Civil emergencies

Post-mortem procedures

Local resilience forum (LRF) plans for mass fatalities should include details of mortuary arrangements. Local authorities are responsible for providing mortuary facilities, arranging a licence for emergency mortuaries with the Human Tissue Authority and appointing a mortuary facilities manager, who sits on the mortuary management team.

Once a pathologist has completed the identification examination process, deceased persons and human remains are re-bagged. After evidence has been stored securely, the deceased can be viewed and released.

Mortuary management team

Responsibilities include:

  • supervising mortuary procedures
  • coordinating supplies, equipment, services and staff
  • briefing family members via the family liaison coordinator (FLC)
  • liaising with the police media liaison officer at the gold tier of command, government departments and press offices.

The mortuary management team must record all decisions made.

Members of the mortuary management team may include:

Police mortuary operations coordinator

A PMOC is a police officer who ensures compliance with all police disaster victim identification (DVI) procedures. The PMOC manages the police mortuary teams and liaises between the mortuary documentation officer and supervising/lead pathologist, while ensuring that the agreed mortuary procedure is implemented.

The PMOC is responsible for:

  • obtaining, seizing and retaining evidence and personal property at the mortuary in line with strategies
  • liaising with the designated individual to ensure the provisions of the Human Tissue Act 2004 are adhered to within the mortuary
  • ensuring continuity and security of evidence
  • completing all relevant post-mortem documentation
  • liaising with the emergency mortuary coordinator
  • coordinating the activities of specialists within the mortuary
  • liaising with funeral directors
  • managing the health, safety and welfare of all personnel within the mortuary and ensuring that the appropriate risk assessments are documented
  • supervising family attendance for viewing purposes
  • security of the mortuary
  • documenting all personal decisions and the rationale for them
  • assisting the mortuary facilities manager to decommission an emergency mortuary
  • ensuring all personal or sensitive information is handled correctly
  • ensuring no photographs are taken within the mortuary unless authorised.

Mortuary facilities manager

If an existing public or NHS facility is used as an emergency mortuary, local authorities or an NHS trust will appoint a mortuary manager. This person usually undertakes the role of mortuary facilities manager, should that mortuary be used for DVI or for a mass fatality incident.

The specific responsibilities of the mortuary facilities manager include:

  • liaising with the Human Tissue Authority to arrange for any necessary licensing of the venue
  • arranging logistical support to all areas of the mortuary facility
  • working with the PMOC to oversee all relevant staffing requirements, including welfare issues
  • arranging for a qualified first aider to be on site and available at all times of operation
  • working with the supervising forensic pathologist to ensure there is appropriate consideration and enforcement of all relevant health and safety legislation and hygiene practices
  • managing the provision, use and stockpiling of personal protective equipment, stationery, office supplies and mortuary staff refreshments (mortuary facilities)
  • arranging for the proper handling, storage and disposal of clinical waste
  • supervising the cleaning of all parts of the mortuary facility
  • organising and supervising the decommissioning of the mortuary facility (including ensuring that all necessary cleansing and repairs are undertaken in advance).

Emergency mortuary coordinator

If an emergency mortuary is established at a location other than an existing mortuary, including where local or national emergency mortuary arrangements are activated, an emergency mortuary coordinator may be appointed to be in overall charge of establishing, running and closing an emergency mortuary.

Mortuary documentation officer

In a large scale incident the PMOC may require additional assistance. The SIM/SIO may appoint a mortuary documentation officer. This post is held by a DVI trained police officer who is responsible to the PMOC.

Their responsibilities include:

  • ensuring evidential continuity
  • completing documentation in the mortuary in relation to the post-mortem examination of victims
  • collating post-mortem data documentation
  • liaising with the pathologist, odontologist and other specialists to establish and agree the appropriate documentation and ensure consistency within the submission process for reconciliation
  • liaising with the major incident room regarding all evidential documentation and other disclosable data created within the mortuary
  • liaising with the reconciliation team (if created) to provide post-mortem information
  • presenting identification evidence to the Identification Commission
  • ensuring appropriate arrangements are in place for viewing the deceased (this is a joint responsibility with the coroner’s officer)
  • liaising with the ante-mortem coordinator (AMC) and/or senior identification manager (SIM) regarding the authorised release of deceased persons or human remains
  • liaising with appointed undertakers
  • appointing (where necessary) a mortuary exhibits officer.

Mortuary exhibits officer

This is usually a police officer who is responsible to the PMOC.

Their responsibilities include:

  • recording details of all property received from the post-mortem team
  • listing the property against the relevant deceased person or human remains
  • providing secure storage of property taken from the deceased
  • recording details of all movement and storage of exhibits
  • ensuring the correct packaging and labelling and continuity of all exhibits generated during the post-mortem process
  • liaising with the major incident room as necessary
  • arranging all forensic submissions in line with the policy decisions of the coroner or procurator fiscal, the senior investigating officer (SIO) and senior identification manager
  • consulting the family liaison coordinator about which items of property the relatives wish to be returned in due course
  • liaising with the FLC, the SIO and funeral directors about the restoration of property to family and friends
  • disposal or release of property in accordance with instructions from the coroner or procurator fiscal, the SIO and/or SIM.

Mortuary officer

This role is usually held by a police officer or member of police staff.

Their responsibilities include:

  • assisting the pathologist to search and strip deceased persons or human remains
  • ensuring that all items of property on or with the body or human remains are recovered, logged and passed to the mortuary exhibits officer as appropriate
  • passing the details of property found on the body of the deceased, which may speed up identification, to the police mortuary operations coordinator or senior identification manager as appropriate
  • recording all relevant post-mortem data on the INTERPOL disaster victim recovery form and associated documentation for submission to the PMOC
  • ensuring that photographs are taken and that they include the body label number in every frame
  • complying with health and safety requirements.

Mortuary arrangements

The requirement for mortuaries depends on the number of deceased, their condition and the required level of post-mortem investigation. There are four options for mortuary arrangements:

The deceased should be taken to a mortuary in line with the policy, and reception and documentation arrangements agreed between the coroner or procurator fiscal and the SIM. The general principle is that one mortuary should be used. Decisions about mortuary arrangements are usually made by the mass fatality coordination group.

Local emergency mortuary arrangements

Each LRF and local authority should have a plan for activating an emergency mortuary. This should include locations identified as suitable (as agreed by the coroner or procurator fiscal) that comply with Home Office (2004) Guidance on dealing with fatalities in emergencies, Annex B Mortuary Requirements.

Where an LRF has been unable to identify suitable existing local mortuary facilities, they may have a formalised arrangement with a private sector company to use emergency mortuary facilities.

National emergency mortuary arrangements

If the demands of a mass fatality incident exceed the capabilities of the local or regional arrangements, the coroner or procurator fiscal request that NEMA be deployed.

NEMA forms the basis of HM Government’s programme of central assistance to supplement local and regional plans, and may be configured in various ways.

NEMA is flexible, and can provide:

  • temporary structure(s) to form an emergency mortuary
  • stockpiles of general mortuary equipment
  • chilled storage for use at an incident site
  • specialist radiographic equipment.

If NEMA is activated, the UK disaster victim identification (UK DVI) team should be informed via the National Police Coordination Centre (NPoCC). Any requests for UK DVI personnel or mutual aid from other police forces to support the deployment of NEMA are made by or on behalf of the gold commander to NPoCC.

NEMA configurations

There are a number of deployments, for example:

  • a 600 fatality facility
  • a 300 fatality facility
  • two separate 300 fatality facilities
  • two separate 96 capacity body storage facilities
  • mortuary equipment with NEMA deployment
  • stand-alone mortuary equipment as required.

The configurations are designed to provide an initial operating capability within 24 hours. Structures completed can include:

  • receiving areas
  • storage areas
  • autopsy areas
  • fluoroscopy
  • radiology.

Once these facilities have been completed, additional structures may be deployed in order to provide the full NEMA operating capability within 72 hours. These include:

  • Counter-Terrorism Command office (if required)
  • operating office
  • embalming area
  • equipment store
  • additional catering and staff changing area
  • family viewing area.

Reception arrangements

Deceased persons and human remains are transported from the scene (usually from the holding audit area) under arrangements agreed by the coroner or procurator fiscal, the SIO and the senior identification manager.

Transportation is subject to local arrangements and may be undertaken by:

  • police
  • funeral directors
  • private ambulances.

Mortuaries usually have a designated reception area to which all arriving deceased people and human remains are taken. On arrival, police personnel should check that the correct documentation has accompanied the deceased or human remains. They should also check that the audit trail is intact and record the details. The deceased or human remains are then accepted into the mortuary and conveyed to the relevant storage area.

The personnel working in the reception area should be briefed on the nature of the scene, and appropriate personal protective equipment provided to enable them to undertake their work safely.

Documentation in the mortuary

Mortuary documentation needs to be stringent. All deceased persons, human remains and related samples undergoing laboratory examination need to be carefully recorded and a method of sample labelling needs to be established.

The recovery of the deceased and human remains should have been documented on either the INTERPOL disaster victim recovery booklet or the INTERPOL disaster victim recovery form.

The pink post-mortem forms should be used throughout the post-mortem procedures. The ACPO victim profile forms may be considered for use in circumstances where the deceased are reasonably believed to be UK citizens and the senior identification manager makes a policy decision that they are used in preference to the INTERPOL forms.

Pathologist

The pathologist examines deceased persons or human remains and ensures that all the appropriate data is recorded on the pink post-mortem form.

The pathologist’s main objectives are to:

  • gather identification evidence, using a team of forensic specialists
  • ascertain cause of death
  • gather evidence for criminal investigation.

The pathologist may take samples for toxicology and DNA analysis, and undertake an autopsy when authorised to do so by the coroner or procurator fiscal.

It is the responsibility of the lead pathologist to analyse and document:

  • external injuries and the position of injuries and/or burns
  • a description and arrangement of traumas, fractures, internal bleeding and any upper respiratory issues
  • old surgical procedures and internal implants, eg, silicone, pacemaker
  • any anatomical particularities.

In England, Wales and Northern Ireland the coroner appoints a lead forensic pathologist. In Scotland the procurator fiscal must apply to the appropriate sheriff court for permission to order an autopsy. In a mass fatality incident, the senior identification manager and lead pathologist may agree to appoint additional pathologists to work under their supervision.

Identification evidence

Prints

A number of areas of the body can be used to recover prints for identification purposes. Areas such as the forehead, lips and ear may be considered, however, the hands and feet are the most commonly used.

Prints are taken from deceased persons or human remains and compared with those that have either been taken at an earlier time or have been gathered as part of ante-mortem procedures. An individual’s fingerprints may have been taken previously and added to IDENT1, United Kingdom Border Agency or Identity and Passport Agency databases.

A team of fingerprint specialists and crime scene investigators should physically take the prints. A recognised fingerprint expert should quality assure the process.

Prints may be used in the reconciliation process as part of identification.

DNA

DNA profiling may be used as a primary tool to reunify remains and identify victims of mass fatality incidents. DNA profiling techniques may be particularly useful if the victims’ bodies are disrupted or decomposing, as DNA may still be successfully obtained from teeth or samples of bone.

DNA profiling is a comparative technique. In order for the Identification Commission  to make a positive identification, there must have been a comparative analysis of the post-mortem DNA sample taken from the victim and a DNA sample collected during ante-mortem procedures from the person believed to be the potential victim.

In managing the DNA identification process, the senior identification manager may need to establish a DNA reconciliation team. This team has three functions:

  • DNA post-mortem team for sample profiling
  • DNA ante-mortem team for sample profiling
  • DNA data reconciliation team for data matching.

DNA samples may be used within the reconciliation process as part of identification.

DNA post-mortem team

The leader of this team is responsible for advising the pathologist and other post-mortem specialists of the best samples to obtain.

The type of post-mortem sample required for DNA profiling of victims’ remains depends on the nature of the incident, the speed of recovery of the bodies and the state of decomposition (or preservation). The post-mortem team is responsible for ensuring that the best samples are selected for DNA analysis in each particular case. It may be beneficial to select multiple samples for analysis at the initial post-mortem examination. In some circumstances the pathologist may seek advice on sample selection from a forensic DNA specialist.

If a body is intact and in a reasonable state of preservation, it might be possible to recover blood samples, pulled hair samples (hair roots), buccal (cheek cell) scrapes or good quality muscle samples. As a deceased person or human remains start to decay, the probability of recovering such samples diminishes and deep muscle, teeth and bone samples should be considered.

DNA ante-mortem team

The leader of this team has responsibility for advising the family liaison officers of the best reference samples to obtain for identification, according to any particular family circumstances.

Forensic odontology

Odontology is a branch of forensic medicine involved with dentistry. The teeth are the hardest tissue in the human body and are the most resistant to trauma, decomposition, water immersion and fire. Odontology may be the primary method of identification in cases where there are more extreme levels of damage or decomposition of a deceased body.

When loose or individual teeth are found at the scene of a major disaster, they should never be destroyed as they are likely to still hold DNA and offer valuable clues to identity later on. If dental items such as false teeth, crowns, bridges, dentures and fillings are found, they should also be retrieved and documented as they may be unique to the owner and lead to identification of that individual.

Forensic anthropology

The human skeleton is a hard tissue that is resistant to decomposition and survives disruption. Forensic osteology is a sub-discipline of anthropology and can be of assistance when bones are being examined . The identification process involves selecting and cleaning bones for examination. This can be done in a mortuary.

An osteological examination may provide information on:

  • age
  • sex
  • racial characteristics
  • physical stature
  • congenital and developmental disease
  • medical conditions
  • healed fractures
  • anomalies or abnormalities, including surgical hardware and prosthetic devices
  • peri-mortem trauma (trauma caused during death)
  • the anatomical location of body parts
  • distinction between human and non-human material.
Environmental identification techniques

These involve specialist examinations based on the environment or geographic location within which a person has lived. These techniques assist in building up a profile of the individual by identifying where deceased persons or human remains have been, rather than providing direct identification.

By analysing a number of stable isotopes which are taken into the body during life, either in the food eaten or the liquid drunk, a geographical profile can be produced which may assist in narrowing down where the body may have lived. This technique usually involves analysing of a small sample of bone, however, hair, nails or teeth can be used. Stable isotope fingerprinting can be used to separate multiple fatalities into common geographic origins.

CT scanning

The lead pathologist may wish to perform CT scanning to assist in the identification of a body or material. CT scanning can be used for the whole body and the teeth to find clues to the cause or manner of death. A CT scan can diagnose a specific injury, disease or abnormality. It may also help to screen deceased persons or human remains for foreign material such as:

  • pacemakers
  • implants
  • metallic items
  • explosives devices
  • firearm projectiles.

CT scanning is of particular use in response to a CBRN mass fatality incident, as it enables the pathology team to view the contents of a body bag in detail before exposing themselves to the risk of opening the bag.

Removal of human remains and taking samples

All requests for specific forensic procedures regarding deceased persons or human remains (including taking samples, organs, limbs) must be made to the coroner or procurator fiscal.

Samples taken during a post-mortem examination, or under a special examination, may have separate or dual status under coronial jurisdiction and as evidence under the Police and Criminal Evidence Act 1984. The SIO and senior identification manager should agree on the nature of samples required for both, or either, investigation and identification purposes and record this in their respective policy books. Once agreed, they should consult the coroner or procurator fiscal to authorise the samples to be taken. The lead pathologist may then arrange for these samples to be taken in conjunction with the police mortuary operations coordinator.

The deceased’s next of kin should be kept informed in respect of any samples taken during the post-mortem process, including why they were taken and the retention arrangements. The coroner or procurator fiscal and the SIM should discuss and agree the most appropriate way for the family to be informed, either by the family liaison officer (FLO) or coroner’s officer.

Re-bagging

After the identification examination process, deceased persons and human remains are stored in a new body bag with the same label details. The original body bag should be retained, carefully sealed, packaged, recorded and processed as an exhibit. As such, it should be formally taken into the possession of the post-mortem team exhibits officer before being passed to the mortuary exhibits officer. This is because the original bag is likely to be soiled and contaminated but may be of significant evidential value. Using colour-coded bags at this stage may assist the system for storing the deceased.

Evidence

Fragments of evidence may be recovered at the mortuary or discovered during radiography or during a post-mortem examination. In terrorist incidents trained exhibits officers from the counter-terrorism unit are attached to the mortuary. The Metropolitan Police Counter Terrorism Command (SO15) is responsible for the safekeeping of all exhibits recovered following a terrorist incident.

Viewing the deceased

The mass fatality coordination group should consider the options for the family and/or bereaved to view the deceased. If considered appropriate, this should take place at either:

  • a designated family viewing area at a location separate from a main emergency mortuary;
  • a funeral director’s premises after the deceased person or human remains have been released by the coroner or procurator fiscal.

The family and/or bereaved should be briefed by an appropriate person on mortuary and viewing procedures.

Requests may be received from parties wishing to view the mortuary. The mortuary management team should consider such requests against the possible effect on the operational efficiency of the mortuary and the mortuary processes as well as on the privacy, confidentiality and dignity of the deceased and their family.

A log of all visitors will be maintained. The PMOC will ensure that suitable arrangements are in place for any visitors to the facility, including crime scene log protocols. All visits should comply with health and safety and risk management advice and guidance.

Property

Careful consideration should be given to cleaning property without first consulting family members through the family liaison coordinator and family liaison officer. Certain faiths require that all parts of a deceased person are buried or cremated and this may include bloodstained clothing. In addition to ascertaining the wishes of families, the senior identification manager or SIO should also seek advice on any health and safety implications in returning unclean items to relatives. A photograph of each item should be retained before it is returned.

Following a mass fatality incident, it is likely that a great deal of property will need to be collected and managed. In these circumstances the SIM may appoint a property manager.

Property manager

The property manager implements the predetermined strategies on the identification, investigation, obtaining/seizure, retention and return of personal property and evidence. They must also complete the appropriate documentation.

Their responsibilities include:

Releasing the deceased

When the coroner or procurator fiscal is satisfied that the deceased can be released to the next of kin, they authorise this and complete the appropriate documentation.

During the identification process, the family liaison officer and/or coroner’s officer should make the bereaved aware of the nature of the deceased. They should then ascertain the family’s wishes regarding the release of the deceased person or human remains. An appropriately trained FLO or coroner’s officer discusses with the bereaved what is likely to happen to any further human remains or body fragments of the deceased that may be recovered and identified during the investigation. The bereaved should be asked about their wishes for those fragments and whether or not they may consent to any communal arrangements. The family’s wishes should be relayed to the coroner or procurator fiscal.

Burial or Cremation Orders are obtained from the coroner when the inquest is opened.

In Scotland the requirements for certification for a cremation are more extensive than those for a burial. Regulation 15 of the Cremation (Scotland) Regulations, 1935, however, allows for the suspension or modification of other parts of the Regulations during an epidemic or for other sufficient reason. The Regulations are suspended by an order of the Scottish Ministers and the order becomes a statutory instrument. Such changes are required only in exceptional circumstances and the practical arrangements to implement these modifications should be tailored to the particular situation.

Unclaimed deceased

The coroner or procurator fiscal decides on the procedures in cases of deceased persons who remain unclaimed.

If a deceased person is unclaimed, local authorities arrange for burial or cremation in accordance with their statutory obligation imposed by the Public Health (Control of Disease) Act 1984. Such a disposal should be in accordance with any identified faith requirements. In circumstances where the next of kin is identified but does not wish to claim the deceased, he or she must still be advised of the time, date and location of a burial or cremation.

Deceased persons to be repatriated abroad

Regardless of how or when a death occurred, if the next of kin wishes to remove a deceased person or human remains from England and Wales for burial or cremation elsewhere, the coroner should be asked to grant an ‘Out of England’ authority form. The coroner considers any request and makes a judicial decision on whether the deceased person or human remains can be released, or whether they need to be retained. The ‘Out of England’ authority should contain the unique reference number(s) allocated to that deceased person or human remains during the victim recovery process.

Different rules apply to the repatriation of bodies from Scotland and Northern Ireland.

Embalming

Embalming is not permitted until written authority is received from the family of the victim or their representative. A third party or private sector representative may embalm and coffin the deceased only when authorised to do so by the coroner or procurator fiscal (on receipt of the written authority). See cultural considerations for more detail.

Page last accessed 23 September 2017