SMORT TEAMFAMILY ASSISTANCE CENTER

STANDARD OPERATING PLAN (FACPLAN)FAC Mini-Conference 5-18-141

Planning Assumption. This FAC plan assumes a mass fatality incident has occurred. FEMA defines a mass fatality incident as an incident of any hazard in which the number of deaths overwhelms local resources and/or expertise and the local jurisdiction has requested through the local EMA, additional mass fatality resources including SMORT where a Family Assistance Center (FAC) is needed.2

Decedents (Maximum.) The State Mortuary Operations Response Team (SMORT,) the parent entity of FAC, assumes that 30 Decedents (or presumed decedents) is the maximum number for planning assumptions. Greater than 30 may require SMORT to request assistance from the federal Disaster Mortuary Operations Response Team (DMORT.) In either case, FAC would be fully involved.

Six family members (FMs) are allowed per decedent.

The full FAC staff (assuming 100% participation on stand-up) consists of 30 Family Assistance Representatives (FARs,) 10 Antemortem Data Interviewers (AMIs,) 5 Exec. Staff, and 5 Administrative Assistants (ADMINs.)

WI-FI Setup. WIFI compatible w/Alabama Department of Forensic Sciences (ADFS) network will be set up.

MISSION. The mission of FAC Team Members is to provide for and respond to the emotional, psychological and spiritual needs of FMs present at the FAC, to provide administrative support and to assist the Coroner/Medical Examiner (ME/C) in obtaining antemortem information for decedent identification.

Understanding the Need for the FAC. In the hours and days after a mass-fatality incident occurs, families and friends will anxiously seek assistance in accessing information about the event and locating their loved one(s). As they search for information, they will frequently go to places where they assume they can find information. This often leads to a surge of individuals arriving at the incident site or presenting at local hospitals.

1 This material is prepared by John R. Wible, Executive Director.2 Modified from FEMA, Disaster Response Operations and Management, 2002.

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In addition to the physical presence at these key locations, an influx of calls with information-seeking inquiries will be made to 911, hospitals, police, and fire departments or the ME/C Office, creating a significant burden on the agencies already busy with other aspects of response.

In this environment of uncertainty, worry, and need for information, the FAC is an important resource for helping a community meet the needs of FMs, and for supporting the overall incident response. The FAC provides a safe, protected, and supportive environment for in which FMs may gather while they await information on their missing, unaccounted for, or deceased loved ones. The FAC can offer a centralized location for providing updates and information to FMs as information becomes available.

The establishment of a FAC is necessary to facilitate the exchange of information and to address the families’ needs. FMs may spend many hours waiting anxiously for information about their loved ones. The FAC provides the families with accurate information in an appropriate manner and setting.

Many families of lost loved ones travel to the disaster site and remain away from home for some time. The FAC addresses the basic physical needs, including food, shelter, communication, and emergency services, that these families will need.

During most mass fatality situations, the FAC will also be a central location for collecting information that will be pertinent to the ME/C in facilitating the identification of the victims.

In general, the primary goals of a FAC are to:

Provide a private and secure place for families to gather, to receive information about the response and recovery, and to grieve.

Protect families from the media and curiosity seekers.

Facilitate information exchange between the ME/C and other agencies and the families so that the ME/C can obtain information needed to assist in identifying the victims and other agencies may perform their delegated responsibilities.

Address families’ informational, psychological, first aid, and logistical needs.

Provide the ME/C the opportunity to do death notifications and facilitate the processing of death certificates and the release of human remains for final disposition.

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Maslow’s Hierarchy of Need. Needs of FMs will be addressed following Maslow’s Hierarchy of Need. Maslow ranked a person’s needs in an order of priority: physiological, safety, belongingness and love, esteem, and self-actualization.3 These needs are further address in the course, Psychological First Aid, available from the National Child Traumatic Stress Network4 that is recommended to all members of the FAC Team regardless of discipline.

FAC Partners. The following is a partial list of FAC’s partners in a response.

Local ME/C – Serves as lead agency and Incident Commander in the Incident Command system.

County and State Health Department – assists in coordination of resources if needed, Emergency Management – Coordinates logistics.

Law enforcement (includes FBI) – provides a certain amount of security and investigates if foul play is suspected. FBI is involved if terrorism or interstate or international foul play is suspected.

Alabama Baptist Disaster Relief - provides some FAC staff as well as chaplains, childcare, food service, shower trailers, and other services.

Alabama Department of Mental Health and Mental Retardation through public and private mental/behavioral health providers – provide referrals as needed.

Hospitals – treat live casualties from the event or subsequent casualties which may be a result of an incident concerning the FAC.

Emergency Medical Services – provide patient transportation to the hospital or other designated site.

Local School Boards or post-secondary educational institutions – may provide facilities.

Spiritual care providers – provide spiritual care to FMs requesting such. Spiritual care providers respond to requests, they do not initiate contact in such role.

3 Maslow, A. (1954). Motivation and personality. New York, NY: Harper.4 http://learn.nctsn.org/course/index.php?categoryid=11

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Crime victim advocates – may provide additional resources if the event is a result of foul-play.

Local faith and cultural leaders – like spiritual care-givers, they may provide faith-based or culture based resources in response to a request from the family routed through the FAC. It is anticipated that cultural leaders would be representatives of an ethnic or racial minority as related to the general population of the area in which the event occurs.

Red Cross and other voluntary agencies – may be identified at the time of the event.

Information Technology provider (e.g., city, county IT support.) FAC support is supplied initially by the ADFS.

Private sector partners (e.g., to provide, facility, IT, or call center support) will be identified at the time of the event.

Local industries that may be performing FAC planning such as airlines, cruise lines, or rail service providers.

Local military – the National Guard at the call of the Governor of the State of Alabama may provide security or other services as directed by the Governor.

National Transportation Safety Board (NTSB) – might be involved if event is a statutory mandated event such as an airplane crash or if the event is of significance as determined by the NTSB. In such an event, regulated carriers will also provide significant resources.

DMORT if needed.

Key Terminology

State Mortuary Operational Response Team (SMORT): A voluntary mutual aid team of mortuary and other professionals that assists the ME/C with a wide range of procedures as regards decedents in a mass casualty event.

Family Assistance Center (FAC): A secure facility established to serve as a centralized location to provide information and assistance about missing or unaccounted for persons and decedents. The FAC also supports the reunification of the missing or deceased with their loved ones. The FAC coordinates with the ME/C to assist in the taking of family information necessary or helpful for the identification of decedents.

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Family: Any individual that considers him or herself to be a part of the victim’s family or household even if there is not a legal familial relationship. No more than six person allowed per decedent.

Antemortem Data: Information about the missing or deceased person that can be used for identification. This includes demographic and physical descriptions, medical and dental records, and information regarding their last known whereabouts. Antemortem information is gathered and compared to post-mortem information when confirming a victim’s identification.

Disaster Mortuary Operational Response Team (DMORT): DMORTs are federal teams within the National Disaster Medical System (NDMS) under the direction of the US Department of Health and Human Services that provide support for mortuary operations following a mass-fatality disaster. In addition to the general DMORT teams, the DMORT capabilities include Disaster Portable Morgue Units (DPMU), a Weapons of Mass Destruction (WMD) Team, and an FAC Team.

Family Interview: A conversation conducted with FMs by representatives from the Medical Examiner/Coroner’s Office or FAC staff to collect antemortem information about the missing or deceased person. This may be an interview to complete the DMORT Victim Identification Profile form, which includes demographic and physical descriptions of the individual.

Reunification: The process of reuniting FMs with their missing or deceased loved one.

Victim Identification Profile (VIP): A database developed and managed by DMORT to manage antemortem and postmortem information for the purposes of helping to facilitate victim identification. This database is used by ADFS.

Guiding Principles. The following principles will guide all FAC planning. Our goal is to serve and support families in their time of need. When in doubt, consider

what would best meet their needs and plan for that.

Our mission is not to “fix” the situation for families, but to create systems that support families with information and assistance, help bring a sense of order during times of chaos.

Family assistance services support the continuum of emergency response and support the surviving family of both the injured and the deceased.

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Families will all grieve and process information on different timelines. There will not be a “one-size-fits-all” solution for everyone.

FAC cannot anticipate every need or issue that may arise. Through planning, FAC will establish relationships and build systems that will help address issues as they arise.

Mass casualty incidents are highly-sensitive, emotionally-strenuous situations, and not everyone is suited to work in these environments. Support for responders and workers will be as important as the support offered to FMs.

Flexibility will be the key to our success. Let our motto be “Simper Mollis” or “Simper Gumby.”

Information for Families. While on scene, the FAC will assist in the conducting of briefings and provision of updates during the investigation or as otherwise needed during a natural disaster. Once the on-scene phase of the investigation is over, the FAC will continue to serve as the primary contact and information resource for FMs as the investigation proceeds.

FMs will be informed of any memorial service details at the FAC family briefings.

The FAC does not coordinate interviews with media for FMs. Nevertheless, media representatives may attempt to contact family member, friend, and survivor after an event. FMs have every right to communicate with the media. However, media interviews will not take place at the FAC.

The FAC will not release the identities of victims or survivors of events. Such information may be released by other authorized persons such as ME/C or the incident Public Information Officer (PIO.)

Site Selection Considerations. Local authorities will determine sites. They must consider many factors when selecting a site for a FAC. For this reason, local jurisdictions are encouraged to identify facilities to potentially serve as a FAC site prior to an event. The type of disaster event and number of fatalities will affect site selection. A FAC should be located close enough to the site of the disaster to allow the ME/C and others to travel easily among the site, morgue, and center but far enough from the site that families are not continually exposed to the scene. If available, a neutral, nonreligious site such as a hotel or school, or community center is often an ideal choice for a FAC because some families may be uncomfortable coming to a religious structure.

Availability of Facility—Immediate and Long Term. The FAC will be established and opened as soon as possible after the event. It may remain in operation for several days.

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Infrastructure. The infrastructure of the site under consideration for the FAC must meet several requirements. The structure must offer adequate services and utilities including electrical power, telephone service, toilets, controlled heat and air conditioning, water, and sewage.

Local authorities in conjunction with FAC staff must determine whether the site can accommodate people with disabilities. A suitable site must allow for implementation of security measures.

General assembly room. A large room must be provided to allow for the dissemination of general information to FMs.

Reflection/Quiet rooms. The site must provide a space where the victims’ families can quietly reflect, meditate, pray, seek spiritual guidance, or observe religious practices. This space must should be chosen to respect diverse cultures and beliefs. Several small rooms must be available to provide a private space where information such as antemortem data can be gathered from families and where families can discuss issues in private

Medical/Paramedical assistance. FMs of the victims may require medical assistance. EMTs and an ambulance must be available to respond to render care to FMs and/or to transport patients to area hospitals if necessary.

Layout. The optimal follows showing location of rooms and secondly, location of equipment including dividers if rooms are not available.

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FAC Layout

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Reception and registration for families. When FMs arrive at the FAC, an ADMIN should greet them and gather information about who will be visiting the FAC. The FMs will be assigned an FAR who will take them to a designated area where they may be more comfortable and can be located if necessary. When FMs leave the FAC, they must check out and leave their contact information/address so that they can be contacted, if needed.

Collect antemortem data. Personnel at the FAC will be assigned to collect accurate and detailed antemortem information from the families of the victims. This information may be gathered by experienced death investigators from the Alabama Department of Forensic Sciences or FAC team members who have been well briefed on the information they need to collect from the families.

Regardless of the various professions of FAC team volunteers, when deployed, team members act as a representative of SMORT and their objective is to support the medical examiner’s or coroner’s office.

Implement security measures. Access to the FAC must be controlled so FMs have privacy and are not overwhelmed by the press, photographers, and the public. Checkpoints will be established at entrances to the FAC and its parking lot. A badging system will be implemented that gives FMs and authorized workers easy access to the FAC.

Communication with the media or Social Media. FAC does not work with the media. FAC staff are specifically forbidden to speak with media. This is the responsibility of ME/C or his/her designee. Additionally, FAC staff must not communicate with persons outside the FAC on matters concerning the FAC or FMs. Specifically, FAC staff is forbidden to post messages or photos on social media concerning the FAC or FMs.

Demobilization/ Debriefing. Demobilization begins when the last decedent is reunified with their FMs. As soon as feasible after this occurrence, the FAC should be demobilized. FMs must be informed of the demobilization in advance of shut down. The FACED will hold a mandatory debriefing for all FAC staff as soon as possible after demobilization to determine methods to improve the process for the next event and to allow FAC staff to “psychologically debrief” and to allow debriefers to evaluate staff to determine any signs or symptoms of PTSD. . There is a two-phase debriefing.

Staffing. The FAC is staffed by the following volunteers:

FACED – FAC Executive Director

DEFACED – Deputy FAC Executive Director

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FARs – Family Assistance Representatives, work with an assigned family to provide for needs and comfort.

CHoPPs -CHIEF OF PROFESSIONAL PERSONNEL – Supervises FARS

AMI - ANTE MORTEM DATA INTERVIEWERS – Interview families to take ante mortem data and may also serve as data entry operators in conjunction with Department of Forensic Sciences.

Ops - Chief of Operations – Supervises AMIs.

ADMINS – Provide necessary administrative support as directed.

CoLog – Chief of Logistics – Supervises ADMINs and logistical issues including mobilization and demobilization.

Registration and Call Down (Activation.)

All FAC Team Members must register with the Alabama Department of Public Heath ESAR-VHP system named “Alabama Responds.”

Call Down (Activation) occurs when there has been a mass casualty event that overwhelms a localities resources and the local ME/C has requested assistance from SMORT. Activation of the FAC will occur when the FACED, in coordination with SMORT and ADPH, notifies ESAR-VHP to activate the system, thus “standing up” an FAC in the affected area.

The ESAR-VHP System will accomplish notification of FAC personnel electronically. You will be notified when and where to report via the mechanism(s) you have chosen in your registration. Two messages will be sent. The first is an alert and query for availability. The second message will be directed to affirmatives advising of time and place to report or of a “stand-down” order.

GO TEAMS – Depending upon personnel availability, the FACED in coordination with other command staff may divide the Corps of FAC members into ground operations “GO” TEAMS. A GO TEAM is a subdivision of the entire Corps into units based on geography and specialty. Team size will depend upon the nature of the event.

All FAC Team members are required to take and successfully pass the following Courses.

FEMA IS-100 or IS-100b 5

FEMA IS-200 or IS-200b 6

5 https://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=IS-100.b6 https://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=is-200.b

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Combat operation Stress Control or equivalent. Similar training offered to chaplains through the Alabama Baptist Convention satisfies this requirement.

Psychological First Aid – to be offered at a later date or available from National Child Traumatic Stress Network.7

All FAC team members must register online and must keep their contact information current notifying FAC online of any changes.

Courtesy dictates that any FAC team member no longer wishing to serve must notify FAC and withdraw.

Reception and Registration. The reception and registration area is the first location families will access upon entering a FAC. In addition to providing the “first impression” of the FAC and setting the tone for visitors, it serves many important functions, supporting the overall FAC operation. ADMINS perform this function. These include:

Welcome and greeting of FMs. In certain circumstances, where FMs are searching for missing persons they should be directed to local authorities or to the Red Cross Safe and Well website8 if such is activated for this event.

Initial registration of FMs, including documenting their contact information, the name of other family or next of kin contacts, and the name and information about their missing or deceased loved one. Individuals arriving at the FAC that are not missing a loved one do not belong at the FAC.

Check in and checkout of FMs and staff.

Security check.

Providing an overview of services available at the FAC including a schedule of briefings.

Providing a tour of the FAC.

In addition to the staff performing the services above, the reception and registration area may also be staffed with FARs that can be assigned or available to the families to assist them with navigating and accessing FAC services.

7 http://learn.nctsn.org/course/index.php?categoryid=118 http://safeandwell.communityos.org/cms/index.php

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ADMINs must be available to circulate through all aspects of FAC operations, including food service areas, child care areas, in the staff respite areas, family interviews, family briefings, and at the reception and registration area.

Family Briefings. From the initial hours after an incident and throughout the response period, families will have a high level of interest in communications and information to help them understand what has happened to their loved one.

Early interest will be in identifying the location and well-being of their loved one, but will also include questions about a range of topics, such as what caused the incident, what is occurring with the recovery of human remains, and what is the process for and status of victim identification.

The nature of families’ questions will change over the duration of the response and recovery. Throughout this process, consistent, transparent, and honest communication with family members is key. Failure to meet families’ informational needs in a timely manner can erode the trust that is essential to successful response and recovery operations.

Family briefings are a core component of FAC operations, and provide a structured and routine mechanism for providing informational updates to families and addressing their questions. This consistency and process can help provide a sense of structure and familiarity for families when many things around them feel chaotic.

In general, the briefings will include information on the progress of recovery efforts (human remains recovery), the identification of victims, the investigation, and other areas of concern.

Ante Mortem Victim Identification Services (AMIs.) AMIs interview FMs to obtain antemortem data. AMIs may be called upon to input data into the data matching computer system established by the Department of Forensic Science (ADFS.)

AMIs perform antemortem interviews of FMs in the presence of their FAR. This is a primary function of the FAC and is designed to collect the necessary antemortem information to support and facilitate the reunification or positive identification of the missing or deceased. The activities involved with conducting family interviews for the purposes of gathering antemortem data are some of the most sensitive aspects of FAC operations, but they are also some of the most critical.

Plan for 2 to 3 hours to process and conduct each family interview, allowing for interview time, data recording, and data entry. Interviews will be recorded on paper forms if notebook computers containing the program are not provided.

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AMIs will work with ADFS to enter the data into their system. It is anticipated that at some time, the interview automated form will be integrated with and linked to the DFS system.

The range of antemortem data that may be gathered can be extensive and requires effective communication with families and having appropriate information management processes in place to support data collection.

Examples of the information that may be gathered include:

Physical description of victim. Description of clothing and jewelry. Description of unique characteristics (like tattoos, scars, and birthmarks). Dental records, medical records, and fingerprint records. DNA reference samples.

Family interviews must be conducted in private areas or rooms.

AMIs will use the DMORT Interview form (See Attachment E of the manual.)

AMIs report to the Chief of Operations (Ops)

Family Assistance Representatives (FARs.) From the onset of the FAC operations, it is essential to have family assistance services available for the families. All family services are provided by Family Assistance Team Volunteers who are members of the SMORT. This includes general assistance provided by Family Assistance Responders (FAR.)

FARs serve FMs providing emotional support and guidance. A FAR is assigned to a family during an event. It is the function of the FAR to attempt to meet the family member’s needs. FARs do not provide specialized counseling such as religions, financial or mental health counseling; however, where such services are needed, it is the duty of the FAR to obtain such services through their chain of command. FAR responsibilities:

Report to the Chief of Professional Personnel.

Assist FMs in understanding and managing the full range of grief reactions. Provide Psychological First Aid as needed.

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Make referrals to mental health professionals and support groups and/or to faith-based counselors/pastors/priests/other clergy members that are in the family member’s local area, as requested or indicated.

Provide Psychological First Aid and grief process educational materials for the FAC.

Cooperate with and assist ME/C and AMIs in obtaining ante mortem information via the DMORT antemortem interview form.

FARs must be available at all group meetings with families and available to meet with families or staff individuals, as needed. FARs work with their family to address the following.

Safety – let them know they and their family are safe

Calming – tell them to take deep breaths

Connectedness – tell them they are not alone physically or emotionally

Self and community efficacy – tell them they and the community have the resources and ability to handle this

Hope – example from Vulcan Marathon, redirect thought to left-brain things

Core Objectives of FARs.

FMs families using principles of Psychological First Aid (PFA) and Combat Operations and Stress Control (COSC.)

Assess the physical and emotional safety of FMs. Gather preliminary data on the FMs Assess emotional and physical stability of FMs. Determine what practical assistance can be offered to FMs. Determine the need for referral to and connection between FMs and other social

support services Acquaint FMs with coping skills Advise FACED or DeFACED of need for a FMs for connection between FMs and other

social support services. FACED, DeFACED or ChOPPs will contact the necessary agency or person following FAC protocol.

FARs should use the PFA Provider worksheet (Pp. 123,124 of PFA Manual) as a guide to meeting the core objectives.

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Other Primary FAC Services. Other Primary Services are provided by ADMINS or are delegated to other agencies in cooperation with local EMA.

ADMINs conduct initial intake using the Intake form in the manual and orientation and provide administrative support as directed by CoLog.

ADMINS maintain daily FM/Staff sign-in/out sheets.

The following are additional primary services that may be available during any FAC activation as provided by other agencies:

First Aid Services. The availability of medical or first aid services is important to FAC operations. At any time, FMs or other FAC visitors or staff may find themselves in need of medical assistance, whether due to injury, reactions to stress, grief or emotional trauma, or as a result of other chronic medical conditions. Through onsite EMS personnel, the FAC must be able to offer basic first aid and a location for individuals to rest and receive basic care. In addition, FAC staff should serve as a liaison to other medical services in the community or that are being coordinated through the response.

Childcare Services. Childcare services should be available during all FAC operations to provide a safe and secure area for the children of FAC visitors during the FAC’s normal hours of operation. The childcare area must provide a safe, friendly, and healthy environment for short-term care, which allows FMs to tend to necessary business and provides a period of respite for parents or guardians during a highly stressful and emotional situation. Childcare may be provided by Baptist Disaster Ministries in cooperation with local EMA.

Death Notifications. Death notification is the process of notifying the next of kin or FMs about the positive identification of their loved one. The official confirmation of a loved one’s death is often an important step in the FMs’ grieving process and allows the next of kin and family to coordinate memorial services and begin dealing with their loved one’s estate.

Death notifications are generally made by the Medical Examiner/Coroner’s Office personnel, but may also involve local law enforcement, and/or FARs.

Food Services. In order to meet family and staff’s basic needs, and to provide a sense of comfort and structure and promote healthy self-care, the FAC should plan to provide three basic meals each day, as well as healthy snacks and beverages throughout the day. Staff and families should have separate areas to eat. Food will be provided through EMA. Typically, the

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Red Cross or Salvation Army provides these services. Local groups may also cooperate in this provision of services.

Translation and Interpretation Services. As a part of FAC operations, it is important to consider the need for interpretation or translation services. These may be needed to provide translation and interpretation services in individual and family meetings and during family briefings, and to translate FAC materials and antemortem records. EMA will be requested to provide necessary translation services. Equipment and Supplies. ADMINs, under direction of CoLog, serve as advanced party and set up the FAC according to floor plan utilizing on-site equipment. ADMINs also take charge of, transport, deploy, and demobilize FAC equipment. ADMINs assist CoLog in maintaining FAC equipment. The following equipment has been requested and/or is on order.

12 Folding Tables – Light Fiberglass 66 Chairs, Light - Folding or Stackable 10 Dividers, Light wt., foldable (Privacy screens) 12 Subnotebook computers 1 32” HD monitor (message board) 2 MIFI units online w/data plan (assuming no ADFS WIFI) 1 Portable Podium 1 Towable trailer 2 10 x 10 pop up tents 2 Printers 1 Exterior Tripod light system.

Resources. For resources, click your browser to http://www.wuala.com/

Download the program for PC or mobile device.

Log on as “jwible15”

Password is “Disaster1” (It is case sensitive.)

Open the public folder, “Disaster1”, Documents, FAC. There you will have access to the following: COSC complete, DMORT interview form, psychological first aid manual, SMORT Code of Conduct, The FAC (SMORT) Operations Plan from which this paper was taken, this paper and the .pptx presentation.

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