After 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 examiners 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 Examiners 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.
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 examiners 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 612 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 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 Examiners 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 Examiners 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 Examiners 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 Examiners Office were inclined to dispose of the 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 victims 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:
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
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 examiners 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 Examiners 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.
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 Examiners Office to discuss the condition of their loved ones 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 examiners office speak to families about the condition of their loved ones, they should use language that is sensitive to the familys 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 examiners 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 learn about the injury or death of their loved ones from a credible source in a compassionate waynot 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 Examiners 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 examiners 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 examiners or coroners 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 examiners or coroners office should also be able to explain to the families how and when the reports will become available.