The 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 Sheriffs 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, long-term accommodations. Finally, those involved in site selection should keep in mind the many agencies that are part of that communitys crisis response plan and consider what those agencies will need to do their jobs effectively.
Availability of FacilityImmediate 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 34 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.
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 centers 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 buildings 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 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 Examiners 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 35 rooms, 101200 fatalities will require 1012 rooms, and more than 200 fatalities will require 1525 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.
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 examiners or coroners office and not as funeral directors. In Oklahoma City, funeral directors acted as representatives of the Medical Examiners 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 they must act as representatives of the Medical Examiners 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 deceaseds 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 Systems 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 DMORTs Family Assistance Center (FAC) Questionnaire and then requests any missing information. DMORTs 7-page FAC Questionnaire 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 familys 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 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 bombs 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 volunteersscreening credentials, examining documents, completing forms, and assessing 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, 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 Nations 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 4½ years, the common tissue was buried on the grounds of the Oklahoma State Capitol in a nondenominational memorial service.
NTSBs 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 perpetrators 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 sheriffs deputies and members of the National 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 examiners or coroners 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 examiners or coroners 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 Examiners 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 Examiners 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. Attorneys 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; Governors Press Office; state departments of insurance, mental health, and human services; State Highway Patrol; State Bureau of Investigation; State Medical Examiners 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 familys 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.