Mass fatality incidents are tragedies that humans have been coping with since the dawn of times. Some of these incidents are unavoidable natural events such as earthquakes, floods and fires, while others can be classified as accidents avoidable or not; however, a third category has emerged, that is, the acts of terrorism. This article seeks to analyze the emotional aspects faced by different stakeholders in this category.
The challenges that must be addressed during the management of a mass fatality incident are without any doubt multiple and complex. Even with the preparation of a Mass Fatality Incident (MFI) plan, some issues will arise, issues that the responsible agency or authorities do not expect, since every incident is unique due to the chain of variables involved in the situation. However, in a broader sense the psychological stress suffered not only by the persons affected but by the responders as well, is an area that can be planned in advance and modified so it will suit to a given incident.
It is important to take the emotional stress suffered by such individuals into consideration since the emotional factor for the survivors will arise during the disaster, and then immediately after the incident for the families, friends and agencies involved, and it will take years to manage. It will perhaps be the most persistent and final issue to be solved, and in some cases, it might take a lifetime for closure to be brought. For example, as we are analyzing the nature of the disaster as an act of terrorism, one of the primary goals of the act is to cause a persistent emotional distress to a group of people or a nation. In comparison to other cases, like a mechanical failure of an aircraft, the closure might be faster, but as stated before it will depend on the personality of the individuals in bereavement.
It would be appropriate now to separate the possible groups that face emotional distress in different levels during a MFI:
1) The families and friends of the deceased.
2) The team working on the incident.
3) A member of the team that is somehow personally related to one or more deceased.
The first group is the one that receives most of the attention, both from the agencies involved and from the media. This can be extremely overwhelming, because the media will demand from those who manage the cases answers that will not be available in short time; for example the nature of the incident (the investigation) might take several years, or the identification of victims might take weeks. This will manifest as frustration and anger, that will undoubtedly be fed by the information presented by the media, and of course harassment from their behalf.
“It is now fairly well established what media do when disaster strikes. The media hear of the event, try to obtain more information, use their own files to add background to their stories, dispatch reporters and report anything they are told. Often they devote all their air time or much of the space available to that single story. To gather material to fill this expanded news hole, the media draft anyone available. When two teenagers killed 15 students – including themselves — and wounded 13 others at Columbine High School in Colorado, KCNC-TV in Denver used every staff member available for its 13 hours of non-stop coverage”.
In some occasions, the media will also use their technical resources and ingenuity to gather information. For example, when Mount St. Helen’s erupted, NBC took a helicopter into the crater and persuaded a geologist to view and comment on the resulting tape. On Three Mile Island, staff from the Philadelphia Inquirer copied the license plates of all vehicles in the parking lot, traced the owners and started phoning them. Many were belligerent but fifty agreed to interviews.
This harassment can be very traumatic as in the case of Lockerbie, when Pam Am 103 went missing over Lockerbie, Scotland. Journalists waiting for information about the flight were cordoned off near the first class lounge at New York’s Kennedy Airport. Seeing them, a woman asked what the fuss was about. An official said a Pam Am plane had crashed. She asked the flight number. He replied, “1-0-3”. She collapsed on the floor, screaming, “Not my baby. Not my baby.” While her husband tried to shield her, photographers and television crews recorded her grief:
“All I remember is losing control… I remember lights all over. I felt like I was being raped by the media. I am usually a woman who is very much in control. I’ll have to say that was one of the few moments in my life where I was out of control. And I felt the media chose that moment. I felt violated. I felt exploited. And there was no one there to protect me.”
Despite the efforts of the authorities and the implementation of a media strategy following a MFI, the media are still extremely unpredictable; they can be beneficial in discrediting rumors but they can also cause panic to the general public. Nowadays the media’s strategy not only is it an integral part of the MFI plan but also of a major forensic investigation. This strategy must be emphasized and implemented rigorously, the teams involved must be briefed in advance to not release any kind of information, and the families involved must be advised to give more emphasis on the official information provided by senior officers. At the same time the media must be confined and briefed constantly in order to be relieved from the pressure of their ‘need for headlines’.
For the second group on the list, the team of responders, the management of a MFI can be extremely demanding. Factors that contribute to emotional challenges are simple such as working extra hours; coping with stress; changing variables and circumstances that demand immediate action; and pressure from the affected families that demand information which, due to the nature of a given disaster, sometimes can take the form of aggression toward the personnel that represents the managing organization of the incident. Another factor that increments the stress in this group is the interval between rescuing survivors and managing the deceased. Rescuing survivors can be a very difficult and dangerous task, but it is time-limited. After a finite interval, the possibility of the victims’ survival is likely to be eliminated. For medical examiners and other forensic workers, the challenges begin with the first deaths, but the duration of the victim identification task is unpredictable. Following the attacks on the World Trade Center (WTC), the fragmented condition of the victims’ remains, presented technical challenges for the identification process and psychological challenges for those involved in managing the task. These challenges meant that the timetable for completing the identification of the victims was continually revised, with the identification process ultimately lasting over four years, creating emotional distress on the families the were waiting for answers.
Depending on the circumstances, a mass fatality incident can present intense demands above and beyond the normal operating caseload and can require individuals to galvanize psychological resources for prolonged and unpredictable periods.
The way this group copes with stress usually doesn’t get as much attention as the first group; fortunately, today, stress management is a consistent part of the health and safety provision, usually taking the form of “Psychological debriefing”. However it is worthy to analyze if these measures are always implemented and if they are enough for the stress management.
Psychological debriefing is the first and most often use of preventive treatment of Post-Traumatic Stress Disorder (PTSD). One of the main reasons for this is the relative ease with which this treatment can be given to individuals directly following an event. It consists of interviews that are meant to allow them to directly confront the event and speak with the counselor in order to help structure their memories of the event. However, while this form of therapy is used most regularly, it is the least effective. Studies have mixed findings concerning psychological debriefings and range from being of significant help in the formation of PTSD in individuals who would otherwise have not developed PTSD.The greatest number of studies tends to simply find that it is neither overly beneficial nor harmful.
Due to the increased concern over the emergency workers’ well-being it was found that humor is another, though controversial, technique for stress management; that is because it allows for the re-interpretation of a given situation or event and provides some form of tension release. Even now that appropriate places are procured to the team of responders in order to relax and share between themselves away from the victim’s families and reporters, the use of humor is still controversial and considered disrespectful; others consider it as an appropriate way of copying method if used under the appropriate circumstances, while others believe that humor is not healthy since it prevents the individual of dealing with anxiety and is more important to face anxiety rather than suppress it with humor. Due to the nature, complexity and multiple dimensions of the subject this is open to debate.
The third group of the list is less likely to exist but is still common in a specific scenario where the parts involved come from a closed circle of professionals, like the aero-space industry. It is not uncommon to find that in an incident involving an aircraft, a member of the investigation team is likely to know some of the pilots or crew. In many cases air crash investigators are former pilots with plenty of experience in the field. This is particularly true for the space industry where astronauts are very popular members of the team and when accident strikes, everyone feels personally related. It is generally advised that any member of the team responding to the incident that is related to some of the victims to step back and not to participate. This is important because otherwise the objectivity of the investigation might be compromised; in reality though this is not always the case. Informally a person in this category might be given the choice at the discretion of its supervisor, and it requires a lot of self-control to decide to stay on an investigation, knowing that a friend was lost on the incident. This is particularly the case of the firefighters involved in the terrorist attack on the World Trade Center.
After examining these categories and the common problems these individuals face, the question to be answered is: Who is in charge?
Given the nature of a MFI we already know that the complexity demands an exhaustive list of teams with their respective leaders in the command structure known in the UK as “Gold, Silver and Bronze”. The Gold level, responsible of the strategy, is already implementing the “Humanitarian Assistance Centre Plan” (HAC) which is a fairly new aspect of the MFI management that arose by the increased criticism of the general public and the media about the government’s care of the victims’ families. Its operation was first tested after the London bombings in 2005 with mixed results. After the incident the final Humanitarian Assistance Centre (HAC) was praised, but unfortunately at a huge cost. It took too long to be established and it was the result of experimentation and error which had no place during a MFI. This raises another question: if London had troubles establishing the HAC, is another locality prepared to establish a HAC? Who is taking the preventive steps in case of a MFI?
Even the HAC seems like the perfect place to provide emotional support, counseling, official information and a shelter away from the media. Several organizations, and religious institutions, might provide further assistance to the families in order for them to cope with the situation. The HAC is not the place or shelter for the overwhelmed team of responders.
As previously discussed, emotional support and psychological assistance to anyone involved in the management of a MFI should be provided as a Health and Safety provision by their respective employer. Even though some scenarios are extremely difficult to cope with; a member of a MFI team is expected to act at the highest professional standards. As an example, it is extremely important for the forensic team to keep distance from the families in order to avoid psychological stress and/or confrontation; all the information between the forensic team and the families should be exchanged through the Family Liaison Officers who are specially trained in how to deal with them legally and emotionally, and finally provide reliable and consistent information. Here, however, there is a gap between theory and practice, since in a real world scenario this kind of issues are often forgotten or overseen.
A final question that must be addressed is: How long the support should be in place? Currently there are not any programs or strategies ruling how long the support should be in place. Some private initiatives might be in place like “the scholarship fund for the victim’s families of the WTC”; but is that enough? Is the full extent of closure understood by the authorities?
Closure is the last stage of a MFI, even after the reconstruction of damaged property, for some people the event will change their life; perhaps one of the best examples of closure, even if it is not related to a terrorist act, is the story of Ian Shaw, father of Stephanie Shaw, a passenger in Swiss Air 111 that crashed near St Margaret’s bay in Nova Scotia, Canada, on its way from JFK airport to Genève on September 2nd, 1998. After crashing on the sea due to an onboard fire, only one body out of the 229 was recovered intact, the body of Stephanie Shaw was never recovered. Ian Shaw waited four years for the report that revealed the cause of the accident. He demanded accountability: “You must declare your sense of responsibility” (from Swiss Air) and accuse them of “unbelievably hiding behind the Swiss flag”. For Ian Shaw, losing his daughter so tragically had left a permanent emotional scar; he left his wife and his wealth behind in Geneva and he now runs a modest restaurant in Nova Scotia, called “Shaw’s landing”, with a view of the sea where his daughter died.
“Why would I come to this particular point in Nova Scotia? Many people say, we fully understand you, you want to be close to your daughter, and the point where the plane crashed, that is not part of being here, Swiss Air ripped out of me any possibility of proximity to my daughter, I found a comfort in the awareness of the presence of the eternal ocean, the ocean that which is going backwards and forwards for many, many thousands of years. I came here because I had to. I can’t give a fully rational declaration to you of why I am here; I can only say to you, I am on the right place for the wrong reasons.”
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 Ian Shaw’s interview on: Discovery Channel’s “Mayday”: Fire on board (Swiss Air 111) Season 1, episode 4. Aired on: October, 22nd, 2003.