title: Mass fatality preparedness among medical examiners/coroners in the United States: a cross-sectional study.
abstract: BACKGROUND
  In the United States (US), Medical Examiners and Coroners (ME/Cs) have the legal authority for the management of mass fatality incidents (MFI). Yet, preparedness and operational capabilities in this sector remain largely unknown. The purpose of this study was twofold; first, to identify appropriate measures of preparedness, and second, to assess preparedness levels and factors significantly associated with preparedness.
  
  
  METHODS
  Three separate checklists were developed to measure different aspects of preparedness: MFI Plan Elements, Operational Capabilities, and Pre-existing Resource Networks. Using a cross-sectional study design, data on these and other variables of interest were collected in 2014 from a national convenience sample of ME/C using an internet-based, anonymous survey. Preparedness levels were determined and compared across Federal Regions and in relation to the number of Presidential Disaster Declarations, also by Federal Region. Bivariate logistic and multivariable models estimated the associations between organizational characteristics and relative preparedness.
  
  
  RESULTS
  A large proportion (42%) of respondents reported that less than 25 additional fatalities over a 48-hour period would exceed their response capacities. The preparedness constructs measured three related, yet distinct, aspects of preparedness, with scores highly variable and generally suboptimal. Median scores for the three preparedness measures also varied across Federal Regions and as compared to the number of Presidential Declared Disasters, also by Federal Region. Capacity was especially limited for activating missing persons call centers, launching public communications, especially via social media, and identifying temporary interment sites. The provision of staff training was the only factor studied that was significantly (positively) associated (p < .05) with all three preparedness measures. Although ME/Cs ranked local partners, such as Offices of Emergency Management, first responders, and funeral homes, as the most important sources of assistance, a sizeable proportion (72%) expected federal assistance.
  
  
  CONCLUSIONS
  The three measures of MFI preparedness allowed for a broad and comprehensive assessment of preparedness. In the future, these measures can serve as useful benchmarks or criteria for assessing ME/Cs preparedness. The study findings suggest multiple opportunities for improvement, including the development and implementation of national strategies to ensure uniform standards for MFI management across all jurisdictions.
authors.affiliation: Department of Epidemiology and Biostatistics and Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA 94118, USA. robyn.gershon@ucsf.edu.
authors.forename: Robyn R M
authors.initials: RR
authors.lastname: Gershon
authors.forename: Mark G
authors.initials: MG
authors.lastname: Orr
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhi
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Merrill
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Chen
authors.forename: Halley E M
authors.initials: HE
authors.lastname: Riley
authors.forename: Martin F
authors.initials: MF
authors.lastname: Sherman
mesh_terms: D003334:Coroners and Medical Examiners / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D004189:Disaster Planning / Q000458:organization & administration*; D006801:Humans; D054527:Mass Casualty Incidents; D014481:United States