As the nation prepared for a high number of COVID-19 deaths, the National Funeral Directors Association expressed a likely shortfall in its ability to process remains. It became clear that the Department of Defense (DoD) Mortuary Affairs program had training and expertise in the dignified handling of remains due to two decades of armed conflict that would serve a critical role to offset that shortfall by providing advice on mortuary affairs collection points and providing assistance in operating mortuary affairs programs and facilities. With many public health officials anticipating a second surge of COVID-19 later this year, we should take the opportunity to review some lessons learned from the mortuary affairs’ initial support effort to provide a more efficient response should the need arise again.
To provide data points for comparison, it makes sense to review two states in which, as of May 6, the Center for Disease Control reports having carried the heaviest death tolls from the virus: New York and New Jersey.
- 316,041 cases of COVID-19
- 25,014 deaths related to COVID-19
- Total population: 19,440,469
- 47,126 square miles
- 414 people per square mile (eighth most densely populated state)
- 130,593 cases of COVID-19
- 8,244 deaths related to COVID-19
- Total population: 8,936,574
- 7,354 square miles
- 1,213 people per square mile (highest population density of any state)
Capt. Cristian Radulescu served as the mortuary affairs planner for both states in April and May. This article highlights his key takeaways from his work with both states’ emergency management teams and the Federal Emergency Management Agency (FEMA).
In New Jersey, Radulescu assisted the Office of the Chief State Medical Examiner (OCSME) and the mass fatality manager. The scope of joint operations is informed by DoD Directive 3025.18 Defense Support to Civil Authorities (DSCA), the Stafford Act, the Posse Comitatus Act, and Army and joint mortuary affairs publications presented in the Joint Mortuary Affairs Officer course at Fort Lee, Virginia.
The New Jersey State Police (NJSP) used incident management teams (IMTs) to support the state’s Office of Emergency Management (OEM) during the crisis. New Jersey is one of two states that operate this way. The OCSME’s mass fatality manager plans mortuary affairs at the state level and NJSP provides resources
to support the plan. New Jersey did not request support from FEMA Region 2 or the Department of Health and Human Services (HHS) Disaster Mortuary Operational Response Teams (DMORT). These teams can augment medical examiners’ offices, able to operate a Disaster Portable Morgue Unit (DPMU) or assist with mortuary affairs during disasters declared by the President of the United States.
Instead, New Jersey bought 20 new 53-foot specialized refrigerated trailers and a privately-owned business donated metal racks to increase storage capacity to 50 human remains per trailer. The plan initially emplaced these trailers in the north, south, and central regions of the state. Initial forecasts of COVID-19 related death tolls anticipated the state’s north region to have the greatest need to require temporary refrigerated storage. A parking lot of Rutgers University Hospital became the site at Newark to support that need.
In the central region, a delay in delivery from the out-of-state vendor prompted New Jersey to contract two 10,000 square-foot warehouses to additionally increase storage capacity to more than 2,000 remains and mitigate an expected spike mid-April which analytics and modeling companies provided the Governor’s office. The site was equipped with sub-zero refrigeration units suitable to provide the required temperature control to delay decomposition. To properly store remains and increase capacity, the same company donated additional metal racks to double the number of rows in the warehouses. These racks allowed the available refrigerated trailers to be repositioned as needed and provided a centralized collection point at the warehouses.
Hospitals sent remains to the prepositioned trailers or, in certain cases, directly to the warehouses. Funeral directors were then able to recover the remains from either the hospitals or any of the temporary morgues without having to bypass proper handling procedures due to time constraints of storing remains in facilities that would allow decomposition to begin. This process was similar to the Army’s use of a theater mortuary affairs evacuation point (TMEP).
Governor Phil Murphy published two key executive orders in support of the mortuary affairs process. One allowed crematoriums older than 30 years, to operate 24 hours a day and the other expedited processes in mortuary affairs and required retrieval from temporary morgues to occur within 72 hours of the time of death.
The state’s mass fatality manager reduced the amount of paperwork necessary for a hospital to release remains, after an appropriate legal review, from four detailed documents to just one custody sheet. This simple change had a far-reaching effect that bought time to avoid overwhelming funeral homes without a negative impact on accountability of the remains.
The New Jersey National Guard (NJNG) quickly mobilized and provided troops at Newark and the central region sites, with approximately 33 Soldiers at each facility to conduct 24-hour operations. They were postured to provide 30 field litter ambulances (FLAs) to help transport five remains at a time and, as a contingency, 11 multi temperature refrigerated container systems (MTRCS) normally used to store food supplies. The Soldiers who handled the remains were not mortuary affairs specialists (92M), but were trained and supervised by qualified OCSME personnel to ensure proper procedures were followed. NJSP provided resources and support at all sites, through the temporary morgue policy and procedures planner. NJSP contracted decontamination teams to be used if the MTRCS or any other nonstandard equipment had to be put into operation. Sites were secured by state troopers to ensure NJNG were well-supported and could safely conduct operations.
A representative from OCSME ensured remains were tracked and accountability was maintained at all sites. Information published on the OCSME site was easy to follow. OCSME and NJSP ensured the New Jersey State Hospital Association, private hospital corporations managing 71 hospitals throughout the state, over 350 long-term care facilities and nursing homes, and three temporary military field medical sites (FMS) knew and followed the plan. The temporary storage sites, especially the warehouses in the central region, bought funeral directors the time necessary to execute final disposition.
Teamwork, simple solutions, and flexibility made the difference in ensuring New Jersey had a plan that was realistic and executable. Adaptations such as the various metal racks that easily snapped into place and could be broken down, reconfigured, and repositioned and the reduction in paperwork to one custody sheet reduced time required to properly transfer remains and made the process flow smoothly. OCSME was receptive to our advisor’s ideas, from considering temporary internment to burial at sea, and collaborated well with NJNG. Everyone’s professional attitudes ensured the dignified transfer and internment of all remains and established the capability to respond to a spike that is forecasted to occur during the upcoming fall and winter seasons.
The city had initially set-up four DPMUs managed by DMORT and 54th Quartermaster Company (54th QM) that fell under the dual-status commander, since New York National Guard’s (NYNG) own mortuary affairs company was deployed. A long-term storage facility, or DPMU No. 4, was set up at the south Brooklyn Marine Terminal on 39th Street. The Office of the Chief Medical Examiner (OCME) set-up a recovery taskforce to assist with what had become a backlog of remains at hospitals.
Initially, the city hospitals transferred remains to refrigerated trailers, what they termed body collection points (BCPs), in parking lots adjacent to hospital morgues. The city has 62 hospitals augmented by the Javits Center and USNS Comfort (T-AH-20). The volume and speed of the death toll overwhelmed hospital staff. Since an estimated 80% of patients on ventilators expired, there was a forecast of a spike in hospitalization cases in the months of March and April. Firms hired to provide modeling and analytics offered data to the governor’s office, and on April 9, New York Governor Andrew Cuomo signed an executive order authorizing out-of-state licensed funeral directors to assist with final disposition. Like in New Jersey, the friction points occurred at hospitals on the front end and funeral homes, cemeteries, and crematories on the back end. Even though the Brooklyn Marine Terminal was set-up for long-term cold storage, the backlog in the hospital BCPs remained the challenge.
To manage this backlog, OCME was augmented with an interagency recovery taskforce, supported by the Fire Department of New York. Per the New York Disaster Management Plan and Mass Fatality Guide, the HHS’ DMORT augmented OCME’s efforts to recover remains from BCPs to the Brooklyn Marine Terminal where 54th QM could apply their expertise and process remains into long-term storage until funeral directors could recover them.
Once this plan went active, it was used to recover an estimated 1,527 unclaimed remains and approximately 3,000-4,000 remains. 54th QM processed approximately 240 cases per day with the intent to maximize their capability to work through the backlog before their redeployment scheduled for late May. The average time for remains in storage was 25 days. The longest time remains were held was 40 days. The manner of performance and professionalism of the 54th QM Soldiers set the standard in the state of New York.
It is beneficial to determine the measures that can make the difference if the forecasted second wave of COVID-19 becomes a reality. Most essential for both states were the long-term warehouse storage facilities with freezing capability. These facilities buy precious time for hospitals and funeral homes to work through what otherwise becomes a backlog of rapidly decomposing remains. A level of flexibility and decisive unity of command between various agencies was required so that a taskforce could be surged to areas of greatest need and streamlined the ‘red tape’ process between privately owned and operated hospitals and government organizations.
Capt. Cristian Radulescu is assigned to Army Logistics University, Fort Lee, Virginia. He has served as commander of Echo Forward Support Company, Regimental Engineer Squadron, 2nd Cavalry Regiment, Vilseck, Germany, and has deployed to Operation Enduring Freedom ‘12. He holds a Bachelor of Science in Sociology from University of Wisconsin-Superior and a master’s degree in transportation and logistics from American Military University. Radulescu is a graduate of the Command and General Staff Officers’ Course and Joint Mortuary Affairs Officer Course.
Capt. Chris Lancia serves as deputy director of public affairs, U.S. Army Combined Arms Support Command, Fort Lee, Virginia. He has served as company commander of Echo Company, 2nd Battalion, 3rd Aviation Regiment, 3rd Combat Aviation Brigade, 3rd Infantry Division, at Hunter Army Airfield, Georgia and has deployed multiple times to Iraq, Afghanistan, and various other countries. He holds a bachelor’s degree in English communications from Armstrong Atlantic State University, in Savannah, Georgia, and is a graduate of the Logistics Captains Career Course.
This article was published in the July-September 2020 issue of Army Sustainment.