources are given in Appendix 1.

In this guidance, the term “mass fatalities” is used to mean:

• Deaths in larger numbers than can be managed under the normal procedures of one or more of the agencies involved; or
• Deaths where the number or fragmentation of bodies, taken together with the circumstances of the incident, require special arrangements for criminal, forensic or other statutory investigations, or where the condition of bodies makes victim identification difficult; or
• Deaths requiring the implementation of NEMA.

The number of deaths constituting a mass fatalities emergency will therefore depend on the type and location of the emergency as well as the requirements for local responders to provide capacity.

Responding to such emergencies, and planning to reduce their likelihood and impact, has many aspects. This guidance is concerned only with those relating to the management of bodies, from their release from the place where the death occurred to the time of cremation or burial. It begins by distinguishing emergencies requiring little or no forensic pathology from those where this is a central part of the response. It then notes some generic aspect of resilience planning: business continuity, prioritisation of activity and communications with the public. Finally, it comments briefly on the deaths arising from CBRNE emergencies.

Types of Mass Fatality Emergencies: Intensive and Extensive

Many different types of emergency may result in mass fatalities, including:

• serious transport accidents
• building collapses
• flooding, fire and other weather related incidents
• accidents resulting from explosions or the release of harmful substances
• serious stadium and crowd emergencies
• epidemic and pandemic illnesses
• hostile acts such as terrorism.

Some emergencies which result in mass fatalities will require intensive and detailed work to investigate their causes, identify victims or to collect evidence to support a possible prosecution. In particular, forensic pathology and DVI are likely to have a dominant role in emergencies where criminality or negligence is suspected or where the deceased have suffered extensive trauma.

In other types of emergencies the causes and the circumstances of deaths may be largely understood, but the impact may be more extensive, e.g. public health incidents. Although emergencies may contain both intensive and extensive aspects, in most cases one or other will predominate; this guidance therefore considers these aspects separately in the Extensive and Intensive Emergency sections.

Table 1 - Comparison of Intensive and Extensive Emergencies

Business Continuity Management and Reserve Capacity

Category 1 responders are required under the Civil Contingencies Act to have in place business continuity management (BCM) arrangements to address potential disruptions to the services they provide. Other organisations and private businesses involved in the provision of care of the deceased may have business continuity management arrangements to a greater or lesser extent. Planners and responders should confirm that business continuity management arrangements for registration offices, mortuaries, crematoriums and burial grounds are current, robust and address all reasonably foreseeable contingencies.

These arrangements should be based on local risk assessments and should take into account the likelihood that mutual aid arrangements may be unavailable during periods of increased demand and during widespread emergencies such as a pandemic.

Planners and responders should ensure that established business continuity arrangements are compatible with mass fatality plans. Any supplementary resources these identify, along with mutual aid arrangements, should be among the first parts of response plans to be considered if there is a shortfall in capacity.

Principles and Priorities

As mass fatality emergencies are, by definition, situations where some normal practices are difficult or impossible to maintain, planners and responders may sometimes have to prioritise some procedures and practices over others. Decisions of this sort may be difficult and their consequences distressing. To assist in making and explaining them, consideration should be given to the principles set out in UK Influenza Pandemic Preparedness Strategy.

In order to prepare and implement mass fatality plans, particularly those parts requiring prioritisation of services and changes to normal working practices, discussion with appropriate representatives of faith communities will also be required. The Scottish Government will assist with this by consulting with faith communities at national level. Suggestions for subjects that should be discussed with faith communities’ representatives locally are given on page 13.

Communications with the Public

Decisions about changes to normal arrangements to care for the deceased will have to be communicated to the staff implementing them, bereaved relatives and other members of the public that they affect. The handling of these communications will be vital to the success of the response and the long term wellbeing of the community. Guidance on this generic emergency response function is available at Responding to Emergencies in Scotland and in Warning and Informing.