Body Count

EMS response to mass-fatality events

You are the director of Tri-County EMS, a third-service EMS agency, and are heading into the office one morning when you hear the call come over the radio: “Dispatch to units EMS 1, EMS 7, Medic 2, Medic 3 and Rescue 311. We have reports of a school bus into a tractor trailer on Interstate 47 northbound. Numerous callers are reporting multiple injuries and fatalities.” You think, Thank goodness we hammered out that mass fatality plan, then get on the air and advise dispatch that you are responding as well.

EMS agencies have the potential to respond to high-impact incidents of all varieties, including transportation incidents, industrial accidents, severe weather or natural disasters, fires or acts of violence and/or terrorism that result in mass fatalities. There is a definitive need for EMS to be an active element of the planning process as well as the response component for these incidents. Just the term “mass fatalities” conjures up images of chaotic scenes with multiple agencies having distinct responsibilities that may or may not be related to their day-to-day operations. When thinking about the various elements involved in mass-fatality management, it is important to keep in mind recent examples of incidents that produced mass fatalities, such as the earthquake/tsunami combination that hit Japan and the tornadoes that recently devastated several areas in the United States.

Prior to discussing the planning elements that must go into incidents involving mass fatalities, a definition is in order. One of the more expansive definitions comes from California Health and Safety Code Section 103451, titled “Mass Fatalities Incident: Definition,” which states:

“(a) For purposes of this plan, ‘mass fatalities incident’ means a situation in which any of the following conditions exist:

1. There are more dead bodies than can be handled by local resources

2. Numerous persons are known to have died, but no bodies were recovered from the site of the incident

3. Numerous persons are known to have died, but the recovery and identification of the bodies of those persons is impractical or impossible.

(b) The county coroner or medical examiner may make the determination that a condition described in subdivision (a) exists.”

For the purposes of this article, a mass-fatality incident can simply be defined as: “An incident where more deaths occur than can be handled by local resources.” This defining point is an important distinction, as some jurisdictions could easily handle 10 or more fatalities at the same incident scene, while others would be quickly overwhelmed.

Although various jurisdictions have different lead agencies in regard to mass-fatality planning, EMS needs to ensure it has a seat at the table. This means being involved with the various planning and response elements—emergency management, fire, law enforcement/public safety and hospitals—on a day-to-day basis. This strong pre-existing relationship will ensure you are invited to the table and your concerns will be heard and addressed.


The first step in the planning process should be a hazard vulnerability assessment, which will, at a minimum, establish specific hazards that have impacted your jurisdiction (this can be local, county, regional or state) in the past and have the potential to impact it in the present and/or future. Understand that this is not something an EMS agency conducts on its own, and EMS plays a valuable role in this regard. Questions surrounding your HVA could typically include:

  • What types of natural disasters/severe weather, such as flooding, hurricanes, tornadoes, major snowstorms, have impacted your community in the past?
  • Do you have an airport, seaport or other transportation hub?
  • Are there major highways running through your jurisdiction?
  • Is there major industry, and what is it?
  • What are the typical large-scale planned events?
  • What past events have occurred in your community? Have these included acts of terrorism?
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