U.S. Department of Justice

Office of Justice Programs

Office for Victims of Crime

Providing Relief to Families

After a Mass Fatality 

Roles of the Medical Examiner’s Office

and the Family Assistance Center

by Ray L. Blakeney

NOVEMBER 2002

Message From

the Director

This bulletin considers the response

of the Office of the Chief Medical

Examiner of the State of Oklahoma following the domestic terrorist bombing

of the Alfred P. Murrah Federal Building

in Oklahoma City, Oklahoma, on April

19, 1995.The recommendations in this

bulletin to medical examiners and coroners come out of the Oklahoma City

bombing experience, the experiences

and recommendations of the Oklahoma

City Medical Examiner’s Office, and the

experiences and practices of the National Transportation Safety Board in 

responding to accidents.

The Office for Victims of Crime (OVC)

is publishing this bulletin to assist medical examiners and coroners in their

work with surviving families of crime

victims.Whether the loss of life is due

to a mass-fatality event like the Oklahoma City bombing or to a homicide,

OVC recognizes that medical examiners and coroners face great challenges.

In addition to taking care of the body of

the deceased and collecting evidence,

medical examiners and coroners need

to know how to work sensitively and

effectively with the victim’s family 

members. In this bulletin, OVC offers

medical examiners and coroners information, guidance, resources, and lessons

learned about working with families of

crime victims.

Primary Issues and

Concerns of the

Victims’ Families

A

fter a mass fatality, the victims’

families will have many questions

and concerns as they assimilate

and accept information about the deaths

of their loved ones. As information and

answers are being provided, the families

may benefit from an explanation about

the organizations and agencies participating in the response effort, their roles, and

the resources and efforts they are contributing. Below are some frequently

asked questions from victims’ families,

arranged in the order they are most typically asked.

How will families be notified if their

loved ones are recovered and identified?

A notification team will be formed to notify families in accordance with established procedures. Information about the

victims should be given to their families

as soon as possible. It is extremely important to the families where the notification

occurs, which family members are notified, and how they are contacted. The

families need to be assured that the

spokesperson is releasing accurate information that was officially issued by the

medical examiner’s office.

In Oklahoma City, the families were told

that notifications would take place at the

designated family assistance center, the

Compassion Center, or at a location convenient to them. Families were warned

that only information and notification

provided by the Oklahoma City Medical

Examiner’s Office through the Compassion Center were credible and that information received elsewhere, such as

from the media, may not be correct.

Some organizations, including the military, law enforcement, and federal agencies, had their own death notification

systems in place. In these cases, the

Compassion Center provided information

to the organizations for distribution

through their own notification systems. Continued on page 2
Families were briefed at 9:30 a.m. and

3:30 p.m. for the 16 days the Compassion

Center was in operation. The Compassion Center closed when the last body

was recovered.

What method is used to identify the

families’ loved ones? Personnel from the

medical examiner’s office should inform

the families about all identification methods, explaining what they involve and

their reliability. In some cases, more than

one method may be used to make the

identification, including fingerprinting,

dental records, DNA testing, and radiology. In particular, DNA testing involves

considerations that should be explained

to the families. For example, DNA testing

may require that family members provide

blood samples. After the blood samples

are obtained, the DNA testing may require 6–12 months before an identification can be made. Families should be

told that during the DNA identification

process, no material will be released until

DNA testing of all common tissue1 is

completed or at the discretion of the

medical examiner in consultation with

the families.

When will the victims’ personal effects

and belongings be returned to the 

families? In some cases, only one personal

item of a victim is recovered and identified. That item becomes very important

to the family. The process for recovering

The Murrah Building was a 9-story, steel and

concrete building that housed 18 agencies

and businesses—15 federal and 3 nonfederal. During normal working hours, more than

500 people were in the building. After the

explosion on April 19, the first call to the

Office of the Chief Medical Examiner came

from the Oklahoma City Police Department, which estimated that more than 700

people may have been killed. Ultimately,

nearly 800 people were injured and 168

were killed.

After a mass-fatality event, the medical examiner’s office faces an enormous challenge.

Critical decisions about many issues and

concerns must be made quickly. A primary

responsibility of those who respond in the

aftermath of a mass-fatality event is providing care, services, and information to the

victims’ families and friends.This bulletin describes how the Medical Examiner’s Office

tried to meet the needs and address the

concerns of the victims of the Oklahoma

City bombing and their families.They began

by determining what was important to the

victims’ families.

The Oklahoma response emphasized compassion while imposing structure on a

chaotic situation. Under any circumstances,

the tasks of gathering accurate and timely

antemortem information and providing

death notifications are difficult.These tasks

were particularly difficult in the midst of the

chaos the bombing created. Large numbers

of distressed victims, families, and friends

had gathered and were anxiously seeking information.The news media arrived in a frenzied response to the bombing.Very quickly,

an overwhelming number of donations

and volunteers arrived that needed to be

screened.A central organizing body was

needed to handle the situation.

Soon after the bombing, the Oklahoma City

family assistance center, called the Compassion Center, was established to provide

families a secure and controlled area in

which accurate notifications could be made

and information exchanged.The Compassion Center was also an appropriate

place for collecting antemortem information

from the victims’ families and friends.This

information was helpful in making identifications and in developing a missing persons

list.The Compassion Center staff had to

consider many difficult issues and develop

sensitive, effective solutions. Some examples

include how to compassionately release information to families, work effectively with

the media, and sensitively inform the families

about the search process and results.

Additional acts of terrorism involving U.S.

citizens since Oklahoma City have shown

that each act of terrorism presents unique

challenges specific to the mass-fatality event

itself and its victims. Each mass-fatality event

teaches new and important lessons for responding to future mass-fatality events and

victims. For example, the complexity and

scope of the Oklahoma City bombing clearly emphasized the need for all communities

to form an effective crisis response plan. In

addition, OVC wants to ensure that all

those who work with mass-fatality victims

and families in the future have the information and training to work with the victims

and their families effectively, compassionately, and sensitively.This OVC bulletin hopes

to help achieve this by reporting the lessons

learned in Oklahoma City while helping victims’ families during the long, difficult recovery process. Families of victims need help

during each stage of the recovery process.

Each family must receive the death notification of their loved one.The family will hear

about and sometimes participate in the

identification of their loved one’s body, personal effects, or belongings. Finally, the family

will claim their loved one’s body, personal

effects, and belongings to take home.

OVC hopes that the information in this bulletin proves helpful to medical examiners

and coroners as they work with the families

of crime victims.Whether the death is the

result of a large-scale, mass-fatality event or

a single homicide, the medical examiner or

coroner will likely interact with the victim’s

family. OVC offers medical examiners and

coroners information and OVC-funded

services, including victim compensation and

assistance, to benefit family members.

John W. Gillis

Director

OVC Bulletin

2

Continued from page 1
and returning victims’ personal effects

and belongings must be established as

soon as possible after the mass-fatality

event and coordinated with other agencies. The procedure needs to be explained

to the families so they will understand the

process and know how long it may take.

In criminal cases, some or all of the personal effects and belongings may be retained as evidence until after the trial.

Responding to the aftermath of the

Oklahoma City bombing was an uncommon experience for the forensic pathologists because it was a criminal event

rather than a natural disaster. As a criminal event, certain procedures were required. For example, a mandatory

evidence collection process was established. The personal effects and belongings on the bodies at the time of recovery

were transported with the bodies to the

Medical Examiner’s Office, which worked

closely with the Federal Bureau of Investigation (FBI), the agency in charge of the

investigation. The FBI stationed agents

with the pathologists to help identify evidence. After evidence was identified, the

agents packaged and documented it. The

teamwork of the Medical Examiner’s

Office and the FBI ensured proper identification, collection, handling, and preservation of as much evidence as possible, all

within a secure chain of custody.

The process of recovering personal effects

and belongings at a mass-fatality site 

involves several agencies and organizations. As is true throughout the entire response effort, it is important for each

agency involved to understand the goals

and responsibilities of all the other agencies and organizations to avoid duplication of effort. In Oklahoma City, for

instance, local law enforcement had overall supervision of the handling of victims’

personal effects and belongings. At the

conclusion of their examination, the FBI

and the Medical Examiner’s Office turned 

the victims’ personal effects and belongings over to the Oklahoma City Police

Department, which was responsible for

cataloging, warehousing, and arranging all

personal effects and belongings for return

to the victims’ families.

Another example of the need for agencies

and organizations to communicate and

coordinate occurred in Oklahoma City.

Initially, staff of the Medical Examiner’s

Office were inclined to dispose of the

3

PROVIDING RELIEF TO FAMILIES AFTER A MASS FATALITY

Special Message to Medical Examiners

The Office for Victims of Crime

(OVC) recognizes that medical examiners (MEs) and coroners encounter family members when they

are not working on mass disasters.

Homicides often bring grieving families of victims to the ME’s office. Surviving family members of homicide

victims often arrive at the ME’s office

distraught, trying to cope with the

murder of their loved one, expressing

concerns, asking questions, and needing support.

In our constant search to find ways to

improve services to victims, OVC recognized that the ME office is in the

unique position of working directly

with surviving family members after a

homicide. OVC sees this time of interaction between the ME staff and the

families of homicide victims as a good

opportunity to improve the services

and information provided to victims’

families. By providing the latest information, tools, and resources for working with victims, OVC can help ME

offices perform their duties while improving the services, assistance, and

information provided to victims’ families. For example, it may be helpful to

the surviving family members to know

that if their loved one was killed in a

criminal act, they may be entitled to

a variety of services, including victim

compensation and assistance. More

precisely, compensation funds may be

available for use to reimburse victims’ families for out-of-pocket expenses that are directly related to the

crime, including assistance with funeral expenses.

Each state and territory has a victim

compensation program office designated by the governor. A list of these programs is available on the Internet.

Find OVC’s Web site at www.ojp.

usdoj.gov/ovc, then select “Help for

Victims” and “Victim Assistance and

Compensation Programs.” The offices

listed provide information about how

victims and victims’ families can obtain crisis intervention, support during

the criminal justice process, help in

preparing victim impact statements

during the presentence phase, help in

applying for compensation, and help

in obtaining restitution.

OVC hopes ME offices will use the

OVC Web site to link to other organizations that offer helpful information

and provide toll-free numbers. For example, through the Mothers Against

Drunk Driving (MADD) Web site,

ME staff can obtain technical assistance for victim issues such as death

notification. The Parents of Murdered

Children Web site also offers support

for homicide survivors.
unidentified human remains collected

from the disaster site because they believed this would save families additional

trauma. It was pointed out, however, that

this was a problem because the unidentified human remains may conceal a victim’s personal effect or belonging and

therefore should not be discarded. It was

decided that the unidentified human remains recovered from the site should not

be discarded or destroyed without first

consulting the families.

May the families go to the disaster site?

Over the years, in different mass-fatality

events, victims’ families have had a common initial response. When they hear

that their loved ones are dead, the families immediately want to go to the event

site or to the designated site when the

original site is too dangerous or cannot be

reached. Feeling compelled, the families

converge on the site where their loved

ones drew their last breaths. For many

family members, being at the site allows

them to feel close to their deceased loved

ones, imagine their last moments, honor

them, and say good-bye. Most important

for the families, being at the site allows

them to begin the long, difficult journey

of psychologically and emotionally processing the event.

Deborah Spungen, a noted author, writes

about the grief and trauma suffered by

those whose loved ones are killed by

homicide. Using the term “co-victim”

to refer to those who survive, Spungen

(1998: 132) writes about the significance

of crime scene visits to surviving friends

and family:

The crime scene often plays an important role to the co-victims as

they begin to process the event.

Some co-victims want to view the

location of the death. This request

is usually made to law enforcement

personnel in the immediate aftermath of the homicide or even days

or weeks later.

Spungen notes that opinions about crime

scene visits differ from jurisdiction to jurisdiction, and not all law enforcement

personnel sanction them. However,

Spungen argues that “this is a matter of

choice, and co-victims should have the

right to make this decision.”

In another observation about crime scene

visits, Spungen (1998: 132) writes

There has been a growing practice

for a crime scene located in a public

place to be made into a shrine.

Friends, family, neighbors, and community members may stop by to

leave a flower, a candle, a card, a

stuffed bear, or other mementos.

Or they may pray or stand in quiet

contemplation of the scene. For

most co-victims, this activity can

be quite beneficial.

Visits to the mass-fatality event site

should always be coordinated with the 

organization or agency that has jurisdiction of the site. If the event was criminal,

the FBI has jurisdiction. If it was a

transportation accident, the National

Transportation Safety Board (NTSB) has

jurisdiction. The office in charge of taking

families to visit the site needs to keep a

few things in mind. If the visit takes place

during the recovery process, recovery

work should stop to show respect. Visiting

families should not be exposed to bodies,

body parts, or personal effects and belongings. Also, it is important for those

overseeing the site visit to be aware that

families of surviving victims and families

of deceased victims will be experiencing

very different feelings during a site visit.

Although both groups will be mournful,

one group will be celebrating the survival

of their loved ones while the other group

will be grieving the deaths of their loved

ones. If both groups are on the same site

visit, there may be problems. Families of

the deceased may feel that the survivors’

joy and celebration are not appropriate at

the site of so much loss and sorrow. Consequently, offices that coordinate site visits should arrange separate visit times for

families of survivors and families of the

deceased.

In addition, the medical examiner’s office

or other offices with a role in coordinating site visits should be aware that visiting families may need to be prepared for

what they are about to see. To meet this

need, NTSB provides mental health professionals to brief visitors before they visit

a site to view the wreckage of a transportation accident. The counselors tell

the visiting families what they will see at

the site, describing the conditions, the

wreckage scene, and the odors. This kind

of preparation makes the site visit less difficult for both visitors and coordinators.

After recovery of bodies in Oklahoma

City was complete but before the site

was released, the victims’ families were

bused to the bombing site in a visit

arranged in coordination with law enforcement, the Compassion Center, and

federal authorities.

What is the condition of the body? The

condition of the body is a major concern

for families. Explaining the condition of

the body requires compassion, honesty,

and tact. In Oklahoma City, the director

of operations of the Medical Examiner’s

Office reminded families that a huge

bomb had destroyed most of a nine-story

concrete and steel building and that the

condition of the bodies, in some cases,

was severe. He explained that the location of a victim in relation to the blast

point affected the condition of the body.

OVC Bulletin

4
After the body of their loved one had

been recovered and identified, each 

family was advised that they could meet

privately as a family at the Medical Examiner’s Office to discuss the condition of

their loved one’s body. It was important to

reassure each family that the body of their 

loved one was being treated with the

highest degree of respect and dignity regardless of its condition.

When personnel from the medical examiner’s office speak to families about the

condition of their loved ones, they should

use language that is sensitive to the 

family’s needs. Avoid words or phrases

such as “damage to the body,” “fragmentation,” “dismemberment,” “pieces,” “parts,”

“destroyed body parts,” and “the body is

in bad condition.” Replace such words

with more appropriate choices like “severe,” “significant,” “trauma to the body,”

or “condition of the body” rather than

“damage to the body.” Often, family

members may prefer that the personnel

from the medical examiner’s office refer to

the victims as “loved ones” rather than

victims. As a general rule, the amount of

information families can handle is revealed by the questions they ask and the

feedback they give. Medical examiner

personnel should take cues from the families and tell them only what they want to

know.

Will an autopsy be performed? The determination of whether to perform autopsies depends on the nature of the event

and the decision of the local medical examiner or coroner. Family requests, cultural customs, and religious beliefs that

prohibit autopsies for their loved ones

should be considered; however, in most

areas of the country, the medical examiner or coroner makes the final decision

about whether an autopsy is necessary. If

an autopsy is recommended, then the

families should be told why it is necessary.

In Oklahoma City, the chief medical examiner made the decision to perform autopsies only for cases in which the cause

and manner of death could not be determined by other means. Of the 168 victims killed in the bombing, 13 were

autopsied.

How do families know that the information they receive is accurate? When a

mass fatality occurs, information becomes

public knowledge through a number of

sources, including print media, television,

radio, and the Internet. Families should

The Office of the Chief Medical

Examiner of the State of Oklahoma

is just one example of a state office

that has used Victims of Crime Act

(VOCA) federal funds to help families

of crime victims. In 1998 and 1999,

VOCA funds totaling more than

$100,000 enabled the Office of the

Chief Medical Examiner to provide

comprehensive assistance to families of

victims killed by homicide and other

criminal acts such as terrorism and

mass fatalities. 

In addition, the Office of the Chief

Medical Examiner’s VOCA project for

Oklahoma City and Tulsa used VOCA

funds to support a family assistance coordinator at each site. The coordinator

provides the following services:

■ Monitors all homicide cases.

■ Coordinates family contact with

law enforcement agencies and

local, state, and federal officials.

■ Assists claimants in applying for

crime victim compensation and

other benefits.

■ Informs families about autopsies,

condition of the bodies, and 

evidence/property collection.

■ Coordinates delivery of death notifications by working with law

enforcement agencies in other

states.

■ Serves as court advocate, provides

transportation and accompanies

families to court, and attends

court during the medical examiner’s testimony.

■ Informs families about support

services and provides referrals.

The VOCA-funded projects of the

Oklahoma City and Tulsa Offices

of the Chief Medical Examiner are

successful examples of state and federal partnerships dedicated to providing compassionate and professional 

assistance to crime victims and their

families. For more information

about program services, contact the

Office of the Chief Medical Examiner

of the State of Oklahoma by telephone (405–239–7141) or e-mail

(medicalexaminer@ocmeokc.state.

ok.us).

5

PROVIDING RELIEF TO FAMILIES AFTER A MASS FATALITY

Example of a State/Federal Partnership To

Provide Victim Assistance Services in a

Medical Examiner’s Office
learn about the injury or death of their

loved ones from a credible source in a

compassionate way—not through the

news media.

Speculation over the cause of the Oklahoma City bombing was widespread.

Generally, the investigative agency does

not disclose to the public every detail of

the investigation and its analysis. Only

general information is released. In that

situation, families should be reminded

that information from any source other

than the officially recognized source(s)

may be unreliable. In Oklahoma City, the

families had been told that the only reliable sources of information were the

spokesperson of the lead investigative

agency and the representative from the

Medical Examiner’s Office. These individuals communicated with the families at

family meetings held in the Compassion

Center.

Family members who live out of town or

are physically unable to come to a family

assistance center should not have to depend on unreliable news reports. They

also should have access to reliable, firsthand information from the investigating

agencies. To solve this problem, NTSB

sets up a telephone-conference bridge at

major accident sites that allows families

to remain at home with their natural support system and receive current, accurate

information. Using a toll-free number and

a pass code, victims’ families back home

can hear updated information in real time

as can families who traveled to the site

or to the city nearest the site. This gives

families at home and at the site the same

information and essentially the same opportunity to ask questions.

The medical examiner’s office should provide victims’ families who travel to a family assistance center with a written record

to help them keep track of the difficult

and overwhelming information they will

receive. In the aftermath of a mass fatality, families often are in shock and may

not accurately recall what was said to

them. In such a stressful situation, families can easily misunderstand what they

read and hear and get an inaccurate perception of past and present events and future expectations. Not having the correct

information can be very distressing to the

families not only at the time of the event

but also later.

May families obtain copies of the medical examiner’s or coroner’s report?

Contact persons from the office of the

medical examiner or coroner should be

sensitive to and understanding of the

needs of family members. The families

should be provided the names and numbers of the contact persons and encouraged to call if they have questions. Many

families will want to go over the case or

see photographs of their loved ones. The

contact person from the medical examiner’s or coroner’s office should also be able

to explain to the families how and when

the reports will become available.

Lessons Learned

About What Is

Helpful When

Working With

Victims’ Families

T

he Crash of ValuJet 592, A Forensic

Approach to Severe Body Fragmentation documents the lessons learned 

in the aftermath of the crash of ValuJet

592 into the Florida Everglades on May

11, 1996, which killed all 110 persons on

board. Written by medical examiners who

worked on this case, this book describes

forensic lessons learned as well as lessons

learned about helping victims’ families.

This book reports that after the crash of

ValuJet 592, the families immediately

wanted information. They expressed 

concern about not knowing what was

going on regarding recovery of the remains, identification, and issuance of

death certificates. It became very important to provide the victims’ families accurate information, so an informational

letter addressing identification and notification procedures, disposition options, issuance of death certificates, and matters

related to unidentified remains was sent

to all families. A followup letter with updated information was later sent to the

families.

In any mass fatality, it is extremely important to be humane and considerate when

notifying next of kin after an identification has been made. Decisions about how

to accomplish this may differ in different

mass-fatality events. The Crash of ValuJet

592, A Forensic Approach to Severe Body

Fragmentation describes the notification

protocol established during the ValuJet

592 recovery effort. The same protocol

was followed for all identifications: all notifications had to be made in person, not

by telephone. This protocol was established to show respect to the families and

ensure that the families received the

proper information and understood it.

Every family was visited by a notification

team consisting of one law enforcement

officer, to show respect, and one mental

health professional or member of the clergy, to offer the family help and support.

Like other air disasters, the ValuJet 592

air disaster left in its wake severely fragmented bodies. The following excerpt is 

taken from The Crash of ValuJet 592,

A Forensic Approach to Severe Body Fragmentation (2000: 52). The medical examiners in this case learned how important

it was to allow the victims’ families a

choice regarding the disposition of body

OVC Bulletin

6
7

fragments that had been identified as

coming from their loved ones.

When severe fragmentation occurs,

it is critical to permit family choice

in the disposition of an identified

fragment, especially when the 

identification process may involve

multiple fragments from one person

recovered over an extended time

period. It would cause great consternation for the family to release their

loved ones’ remains for burial only

to inform them later that another

fragment has been identified.

Choice in the disposition of such

remains is best decided as soon as

one piece of tissue is identified.

Family Assistance

Center

T

he establishment of a family assistance center is necessary to facilitate

the exchange of information and

to address the families’ needs. Families

and friends may spend many long hours

waiting anxiously for information about

their loved ones. The family assistance

center provides the families with accurate information in an appropriate manner and setting.

Many families travel to the disaster site

and are away from home for some time.

Other families are displaced as a result of

the disaster. The family assistance center

addresses the basic physical needs, including food, shelter, transportation, telephones, and emergency services, that

these families often will have.

When a community develops a crisis response plan, it is essential that county and

state victim assistance and compensation

staff collaborate to ensure that the family

assistance center has information about

community resources such as mental

health support, spiritual counseling, grief

support, and childcare. Then, in the

event of disaster, an effective family assistance center can be established quickly.

The Oklahoma City family assistance

center, the Compassion Center, was in

operation by 3:30 p.m. on the day of the

bombing.

The Compassion Center was initially set

up by the Office of the Chief Medical

Examiner. The Oklahoma Funeral

Directors Association provided about 20

funeral directors to greet families and

gather antemortem (predeath) information.2 By the next day, April 20, the

American Red Cross was operating the

Compassion Center and serving victims

and families. Hundreds of local clergy, 

police, military chaplains, and mental

health professionals from across the

Nation supported the Compassion

Center. Other agencies also shared support responsibilities for the Compassion

Center, including the County Sheriff’s

Office, the Oklahoma National Guard,

the Salvation Army, Tinker Air Force

Base, and the Department of Veterans

Affairs.

The effective operation of a family assistance center like the Compassion Center

depends on many organizations and individuals working together as a team, the

establishment of a chain of command,

and the selection of a site that is acceptable to all the individuals and agencies

that will be working there. Commitment

and coordination by all involved in the

establishment of a family assistance center will enhance the rescue and recovery

effort.

The following text discusses the considerations and factors involved in selecting a

site for the family assistance center and in

establishing policies and procedures that

will ensure that the work of the family 

assistance center is effective.

Site Selection Considerations

Site Selection Factors

Many factors must be considered when

selecting a site for a family assistance center. The type of disaster event and number of fatalities will affect site selection. A

family assistance center should be located

close enough to the site of the disaster to

allow the medical examiner or coroner

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 is often an ideal choice for a family

assistance center because some families

may be uncomfortable coming to a religious structure. In addition, a hotel or

school often can provide flexible, longterm accommodations. Finally, those involved in site selection should keep in

mind the many agencies that are part of

that community’s crisis response plan and

consider what those agencies will need to

do their jobs effectively.

Availability of Facility—Immediate and

Long Term

The family assistance center should be

established and opened as soon as possible

after the incident. The center may be

needed for as long as 3–4 weeks, depending on the length of time necessary to 

recover the bodies. In Oklahoma City,

the site was selected and the Compassion

Center was available to the victims’

friends and families immediately after

the bombing. The massive destruction of

the building made recovery of the bodies

difficult and slow. The Compassion

Center was open and operating for 16

days, until the last body was recovered.

Other large-scale events may require additional resources, including mental health

care. More information about crisis 

response planning appears later in this 

bulletin.

PROVIDING RELIEF TO FAMILIES AFTER A MASS FATALITY
Infrastructure

The infrastructure of the site under

consideration for the family assistance

center must meet several requirements. It

is very important to estimate the number

of family members and friends who may

visit the center to determine whether

the center’s infrastructure is adequate

to handle that number of people. The

structure must offer adequate services and

utilities including electrical power, telephone service, toilets, controlled heat and

air conditioning, water, and sewage. A

determination must be made about

whether the site can accommodate people

with disabilities. In addition, a suitable

site must allow for implementation of 

security measures. Information about 

procedural considerations appears later

in this bulletin.

The First Christian Church in downtown Oklahoma City was selected as the

Compassion Center because of the building’s proximity to the bombing site, size

and floor plan, food service facilities, and 

adequate parking spaces for about 1,200

vehicles. The bombing resulted in 168 fatalities. As many as 1,200 family members

and friends were at the Compassion

Center at one time, especially during the

first days following the bombing. The

Compassion Center did not need to 

include overnight facilities because the

Oklahoma City bombing was a local

event.

Space and Floor Plan

The family assistance center needs to

have a floor plan that will accommodate

the simultaneous and effective performance of many functions for and delivery

of services to the families and friends of

the victims.

Operations center and administrative 

offices. An operations center is necessary

to allow the different service groups and

organizations to meet. If representatives

from all organizations are present at meetings, then victim services can be coordinated and efforts will not be duplicated.

In addition, administrative offices should

be available for all of the different service

groups including mental health professionals, clergy, and medical examiners and

organizations including the American

Red Cross and Salvation Army. Since

these administrative offices will hold files

and confidential information generated

by the family assistance center, they must

be kept secure. It could be devastating to

the victims’ families if information about

their loved ones was leaked before the

families were properly notified. Controlling how, when, and where official

death notification information is released

minimizes confusion and helps staff avoid

problems. Later, this bulletin discusses the

concerns related to releasing search, recovery, and death notification information to the families and the press and

describes the procedures that Oklahoma

City adopted. Finally, the family assistance center should have a separate 

OVC Bulletin

8

Summary of Site Selection Considerations

for the Family Assistance Center

■ Site selection factors.

❏ Type of disaster event and

number of fatalities.

❏ Location in relation to the

disaster site and the morgue.

❏ Availability of a neutral, nonreligious site (e.g., hotel,

school).

❏ Needs of the many participating agencies.

■ Availability of facility—

immediate and long term.

■ Infrastructure.

❏ Electrical power.

❏ Telephone service.

❏ A sufficient number of 

toilets.

❏ Controlled heat/air conditioning, water, and sewage.

❏ Adequate parking.

❏ Security options.

❏ Disability accommodations.

■ Space and floor plan. Accommodate the performance of many

functions and delivery of services.

Space should be provided for

❏ Operations center and administrative offices.

❏ Large general assembly room

with a public address system.

❏ Reflection room.

❏ Death notification rooms.

❏ Counseling rooms.

❏ Medical area.

❏ Reception area.
9

entrance for its staff so they can check in,

be briefed, and receive their assignments

before they interact with the families.

General assembly room. A large room

with a public address system should be

available so that updates on the search

and recovery process can be given at least

twice daily to large gatherings of family

members and friends. Activities in this

room may require translator services, 

including sign language interpretation. In

large cities, possible sources for translators

include a local consulate, embassy, or the

U.S. Department of State. For more information about such services, contact a

local federal agency, university, hospital,

or judicial system or court.

Reflection room. The family assistance

center should provide a space where the

victims’ families and friends can quietly

reflect, meditate, pray, seek spiritual guidance, or observe religious practices. This

space must be designed and furnished to

respect diverse cultures and beliefs. The

family assistance center made such a

space available after the October 31,

1999, EgyptAir Flight 990 crash into

the Atlantic Ocean 60 miles south of

Nantucket Island, Massachusetts.

Death notification rooms. To provide

privacy and to expedite the notification

process, several rooms should be set aside

for families to receive the information

that their loved ones have been identified. Circumstances may dictate how

death notification takes place. In Oklahoma City, families were asked to 

return to the Compassion Center to receive the death notification of their

loved ones. Some families felt retraumatized when asked to return to the Compassion Center because they knew that

this request was made so that they could

be given the official death notification.

In most cases, it is preferable for death

notification teams to be sent to the 

families’ homes rather than requiring

families to come to the family assistance

center. The Oklahoma City Medical

Examiner’s Office coordinated with organizations such as the military and the police departments that sent their own

personnel to the families’ homes to carry

out death notification.

Counseling rooms. Several small rooms

should be available to provide a private

space where information such as antemortem data can be gathered from families and where families can receive

counseling from clergy and mental health

professionals. In addition, these rooms

can be used for family members to spend

time together and to use the telephone to

contact other relatives and friends. The

number of rooms necessary will vary depending on the number of fatalities. The

following is a general rule: 100 or fewer

fatalities will require 3–5 rooms, 101–200

fatalities will require 10–12 rooms, and

more than 200 fatalities will require

15–25 rooms. Counseling that is meant

to convey positive identification of the

loved one and emotional support for families should not be conducted in hotel

rooms with bedroom furniture. If hotel

rooms are the only rooms available, replace the bedroom furniture with couches

and chairs.

Medical area. Family members and

friends of the victims may require medical

assistance. In Oklahoma City, the Compassion Center provided an area that had

eight beds and was staffed with registered

nurses, paramedics, and doctors. For the

first 3 or 4 days, this medical area was

very busy caring for the medical problems

of family members, friends, and Compassion Center workers. In addition, an

ambulance was on standby at all times at

the Compassion Center to transport patients to area hospitals if necessary.

Reception and registration for families.

When family members and friends arrive

at the family assistance center, the staff

should greet them and gather information about who will be visiting the family 

assistance center. Staff will assign them

an escort who will take them to a designated area where they may be more 

comfortable and can be located if necessary. When families and friends leave the

family assistance center, they should

check out and leave their address so that

they can be contacted with additional information and support and notification of

their loved ones’ deaths. When adequate

personnel are available, an escort may be

assigned to each family group. Escorts

may help the families with any need that

arises during their stay at the family assistance center. At the Oklahoma City

Compassion Center, the American Red

Cross provided personnel who were

trained in counseling to serve as escorts.

Procedural Considerations

Collect antemortem data. Personnel at

the family assistance center will be assigned to collect accurate and detailed antemortem information from the families

and friends of the victims. This information may be gathered by experienced

death investigators or funeral directors

who have been well briefed on the information they need to collect from the families. If funeral directors are providing this

service, it is critical that they act as representatives of the medical examiner’s or

coroner’s office and not as funeral directors. In Oklahoma City, funeral directors

acted as representatives of the Medical

Examiner’s Office in gathering antemortem information. Funeral directors

were selected to perform this service for

many reasons, including their training in

collecting antemortem information and

their experience in dealing with families

in crisis. However, they were told that

PROVIDING RELIEF TO FAMILIES AFTER A MASS FATALITY
they must act as representatives of the

Medical Examiner’s Office.

Death certificate information can be collected at the initial interview to save the

families from going through another interview at the funeral home. Many states

require that similar information be provided on death certificates, including the

deceased’s occupation, level of education,

and residency and the name of the informant (person providing the information).

During an investigation, NTSB uses another form, the National Disaster Medical

System’s Disaster Mortuary Operational

Response Team (DMORT) questionnaire

form, which DMORT developed as a universal questionnaire designed to expedite

antemortem data collection. Before conducting antemortem interviews, NTSB

compares the information on the state

death certificate with the information

on DMORT’s Family Assistance Center

(FAC) Questionnaire and then requests

any missing information. DMORT’s 7-

page FAC Questionnaire (see below) can

be downloaded from the DMORT Web

site at www.dmort.org by clicking “FAC

Questionnaire.” During antemortem

data collection, it is important to reassure

families that all information will remain

confidential.

The U.S. Department of Health and

Human Services (HHS), DMORT, and

the Disaster Medical Assistance Team

(DMAT) are resources that medical examiners and coroners can draw on to 

assist with victim identification and 

provide medical services. (See DMORT 

contact information at the end of this

bulletin.) In a major criminal event, the

FBI will be involved, and its disaster

squad can assist the medical examiner or

coroner by providing fingerprint experts.

The American Red Cross can assist the

medical examiner or coroner by providing

mental health professionals who may be

needed during antemortem interviews or

memorial services. Victim advocates can

identify community resources and refer

the victims’ families to them for help

throughout the recovery process.

Conduct death notifications. The procedures for death notification are an 

important component of a sensitive family assistance plan. Whenever possible,

death notification should be made by a

team rather than an individual. The team

may consist of a representative of the

medical examiner or coroner, a member

of the clergy, a mental health professional, and possibly a medical professional.

Some families may feel a notification

team is not necessary, but other families

may need the support. It is better to err

on the side of having support persons 

present in case they are needed than to

need them and not have them present. If

the family’s own pastor or other clergy

member is present, the team clergy should

play only a supportive role. The notification team should be well briefed on the

information being provided to the families so they can answer as many questions

as possible. The team should be given a

fact sheet that contains relevant information that they can leave with the family

DMORT developed this questionnaire to

expedite antemortem data collection.

Visit www.dmort.org and click on “FAC

Questionnaire” to download a copy.

OVC Bulletin

10

Summary of Procedural Considerations for

the Family Assistance Center

In a mass-fatality event, procedures

must be established and followed to 

effectively accomplish the following:

■ Collect antemortem data.

■ Conduct death notifications.

■ Coordinate and manage many 

volunteers.

■ Determine fiscal responsibility

for expenses.

■ Dispose of common tissue.

■ Establish victims’ suffering.

■ Implement security measures.

■ Work with the media.

DMORT’s Family Assistance

Center Questionnaire
11

for later reference, because family members may forget to ask questions at the

time of the notification.

Death notification teams also should be

available to travel to meet with families

who do not want to or are not physically

able to come to the family assistance center. Next of kin who are out of town

should always be notified in person.

When a death notification must be made

in a distant location, the office charged

with death notification responsibilities

can contact the sheriff or chief of police

in the distant community to request coordination of notification. The American

Red Cross or the state VOCA victim

assistance agency can assist in providing a

mental health professional. The office

charged with death notification responsibilities can provide the notifying law enforcement agency with a letter from the

medical examiner or coroner that contains information about the deceased and

the name and contact number for the

medical examiner or coroner in case the

family has questions.

In Oklahoma City, the team approach

was used to notify families. The teams

were prepared to answer questions and 

assist families with any needs they had,

including transportation, funeral arrangements, and spiritual and mental health

counseling. Families were advised about

unidentified human tissue. They were

told about the bomb’s violent impact and

the resulting presence of unidentified

human tissue. They were informed that

they would be notified later about a

memorial service and burial of the common tissue. Families also were told that

the name and age of their loved ones

would be released to the press. They were

asked how long they needed to notify the

rest of their family and friends before that

information was released to the media.

Staff conducting a death notification for a

victim whose body is not intact must ask

the family at the time of notification if

they want to be informed about later

identification of common tissue. Informing the family later about common tissue

identification without their consent may

be upsetting to them once they have

buried their loved one. Families may prefer to be notified only about the memorial

service and burial of the common tissue.

After the family members make their decision, staff should provide them with a

written copy of their decision as a reference for what they agreed to at that time.

Coordinate and manage many volunteers. In Oklahoma City, thousands

of volunteers turned out to help in the 

recovery effort, but they needed to be

screened and directed. While preventing

the entry of unauthorized persons,3

Compassion Center staff admitted and

processed thousands of volunteers—

screening credentials, examining documents, completing forms, and assessing

PROVIDING RELIEF TO FAMILIES AFTER A MASS FATALITY

The Disaster Mortuary Operational

Response Teams (DMORTs) were

tasked with providing victim identification and mortuary services by the

Federal Government through its

National Disaster Medical System

(NDMS), U.S. Department of Health

and Human Services (HHS), under

Emergency Support Function #8.

DMORTs are composed of private citizens, each with a particular field of expertise, who are activated in the event

of a disaster. The Federal Government

compensates them for their duty time

as temporary federal employees.

DMORT members must maintain appropriate certifications and licenses

within their disciplines that all states

recognize. Activated DMORTs assist

local authorities by providing technical

assistance and personnel to recover,

identify, and process deceased victims.

DMORTs are directed by NDMS in

conjunction with a regional coordinator in each of the 10 federal regions.

During an emergency response,

DMORTs work under the guidance of

local authorities to coordinate disaster

mortuary planning and response.

Teams include forensic pathologists,

forensic odontologists, forensic anthropologists, fingerprint specialists, funeral

directors, morticians, embalmers, medical records technicians and transcribers, X-ray technicians, mental

health specialists, security and administrative personnel, and support personnel. Within HHS, the U.S. Public

Health Service’s Office of Emergency

Preparedness (OEP)/NDMS, in support of the DMORT program, maintains a Disaster Portable Morgue Unit

(DPMU) at the OEP warehouse in

Gaithersburg, Maryland. A DPMU is a

depository of equipment and supplies

for deployment to a disaster site. It

contains a complete morgue with designated workstations for each processing element and for prepackaged

equipment and supplies. For more information, contact DMORT, NDMS,

and HHS at 1–800–USA–NDMS, or

visit their Web site at www.oep-ndms.

dhhs.gov.

DMORT Teams
experience and specialized training. The

task of providing appropriate victim services for an event of this scope and nature

was very difficult. The American Red

Cross Web site provides the “Guide to

Organizing Neighborhoods for Preparedness, Response, and Recovery” (www.

redcross.org/disaster/safety/marin%2Dg2.

html), which offers several ideas about

volunteer management and support services for disaster preparedness. This site

also helps communities identify their own

resources and teaches them how to avoid

pitfalls as they develop a crisis response

plan.

Determine fiscal responsibility for expenses. The expense of setting up the 

investigation site and providing family assistance accommodations varies depending on the event and the state in which it

occurred. If the President of the United

States declares the event a disaster, the

Federal Emergency Management Agency

(FEMA) is immediately contacted.

FEMA provides “consequence management” that involves emergency management to save lives, protect property,

restore government services, and provide

emergency relief. It also funds a crisis

counseling program that is carried out

through the Center for Mental Health

Services. In the event of a major transportation accident, the medical examiner

or coroner for the locality in which the

accident occurred is contacted within an

hour of the accident. NTSB discusses

with the medical examiner or coroner the

capabilities and resources of the local office. If the medical examiner or coroner

believes the operation is beyond local capabilities, HHS and DMORT can provide

support services. Generally, NTSB assumes investigative expenses, and the airline involved assumes the expenses to

shelter and care for the families, including

flying relatives to a location near the

site, and the victim identification costs,

including DNA analysis. The American

Red Cross manages and coordinates volunteer and support services to provide disaster relief for victims that addresses basic

human needs, including shelter, food, and

health and mental health services. The

American Red Cross also feeds emergency

workers, provides blood and blood products, and helps locate other resources for

those affected by the disaster.

Dispose of common tissue. After incidents such as high-impact aviation crashes, bombings, and tornadoes, some human

tissue may not be identifiable. When the

medical examiner or coroner determines

that all means of identification have been

exhausted, the decision about the disposition of common tissue must be made.

Typically, common tissue is interred at a

memorial service to which the victims’

families are invited. In a major aviation

accident, the American Red Cross is the

designated planning organization for

memorial services and may also assist the

medical examiner or coroner.

In Oklahoma City, burial arrangements

for the common tissue were complicated

because, at that time, the bombing was

the largest mass murder in the Nation’s

history, and a burial could not take place

until after the federal trials. The families

were consulted about the selection of the

burial site, type of service, and memorial

marker. After 41

⁄2 years, the common 

tissue was buried on the grounds of the

Oklahoma State Capitol in a nondenominational memorial service.

NTSB’s Office of Family Affairs developed a promising practice for handling

the unidentified remains of victims. They

notify families that a memorial service

will be held at a later date to honor these

final remains. In the case of the EgyptAir

crash, a stone was erected for the victims

at the 1-year anniversary of the crash, and

flowers were dropped into the sea by the

Coast Guard in honor of the victims.

Bricks, one for each victim, led to the

memorial site. Each brick had been inscribed with the name of a victim. A similar ceremony was held for the families of

the victims of the Alaska Air crash. As in

the case of the Oklahoma City bombing

and many airplane crashes, interment of

common tissue may not occur soon after

the mass-fatality event due to the length

of time required to complete the scientific

identification of the tissue and/or the

length of time required to investigate and

complete legal proceedings.

Establish victims’ suffering. The issue of

victims’ suffering can cause tension. On

the one hand, there is a need to preserve

evidence that establishes the amount of

suffering the victim endured for use at the

perpetrator’s sentencing hearing. On the

other hand, there is great need to comfort

families and answer their questions about

how much their loved ones suffered before dying. During the recovery of bodies,

the medical examiner or coroner must

sensitively convey information to families

that is consistent with the information

provided to the prosecution.

Implement security measures. Access

to the family assistance center must be

controlled so families and friends of the

victims have privacy and are not overwhelmed by the press, photographers, and

the public. Checkpoints may need to be

established at entrances to the family assistance center and its parking lot. A

badging system can be implemented that

gives family members and authorized

workers easy access to the family assistance center. The American Red Cross has

a badge system that simplifies the process

of signing in and out.

In Oklahoma City, uniformed sheriff’s

deputies and members of the National

OVC Bulletin

12
13

Guard were stationed at the outside 

entrances to the Compassion Center to

check identification. Also, police in plain

clothing patrolled inside the center to ensure that no unauthorized persons gained

entry.

Work with the media. The medical examiner or coroner should designate a 

public information officer to release information about the mass-fatality event.

The press will have questions that only a

representative of the medical examiner’s

or coroner’s office can answer properly, 

including questions about the recovery 

operation, identifications, and condition

of the bodies. Information must be released to the press only by the designated

public information officer and not by any

staff members of the medical examiner’s

or coroner’s office. A joint information

center should be set up to coordinate the

release of information, and no information should be released to the media unless it has been discussed with the families

first.

In Oklahoma City, the director of operations for the Medical Examiner’s Office

released information to the press twice a

day, including the names of those who

had been identified as being among the

dead. The director also tried to answer all

press questions concerning the operation

of the Medical Examiner’s Office.

In Oklahoma City, the media persistently

and intensely requested interviews with

city, state, and federal officials, survivors,

family members, and rescue workers. 

Consequently, the Joint Information

Center (JIC) was established on April 23, 

1995, to monitor print and broadcast

media, disseminate information, answer

inquiries, and assist officials in scheduling

interviews. JIC operated in coordination

with the following agencies and organizations: the local U.S. Attorney’s Office;

U.S. Department of Justice; Small

Business Administration; the FBI; Bureau

of Alcohol, Tobacco and Firearms; Social

Security Administration; General Services Administration; Federal Executive

Board; Governor’s Press Office; state 

departments of insurance, mental health,

and human services; State Highway

Patrol; State Bureau of Investigation;

State Medical Examiner’s Office; American Red Cross; United Way; and Feed the

Children.4 In addition to coordinating

media communications, JIC made it 

possible for many diverse agencies and organizations to speak with one voice, reducing public confusion over policies and

resources. For example, it was established

that when a family’s representative indicated that the family wished to speak to

the press, the public information officer

from the American Red Cross would always coordinate it.

The press served several important functions as it covered the Oklahoma City

bombing and recovery effort. It focused

world attention on this most tragic event.

The press also identified victim services

and provided information to citizens who

wanted to contribute toward victim 

assistance.

Formulating a Crisis

Response Plan

When a mass-fatality event occurs,

the community should already

have in place a crisis response

plan to effectively respond to the needs of 

victims and families. The many tasks and 

challenges involved in crisis response and

recovery efforts require prior planning to

ensure that adequate resources are identified, procedures are in place, and protocols are established. Prior planning by a

community will enhance a coordinated

response when a mass-fatality event occurs and help make it possible to meet

the needs of victims and families. When

a community has in place a crisis response

plan, they will more effectively coordinate appropriate victim services and ensure that victims are notified of their

statutory rights as victims of crime. As

communities develop crisis response

plans, they should keep in mind that effective crisis response planning includes 

representatives from relevant organizations and offices, including the medical

examiner or coroner, law enforcement,

the victim advocacy community, rescue

workers, the prosecutor, mental health

professionals, volunteer agencies (American Red Cross, Salvation Army), and the

state VOCA victim assistance and compensation programs. As communities plan

for a mass-fatality event, they need to realize that the chain of command will be

altered with the arrival of each new group

of volunteers and staff members. During

the preplanning process, the community

should put in place memorandums of understanding and service agreements in anticipation of the many changes that occur

during the management of a mass-fatality

event.

Agencies that the medical examiner or

coroner may encounter at a mass-fatality

or terrorism incident include HHS,

DMORT, DMAT, FEMA, the American

Red Cross, the U.S. Department of State,

and the U.S. Department of Justice, including the FBI and the local U.S.

Attorney’s Office. NTSB will be involved

in an aviation disaster or other major

transportation accident; its Family Affairs

Office is responsible for assisting victims

and their families.

When planning a crisis response plan for

a multiple-fatality event, a family assistance center is an important part of that

plan. The crisis response plan must include consideration of locating and funding material resources as well as people 

resources—the personnel and agencies

PROVIDING RELIEF TO FAMILIES AFTER A MASS FATALITY
that will assist in the operation. Crisis 

response planners should regularly update

materials on how to access these resources

as well as any contracts, agreements, and

memorandums of understanding. The

Oklahoma Medical Examiner’s Office had

a crisis response plan in place before

1995. Twice in 5 years the crisis response

plan was implemented: on April 19, 1995,

for the Oklahoma City bombing and on

May 3, 1999, for the Oklahoma City tornado. Having a plan in place prior to

these crises resulted in smoother, more effective response operations.

With advance planning, coordination

among agencies, meetings to discuss each

agency’s responsibilities, and practice of

tabletop exercises and mock disasters,

each community can develop a crisis response plan.

Promising Practices

Grassroots efforts by family members

who lost loved ones in aviation

crashes have led to the development of a coordinated response to assist 

family members in the aftermath of massfatality events. A large number of family

members approached the NTSB chairman

during the public hearing that followed

the 1994 tragedy involving USAir Flight

427 out of Pittsburgh. After sharing their

stories about how they were treated after

losing their loved ones in aviation crashes, these family members expressed the

need for one agency to lead a coordinated

crisis response to reduce the chaos they

had experienced.

While every mass-fatality event will present unique challenges, all will present

the constant challenge of trying to provide for the basic needs of the victims’

family members. This challenge is best

met through the work of the family assistance center. In Oklahoma City, the establishment of the family assistance center

was made possible through the collaboration of government agencies, family

members, and industry. A family assistance center provides a special place in

which services can be delivered and 

information can be gathered from family

members in a sensitive and timely manner. Above all, the family assistance 

center’s most important function is to

provide a private place for families to

grieve.

On September 9, 1996, then-President

Bill Clinton, in an Executive memorandum, designated NTSB as the coordinator

of federal services to victims and their

families in major transportation disasters.

As the designated responsible agency,

NTSB ensures that the following family

services will be provided in a sensitive

and timely manner: notification of the accident, updates about search and recovery

efforts, updates about the investigation,

delivery of mental health support, and establishment of a place in which victims’

families can grieve in private.

Families affected by past aviation disasters

became the driving force behind the creation of new legislation called the Aviation Disaster Family Assistance Act of

1996 (49 U.S.C. § 1136). Family members were asked to participate on a task

force that generated 61 recommendations

that were presented to the Federal Government, the airline industry, and other

organizations about how to treat and 

better assist the victims of major aviation 

accidents and their families.5

OVC Bulletin

14

The Jefferson Institute for Justice

Studies (JIJS) designed a 1- to 5-day

training session to help local communities and states develop, implement,

and coordinate long-range crisis response plans. JIJS also works with local

and state agencies to prepare response

plans for incidents that involve victims

of mass violence and terrorism. Training focuses on response to trauma,

both psychological and medical, as

well as long-term stress, death and

dying, intervention, spiritual considerations, and media management. Curriculum modification can produce 

1-day overview training or expanded

training with comprehensive, interactive sessions. For more information

about this training, go to JIJS’s

Web site at www.jijs.org/ccri/ccri_

background.htm or contact JIJS at

1015 18th Street NW., Suite 902,

Washington, DC 20036, (telephone)

202–659–2882, (fax) 202–659–2885.

Go to the American Red Cross Web

site at www.redcross.org/disaster/

safety/marin%2Dg2.html to access

the “Guide to Organizing Neighborhoods for Preparedness, Response,

and Recovery.”

Coordinating Long-Term Crisis

Response Plans
15

Pursuant to the Act, NTSB created the

Office of Family Affairs and assigned it

the responsibility for coordinating the

provision of federal services to victims

and their families after major aviation disasters. While coordination for these services is outlined in the Federal Family

Assistance Plan for Aviation Disasters

(to find out more about this plan, visit

www.ntsb.gov), the principles and resources are applicable to any mass fatality.

A brief summary of the victim support

tasks performed by various agencies follows.

National Transportation

Safety Board

■ Coordinates federal assistance efforts

with local and state authorities.

■ Coordinates and conducts briefings

for victims’ families and friends to

provide information about resources

for recovery, progress of the investigation, and identification of victims and

their personal effects and belongings.

■ Coordinates with the investigator in

charge of the accident and local and

state authorities to try to arrange a

family visit to the crash site or to an

appropriate alternative site.

Airline

■ Notifies the families of passengers in

a timely manner that their relatives

may have been on the flight.

■ Secures a facility to establish a family

assistance center in which family

members can receive investigative

updates, support, and protection from

the media.

■ Supports logistically those family

members who want to travel to the

accident city and maintains contact

with the families who stay at home.

American Red Cross

■ Coordinates the mental health services and emotional care and support

for families as designated by NTSB.

■ Manages and coordinates volunteer

and support services.

■ Arranges suitable interfaith memorial

services.

U.S. Department of Health and

Human Services, supported by

U.S. Department of Defense

■ Assists with victim identification,

mortuary support, and the setup of

temporary morgue facilities if the

medical examiner or coroner reports

insufficient resources to support the

operation.

■ Provides experienced personnel to

collect antemortem information from

the victims’ next of kin.

■ Assists the designated medical examiner or coroner with notifying 

victims’ families of positive identification, providing particular expertise in

explaining how identification was

made.

U.S. Department of State

■ Assists foreign families and interested

parties with translations.

■ Aids with collection of antemortem

medical and dental radiographs and

records from non-U.S. passengers.

■ Assists in returning the deceased to

their native countries.

Federal Emergency Management

Agency

■ Provides communications assets in

the event the accident site is in a 

remote location and there is no way

to convey information.

■ Provides personnel to assist with disseminating public information.

■ Assists in the event of an urban aviation disaster.

U.S. Department of Justice

■ Provides, on request, the FBI Disaster

Squad to assist local jurisdictions with

fingerprint identification for criminal

and noncriminal events.

■ Provides information, through the

Office for Victims of Crime, to victims of criminal acts and their families about programs to which they are 

entitled.

As previously mentioned, a victimsensitive crisis response plan for addressing mass fatalities had been developed

prior to the Oklahoma City bombing.

This plan was developed in reaction to

the 1986 Edmund, Oklahoma, U.S. Post

Office shooting of 14 employees and to

the state’s long history of mass fatalities

from tornadoes. The plan was put to the

test after the Oklahoma City bombing,

and it served well. In fact, many consider

the victim response in Oklahoma City to

have set a standard for responding to

mass-casualty incidents. The effectiveness of the Oklahoma City Compassion

Center as a central gathering place and a

place to meet the special needs of disaster

victims won the center recognition as a

promising practice. Within the past 10

years, family assistance has evolved and

continues to grow. Once nonexistent,

family assistance is now a major part of

crisis response efforts after mass fatalities.

Family assistance operations face a major

challenge as they work with victims and

families from many countries and cultures. In many ways, multicultural issues

PROVIDING RELIEF TO FAMILIES AFTER A MASS FATALITY
complicate the family assistance effort,

from basic communication to sensitive

cultural differences. This has an impact

on recovery and investigative efforts.

Having had experience in several major

aviation accidents, NTSB was able to

provide valuable insight about multicultural issues. Important considerations 

include the proper formatting of first and

last names and recording correctly the

spelling differences in similar sounding

names. This is particularly important

when recording family information and

creating records that will be referenced

by many agencies. When working with

families from other cultures, the family 

assistance operation needs to note information about the family’s religious or spiritual beliefs, including practices and

rituals, daily prayer times, important

dates, beliefs about autopsy, and other 

information that may be relevant to the

rescue, recovery, and disposition of their

loved ones. For guidance in emergency

situations like this, it may be beneficial to

consult a leader of the appropriate religious or spiritual community or contact

the American Red Cross, which provides

contacts with national chaplain organizations that can provide interdenominational perspective.

Other resources with information on handling mass fatalities include the Mass

Fatalities Incident Response Course at the

National Emergency Training Center in

Emmitsburg, Maryland,6 and NTSB’s

Federal Family Assistance Plan for Aviation Disasters. The NTSB plan describes

airline and federal responses to an aviation crash involving a significant number

of passenger fatalities and/or injuries.

DMORT, part of the National Disaster

Medical System (NDMS), may be dispatched through NTSB or the Federal

Response Plan (to find out more about

this plan, visit www.fema.gov/r-n-r/frp/

frpfore.htm) to mass-fatality incidents

throughout the country on request by the

medical examiner or coroner at the disaster. The DMORT experts and equipment

can respond within a few hours of a request. For more information about training and all aspects of mass fatalities, contact

NDMS by calling 1–800–USA–NDMS.

Conclusion

E

xperiences gained from mass-fatality

incidents, including the Oklahoma

City bombing, reinforce the need to

impose the structure of a family assistance

center on an otherwise chaotic event.

Although in most cases the response falls

on the medical examiner or coroner who

is local to the incident, preplanning for

an effective crisis response should

be based on the collaboration of many.

Many lessons were learned from the

Oklahoma City experience. The response

efforts in Oklahoma City became another

step forward in developing a more effective crisis response plan for the next disaster and its victims and their families. The

Oklahoma City bombing became the impetus for congressional hearings, passage

of special funding legislation for victim

relief, training development, and identification and coordination of resources.

Experts in many fields, including emergency preparedness, medical and mental

health, and victim assistance, were motivated to examine their local crisis response plans and their capacity. The

knowledge that we have today came from

those involved in responding to victims

and from the victims themselves, who

have shared their painful experiences so

that lessons could be learned and so their

losses would not be in vain.

Recommendations presented in this report are not comprehensive, but they are

practical and useful and will help refine

and improve the crisis response to 

terrorism.

For More Information

F

or more information on meeting

victims’ needs after a mass fatality,

contact

Office for Victims of Crime

U.S. Department of Justice

810 Seventh Street NW., Eighth Floor

Washington, DC 20531

202–307–5983

Fax: 202–514–6383

Web site: www.ojp.usdoj.gov/ovc

National Transportation Safety Board

Office of Government, Public and Family 

Affairs

490 L’Enfant Plaza East SW.

Washington, DC 20594–2000

202–314–6185

1–800–480–2520 (to order publications)

Web site: www.ntsb.gov

Federal Emergency Management 

Agency

500 C Street SW.

Washington, DC 20472

202–646–2500

1–800–480–2520 (to order publications)

National Emergency Training Center

16825 South Seton Avenue

Emmitsburg, MD 21727

301–447–1000

Web site: www.fema.gov/emi/nrcrs.htm

Disaster Mortuary Operational 

Response Teams (DMORTs)

Tom Shepardson, National Team Leader

315–471–2349

1–800–USA–NDMS

Web site: www.dmort.org

OVC Bulletin

16
17

American Red Cross

17th and D Streets NW.

Washington, DC 20013

202–737–8300

Web site: www.redcross.org

For copies of this bulletin, other OVC

publications, or information on additional

victim-related resources, please contact

OVC Resource Center

P.O. Box 6000

Rockville, MD 20849–6000

1–800–627–6872 or 301–519–5500

(TTY 1–877–712–9279)

E-mail: askovc@ojp.usdoj.gov

Web site: www.ncjrs.org

Or order OVC publications online at

http://puborder.ncjrs.org.

For information on training and technical

assistance available from OVC, contact

OVC Training and Technical Assistance

Center

10530 Rosehaven Street, Suite 400

Fairfax, VA 22030

1–866–OVC–TTAC (1–866–682–8822)

Fax: 703–279–4673

E-mail: TTAC@ovcttac.org

Web site: www.ojp.usdoj.gov/ovc/assist/ 

welcome.html

Notes

1. Unidentified human remains are also

referred to as common tissue.

2. American Psychological Association,

July 1997.

3. Oklahoma Department of Civil

Emergency Management, 1996.

4. American Psychological Association,

July 1997.

5. National Transportation Safety Board,

October 29, 1997.

6. Federal Emergency Management

Agency, January 1996.

Bibliography

American Psychological Association. July

1997. Final Report of the Task Force on the

Mental Health Response to the Oklahoma

City Bombing. Washington, DC: American Psychological Association.

Bennett, Thomas L., Iowa Organization

for Victim Assistance, MADD/Polk

County Chapter, and Polk County

Victim Services. n.d. In Person, In Time:

Recommended Procedures for Death Notification. Des Moines, IA: Crime Victim

Assistance Division, Iowa Department

of Justice.

Center for Mental Health Services. n.d.

Human-Caused Disasters: Recommendations for the Crisis Counseling Assistance

and Training Program. Rockville, MD:

U.S. Department of Health and Human

Services.

Federal Emergency Management Agency.

January 1996. Mass Fatalities—Incident

Response Course (Instructor Guide 403),

Emmitsburg, MD: Emergency Management Institute, www.fema.gov/emi/

nrcrs.htm.

Jordan, F.B. April 1999. The Role of the

Medical Examiner in Mass Casualties With

Special Reference to the Alfred P. Murrah

Building Bombing. Oklahoma State Medical Association 92(4): 159–63.

Kelly, C.C. 1998. “Dealing With the

News Media: Effective Communication

Strategies for Medical Examiners.” American Journal of Forensic Medicine and Pathology 19: 181–85.

Mahoney, Emmet Louis. July 1986.

Disaster Medical Assistance Team 

Organization Guide. Report NDMS–86.

Manpower Task Force, National Disaster

Medical System. Washington, DC: U.S.

Department of Health and Human

Services, Public Health Service, Health

Resources and Services Administration,

Bureau of Resources Development.

“Mass Fatalities Incident Response

Course.” January 1996. Emergency

Management Institute, National

Emergency Training Center, Federal

Emergency Management Agency.

Emmitsburg, MD. Available at

www.fema.gov/emi.

Mittleman, Roger E., M.D., Jay S.

Barnhart, Jr., M.D., Joseph H. Davis,

M.D., Ray Fernandez, M.D., Bruce A.

Hyma, M.D., Robert D. Lengel, Lt. Ret.,

Emma O. Lew, M.D., and Valerie J. Rao,

M.D. 2000. The Crash of ValuJet Flight

592, A Forensic Approach to Severe Body

Fragmentation, Miami, FL: Miami-Dade

County Medical Examiner Department.

Morgan, J. 1994. “Providing Disaster

Mental Health Services Through the

American Red Cross.” National Center

for PTSD Clinical Quarterly 4: 13–4.

Mothers Against Drunk Driving

(MADD). 1996. Death Notification:

Breaking the Bad News With Concern for

the Professional and Compassion for the

Survivor—A Seminar for Medical Professionals. Washington, DC: U.S. Department of Justice, Office of Justice

Programs, Office for Victims of Crime.

National Organization for Victim Assistance. May 1998. The Community Crisis

Response Team Training Manual, 2d ed.

Washington, DC: U.S. Department of

Justice, Office of Justice Programs, Office

for Victims of Crime. Available at

www.ojp.usdoj.gov/ovc/publications/

infores/crt.

National Transportation Safety Board.

October 29, 1997. Final Report: Task

PROVIDING RELIEF TO FAMILIES AFTER A MASS FATALITY
Force on Assistance to Families of Aviation

Disasters. Washington, DC: U.S. Department of Transportation.

Office for Victims of Crime. October

2000. Responding to Terrorism Victims,

Oklahoma City and Beyond. Washington,

DC: U.S. Department of Justice, Office of

Justice Programs, Office for Victims of

Crime.

Oklahoma Department of Civil Emergency Management. 1996. After Action

Report: Alfred P. Murrah Federal Building

Bombing. Oklahoma City, OK: Oklahoma Department of Civil Emergency

Management.

Phillips, Brenda D. 1989. “Cultural

Diversity in Disasters: Sheltering,

Housing and Long Term Recovery.”

International Journal of Mass Emergencies

and Disasters 11: 99–110.

Spungen, Deborah. 1998. Homicide: The

Hidden Victims—A Guide for Professionals.

Thousand Oaks, CA: Sage Publications,

Inc.

Task Force on Assistance to Families of

Aviation Disasters. n.d. Aviation Disaster

Assistance Guide. Prepared through a

grant by the U.S. Department of Justice,

Office for Victims of Crime, and the

National Organization for Victim

Assistance.

U.S. Department of Justice. 2000.

Attorney General Guidelines for Victim and

Witness Assistance. Washington, DC: U.S.

Department of Justice.

Volunteer Center of Marin. n.d. “Guide

to Organizing Neighborhoods for Preparedness, Response, and Recovery.”

California Preparedness Materials. Prepared through a grant from the Northern

California Disaster Preparedness Network

and the American Red Cross. Available

at www.redcross.org/disaster/safety/

marin%2Dg2.html.

Acknowledgments

OVC gratefully acknowledges the dedicated efforts of Ray L. Blakeney, Director

of Operations for the Office of the Chief Medical Examiner of the State of

Oklahoma, and Sharon W. Bryson, Deputy Director of the Office of Family

Affairs, and Brian Fiffick, Manager of Forensic Operations, both of NTSB, for

their work on this bulletin. 

OVC also gratefully acknowledges the following contributors and reviewers who

provided a wealth of thoughtful recommendations:

OVC Bulletin

18

Gwen Allen, M.S.W., M.P.H.

Director, Project Heartland

Department of Mental Health and 

Substance Abuse 

Oklahoma City, OK

Joseph H. Davis, M.D.

Director (Retired), Medical Examiner 

Department

Miami-Dade County, FL

Anthony Falsetti, Ph.D., D–ABFA

Director and Associate Professor

C.A. Pound Human Identification 

Laboratory

Department of Anthropology

University of Florida 

Gainesville, FL

Stephanie Frogge, M.T.S., C.T.S.

National Director, Victim Services

Mothers Against Drunk Driving

Irving, TX

Fred B. Jordan, M.D.

Chief Medical Examiner,

State of Oklahoma

Oklahoma City, OK

Gary Moore

Director, Division of Emergency

Preparedness and Operation

U.S. Department of Health and 

Human Services 

Twinbrook Metro Plaza

Rockville, MD

Mary Elizabeth Nelson, M.S.W.

Branch Chief, Emergency Services and

Disaster Relief Branch

Center for Mental Health Services

Rockville, MD

Jack O’Brian Poe, D.Min., F.T., C.F.S.

Chaplain, Oklahoma City Police 

Department

Oklahoma City, OK

Thanks also go to OVC staff members Laura Ivkovich (nee Federline), Program

Specialist, and Writer/Editors Grace Coleman and Debra Christenberry for the

time and talent they invested in this bulletin.
19

Preparation of this document was supported by the Office for Victims of Crime,

Office of Justice Programs, U.S. Department of Justice.The opinions, findings, conclusions, and recommendations expressed

in this document are those of the author

and do not necessarily represent the 

official position or policies of the U.S.

Department of Justice.

The Office for Victims of Crime is a component of the Office of Justice Programs,

which also includes the Bureau of Justice

Assistance, the Bureau of Justice Statistics,

the National Institute of Justice, and the

Office of Juvenile Justice and Delinquency

Prevention.

About the Author

Ray L. Blakeney is the Director of Operations for the Office of the Chief Medical Examiner of the State of Oklahoma. He is an adjunct faculty member for the

National Emergency Training Center in Emmitsburg, Maryland, and a member

of the Disaster Mortuary Operational Response Team, National Disaster Medical

System. He set up family assistance centers for the Oklahoma City bombing and

the 1999 Oklahoma City tornado. As a member of DMORT, he has assisted

with the setup and operation of family assistance centers at other mass-fatality

incidents.

PROVIDING RELIEF TO FAMILIES AFTER A MASS FATALITY

NCJ 188912