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Are We Ready for Mass Fatality Incidents? Preparedness of the US Mass Fatality Infrastructure

  • Jacqueline A. Merrill (a1), Mark Orr (a2), Daniel Y. Chen (a2), Qi Zhi (a3) and Robyn R. Gershon (a4)...



To assess the preparedness of the US mass fatality infrastructure, we developed and tested metrics for 3 components of preparedness: organizational, operational, and resource sharing networks.


In 2014, data were collected from 5 response sectors: medical examiners and coroners, the death care industry, health departments, faith-based organizations, and offices of emergency management. Scores were calculated within and across sectors and a weighted score was developed for the infrastructure.


A total of 879 respondents reported highly variable organizational capabilities: 15% had responded to a mass fatality incident (MFI); 42% reported staff trained for an MFI, but only 27% for an MFI involving hazardous contaminants. Respondents estimated that 75% of their staff would be willing and able to respond, but only 53% if contaminants were involved. Most perceived their organization as somewhat prepared, but 13% indicated “not at all.” Operational capability scores ranged from 33% (death care industry) to 77% (offices of emergency management). Network capability analysis found that only 42% of possible reciprocal relationships between resource-sharing partners were present. The cross-sector composite score was 51%; that is, half the key capabilities for preparedness were in place.


The sectors in the US mass fatality infrastructure report suboptimal capability to respond. National leadership is needed to ensure sector-specific and infrastructure-wide preparedness for a large-scale MFI. (Disaster Med Public Health Preparedness. 2016;10:87–97)


Corresponding author

Correspondence and reprint requests to Robyn R. Gershon, DrPH, MHS, Phillip R. Lee Institute for Health Policy Studies and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 3333 California Street, Suite 280, San Francisco, CA 94118 (e-mail:


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