Mass casualty response planning is part of an all-hazards approach to planning. This lesson will describe planning considerations for managing the recovery process following a mass casualty incident.

After completing this lesson, you should be able to identify:

• The role of crisis recovery teams in recovery.
• Considerations for community recovery immediately following an incident.
• Promising practices for longer term community recovery.

Audio Transcript

Mass casualty incidents often last just a few minutes while having a lasting effect on communities. And, the recovery process requires that the whole community join together.

The initial recovery involves a unity of effort between law enforcement to begin the investigative process and crisis recovery teams to begin the reunification and healing process.

Teams of staff, counselors, faith-based leaders, and others attend to the emotional needs of survivors and their loved ones.

Public information officers help ensure that family members and the community receive accurate information while protecting the privacy of those affected by the incident. In addition, these individuals help dispel rumors.

Crisis recovery teams consider other practical details such as how to handle the outpouring of donations from the local and extended community, and how best to manage memorials.

In this lesson you will learn how the recovery process helps provide emotional support and rebuilds a climate of safety and security.

The goal of recovery is to successfully overcome the impacts—physical and emotional—of the incident and to return to the main mission of learning, or worship, as quickly as possible. After a mass casualty incident, the greatest focus will be on providing a caring and supportive environment and helping survivors recover emotionally. In addition, the recovery process needs to support law enforcement’s investigative objectives.

In the beginning, the process may be intensive and stressful, with demands from many directions. It may be emotionally taxing, as situations involving fear, shock, and grief inevitably are. And it is likely to last for an extended period because healing takes time.

A recovery plan provides the foundation for uniting the whole community carrying out this process in a coordinated manner and for having the appropriate resources available when needed.

In the beginning, the process may be intensive and stressful, with demands from many directions. It may be emotionally taxing, as situations involving fear, shock, and grief inevitably are. And it is likely to last for an extended period because healing takes time.

A recovery plan provides the foundation for uniting the whole community carrying out this process in a coordinated manner and for having the appropriate resources available when needed.

Planning for recovery will help you identify issues and make decisions to guide the recovery process. For example, you may need to consider such questions as:

• How will reunification with families and loved ones be handled?
• What type of coordination will be needed with law enforcement?
• What, how, and when should we tell people about an incident?
• How will counseling resources be provided? Are critical incident stress management teams needed?
• How should survivors be encouraged to express their reactions?
• How will we handle public information? Should we turn to outside consultation for help? To whom?
• How soon should we return to regular routines?
• Should we plan commemorative activities?
• What is the best way to assist families and loved ones of victims and survivors?

Planning in the following areas can help you answer these questions. In the sections that follow, we will explore some of the key considerations related to each area.

• Establishing Recovery Procedures
• Establishing Crisis Recovery Teams
• Preparing for the Return to Routine

Crisis recovery teams manage the impact of serious incidents. A crisis recovery team can help in the healing process by:

Planning for immediate post incident actions — Identifying and contacting any at-risk survivors, holding meetings with family or the community, and updating the plan.

Establishing casualty and fatality process — Determining who tells loved ones about casualties and fatalities

Reducing fear — Helping to restore confidence in the safety of the environment by discussing security measures and addressing fears that an incident may occur again.

Facilitating grieving — Formulating a policy on funerals and other memorials, helping plan incident- and age-appropriate activities, and obtaining as needed the services of trained counselors and other experts from the community.

Supporting loved ones — Answering questions about the incident and the response, and offering advice on addressing children’s needs.

Promoting the primary mission — Promoting the mission of the organization (education or worship) by supporting a return to regular schedules and calling in substitute personnel as needed.

Community responders may have resources available to help staff recovery teams.

Crisis recovery teams should include counselors and others who are:

• Trained to handle emotional response issues.
• Able and authorized to make decisions.
• Respected within the organization and the community.
• Sensitive to student/member, staff, and community needs.
• Calm and able to make decisions in stressful situations.

Qualified mental health professionals in the community that can assist during recovery should be identified.

• Consider including:
• Organization leaders—people with authority to make decisions in the time of crisis.
• Staff—those who have day-to-day contact with survivors, such as teachers, counselors, coaches, faith-based leaders, or others.
• Key personnel—Individuals who have expertise in aspects of recovery operations, such as communications systems, information management, or crowd control.
• Law enforcement personnel—those who will conduct the investigation and interact with staff, leaders, survivors, and the community.
• If an incident occurs, it will be important to have professionals in the community who are able to respond quickly and who will be committed to the effort over time.
• Contact outside resources ahead of time to determine their availability and willingness to help by:
• Being available to talk with individuals needing support or counseling.
• Seeing professionally any individuals who are referred by the school.
• Once a support program has been set in motion, it is important to have continuity. Clarify understandings with key resources by establishing Memoranda of Understanding.
• Some organizations use a crisis consultant to help develop, review, and implement crisis plans. Sometimes consultants are able to be more objective than staff because they are not emotionally tied to the victims.

The crisis recovery team should identify responsibilities for coordinating various aspects of recovery. Examples of key functions requiring coordination include:

Team Oversight

Crisis team chair—Convenes scheduled and emergency team meetings, oversees both broad and specific team functions, ensures that the required resources are available to each team member for assigned duties, and communicates with the district-level team. Is often an administrator or designee.

Assistant chair—Assists the crisis team chair with all functions and substitutes for the chair in the chair’s absence.

Incident crowd management

In collaboration with law enforcement and first responders, develops and implements plans for crowd management and movement during crises, including any required evacuation plans and security measures. Crowd management plans must anticipate many scenarios, including the need to cordon off areas to preserve physical evidence or to manage increased vehicular and pedestrian traffic. Because of the possibility of actual threats to physical safety, crowd management plans must provide for safe and organized movement in a way that minimizes the risk of harm under various threats, such as sniper fire.

Establishes, coordinates, and initiates the telephone tree to contact the crisis team and general staff, including itinerant, part-time, and paraprofessional staff. Also establishes a plan to rapidly disseminate relevant information to all staff during regular hours.

Communications coordinator

Conducts all direct in-house communications, screens incoming calls, and maintains a log of telephone calls related to the crisis event. Helps the staff notification coordinator develop a notification protocol for a crisis event that occurs during the day.

Reunification coordinator

Establishes the reunification center/area and manages the reunification process.

Public information officer

Works through the Incident Command public information officer to deliver a single, coordinated message to the public. Prepares statements to disseminate to staff, students/members, families and loved ones, and the community. Maintains ongoing contact with law enforcement, emergency services, hospital representatives, and others to keep information current. Handles all media requests for information and responds through appropriate channels.

Coordinator of counseling

Develops mechanisms for ongoing training of crisis team members and other staff and identifies and establishes liaisons with community resources for counseling. At the time of a crisis, determines the extent of counseling services needed, mobilizes community resources, and oversees the mental health services provided to individuals. Must have appropriate counseling and mental health skills and experience.

In preparation for activation in a crisis, consider how team members will be trained in appropriate intervention techniques.

Training should focus on how crisis interventions can be applied in your particular setting and with your population.

Training that takes relatively little time is available through various sources. The following are examples:

The U.S. Department of Education has information on an early intervention approach that staff can learn in as little as an hour.

U.S. Department of Education. (2008). Psychological First Aid (PFA) for Students and Teachers: Listen, Protect, Connect—Model & Teach. Helpful Hints for School Emergency Management. 3,3. Retrieved from http://rems.ed.gov/docs/HH_Vol3Issue3.pdf

The National Organization for Victim Assistance offers resources and training in community crisis response. NOVA’s basic course covers techniques and protocols for providing crisis intervention to traumatized people. It focuses on the fundamentals of crisis and trauma, and how to adapt the basic techniques to individuals and groups. 

National Organization for Victim Assistance. (2012). NOVA Training and Credentialing. https://www.trynova.org/training/

International Critical Incident Stress Foundation, Inc. provides education, training, consultation, and support services in comprehensive crisis intervention and disaster behavioral health services to the emergency response professions, other organizations, and communities worldwide. https://icisf.org/

Recovery begins immediately after an incident and continues throughout the healing process and even as regular operations resume.

To facilitate this process, procedures should be developed for supporting key recovery functions, including:

• Reunification.
• Information management.
• Provision of counseling and support services.
• Planning for healing events and memorials.
• Managing donations.

After a mass casualty incident it is important to quickly reunite survivors with their loved ones. Often, the best approach is to relocate survivors to a location away from the incident scene. Key planning considerations include:

• Site selection and security.
• Transportation logistics.
• Resources.
• Protocols for notification, information release, orderly check-in, check-out, record keeping, and release of minors to adults.

The reunification decision should be made quickly—within 5 to 10 minutes of the event. As soon as the media begins reporting an incident, it is natural for concerned individuals to rush to the scene unless given other guidance. Conducting reunification at the incident site has several disadvantages. It may:

• Hamper emergency response and crime scene investigation.
• Complicate an already emotionally charged situation.
• Expose family members to the media and onlookers.

Below are suggestions for reunification procedures.

Site selection and security: Select a site that:

• Is available at a moment’s notice.
• Have a backup site.
• Is safe—away from any damage and out of sight of assembly areas.
• Can be secured and people entering the area be screened.
• Has enough parking and enough safe entrances and exits to minimize congestion.
• Is accessible by individuals with access and functional needs.
• Has secure and safe facilities for individuals while they wait (e.g., shelter, restrooms, food).
• Allows for limiting access by the media and the general public.

Transportation logistics: Coordinate with:

• Transportation officials to verify that everyone can be safely evacuated.
• Security staff to identify ways to maintain control and limit access to the site.
• Public safety personnel to coordinate traffic and parking support.

Resources: Station key resources at the site, including:

• Crisis recovery personnel, including law enforcement and security personnel.
• Initial mental health personnel.
• The emergency kit containing records and release forms and first aid supplies.

Protocols:

• Plan for immediate notification to loved ones through local media.
• Do not publicly announce the location before an incident, to reduce the possibility of a secondary attack at the site.
• Have procedures for the release of minors, such as photo identification.
• Consider seeking help from local emergency management to manage the center.
• Consider sharing evacuation and reunification portions of your emergency plan with parents/guardians in advance.
• Experience has shown that if parents/guardians are aware of the procedures before an event, they are less likely to go directly to an incident site.

Mass casualty incidents are extraordinarily emotional events, and they leave intense emotions in their wake. The stress and uncertainty created by the incident tend to linger on, both in the survivors and witnesses to the event and in the community at large. When intense emotions can propel community members to action, effective messages from officials can help them make appropriate decisions.

After a mass casualty incident, people need clear, timely, and factual information to avoid relying on rumors. Great distress can make it hard for people to process information, so it is important to word messages simply, repeat them often, and provide regular updates.

In an educational setting, teachers and staff carry much of the load in reestablishing a sense of security and providing support. In a religious setting, this role may be filled by faith-based leaders, volunteers, teachers, and others. Procedures should address training these individuals and keeping them well informed. Consider:

• How and when will you notify staff of an event?
• How will you provide them with more in-depth information about the situation and their roles?
• How much information will you provide? How will you keep them updated?
• How will you obtain their input on improving the process and about their own need for assistance?

• Activate a notification process such as a calling tree or email/pager alerts to notify them of the event. Do this immediately after the event. Provide a script so the message does not degrade as it is passed from one person to the next. Advise them of the next day’s morning meeting.
• Hold a morning meeting for all staff the first day after the incident, before the regular school or work day. This meeting may be used to:
• Explain the incident in greater detail, including details that were not initially known.
• Answer staff questions.
• Introduce the crisis recovery team, crisis consultant if used, community resource people, and media and family liaisons.
• Spell out the plan for the day.
• Provide locations of a crisis center room, counseling rooms, and other resources.
• Ensure everyone knows their role.
• Hold a similar meeting at the end of the day to review progress, answer questions, share insights, and set out plans for the next day.
• Keep staff updated with daily newsletters.
• Obtain a central contact from the law enforcement organizations who can answer questions and address concerns. Provide that information to staff members.

In the absence of factual information, rumors inevitably fill the void. It is essential to get the facts out quickly to ensure an accurate message. In planning for communications, consider how you will be proactive in communicating the facts, deliver a positive message that you are attending to security, and keep updated information flowing.

Be sure to make information available in diverse, culturally appropriate, and age-specific formats to reach multiple audiences. And keep a careful balance between providing enough information to dispel rumors and protecting the privacy of victims and survivors.

• Develop templates in advance of incidents with prepared statements so that general information can be released quickly.
• Agree with partners to coordinate messages and to speak as one voice. Establish a schedule for the release of information and briefings. Write a letter to families and loved ones the first day after the incident about the incident, memorials, and available support.
• Issue updates as more information becomes available. Consider using a Web site to share updated information.
• Provide tip sheets for families/caregivers/loved ones on how to provide support. Examples of tip sheets are available from:
• Federal Emergency Management Agency. (2004). Helping Children Cope with Disaster. http://www.fema.gov/pdf/library/children.pdf
• National Association of School Psychologists. (2006). Talking to Children About Violence: Tips for Parents and Teachers. Retrieved from http://www.nasponline.org/resources/crisis_safety/talkingviolence.pdf
• U.S. Department of Education. (n.d.). Tips for Helping Students Recovering from Traumatic Events. Retrieved from http://www2.ed.gov/parents/academic/help/recovering
• U.S. Department of Health and Human Services. (2102, November). Tips for Talking With and Helping Children and Youth After a Disaster or Traumatic Event: A Guide for Parents, Caregivers, and Teachers. Retrieved from https://store.samhsa.gov/product/tips-talking-helping-children-youth-cope-after-disaster-or-traumatic-event-guide-parents/sma12-4732
• Conduct a community meeting where people can voice their concerns and be assured that safety issues are being addressed. Include law enforcement representatives to answer questions and address concerns.

Very soon after a mass casualty incident, the media will arrive at the scene. Managing the media can be a challenge—especially if individual reporters are insensitive to the needs of survivors. However, when managed effectively the media can also be an asset.

After any incident, it is important to speak with one voice and to manage the release of information without compromising the investigation. To accomplish these objectives, the Incident Commander should assign a Public Information Officer (PIO) to coordinate the release of information to families, community members, and the media. In a complex incident, there may be several PIOs representing different organizations. Coordination among the PIOs is important to avoid disseminating conflicting information.

Form mutually beneficial relationships:

• Cooperate with the media, but do not let them dictate.
• Remember, each reporter will seek a unique angle or perspective.
• Individual interviews can be good opportunities to get information out.
• Try to ensure that all reporters hear the same information.
• National and perhaps international media typically arrive. Do not forget the local media.

Plan what you will say:

• Convey a message of resilience, continued healing, and a return to normalcy.
• Be proactive about pitching story ideas to the media that promote hope and healing.
• Issue media advisories about memorial events open to the public, anniversary dates, fundraising or donations, etc.
• In preparing a media message, think about:
• What are the facts? Clarify the situation.
• What DO you know, and what do you NOT know?
• What steps are you taking to address the situation?
• Provide a “call to action” for members, or parents, or students.
• Express empathy.
• Develop two or three key messages that are honest, consistent, responsive, and responsible. Strive to be positive and proactive.
• Never guess, speculate, or predict the future. Do not release information until you have verified its accuracy. Never go off the record. Avoid saying, “No comment.”

Consider privacy issues:

• Consider privacy issues and release of victim and perpetrator names. What are the roles of law enforcement, schools, hospitals, and families in releasing names and conditions of victims?
• Have a carefully considered and crafted policy regarding release of staff, member, or student photos; yearbooks; congregational directories; and the like. Think about laws such as the Family Educational Rights and Privacy Act.

Manage media coverage of benchmark dates:

• The media will cover benchmark events, such as the first anniversary. Establish a media area where the media will set up cameras so as not to intrude on the ceremony. Create a perimeter for photographers and satellite trucks.
• Set guidelines on still and video cameras in the building.
• Develop a list of people willing to talk to the media.
• Decide if you will have a media pool (selected media representatives who share information) or allow all media to attend. If possible, meet with the media in advance to establish mutually beneficial guidelines.
• Ask the media to:
• Refrain from replaying or reprinting images of the crisis. Showing disturbing pictures has the potential to re-traumatize victims.
• Honor the victims while not glorifying the perpetrators.
• Avoid memorizing suicides in order to discourage copycats.
• Respect the privacy of those who do not want to be interviewed.
• Consider a “no fly” zone over an outdoor memorial service.

• In the wake of a traumatic incident, a significant part of the recovery effort will be devoted to providing counseling and support services to help with the process of emotional recovery. Research suggests that:
• People who have witnessed a traumatic event find comfort in returning to routine and being in the company of their peers and trusted adults, need to reestablish their sense of safety and security, and may have a need to talk about the experience.
• Early, brief, and focused intervention can reduce social and emotional distress.
• Some individuals have more difficulty coping and may require more in-depth professional assistance for emotional recovery.

Based on the research findings and the principles of mental health triage, recovery plans should address:

• Engaging staff in initially assessing emotional needs.
• Identifying individuals who need mental health referrals.
• Providing limited interventions, such as group discussion, for those not in need of urgent mental health services.
• Identifying available services for families, loved ones, and community members who may want to seek assistance for their children or themselves.

Engaging staff in initially assessing emotional needs. Identifying individuals who need mental health referrals. Providing limited interventions, such as group discussion, for those not in need of urgent mental health services. Identifying available services for families, loved ones, and community members who may want to seek assistance for their children or themselves.

Psychological first aid is a process that can be quickly learned and applied by educators to assist with emotional recovery. It involves five simple steps:

• Listen—Provide an opportunity to share experiences and express feelings.
• Protect—Protect individuals from further trauma and help reestablish feelings of physical and emotional safety.
• Connect—Help individuals reestablish supportive connections.
• Model—Demonstrate calm and optimistic behavior.
• Teach—Help individuals understand the normal range of stress reactions.

Members of the crisis recovery team can easily become overwhelmed by dealing with intensely emotional topics over a long period. It is important to ensure that those who are providing psychological first aid are also supported. Possible measures include:

• Critical incident stress debriefings.
• Arranging for substitutes or time off when needed.
• Mechanisms that enable staff to provide support for one another during a crisis.
• Openly communicating opportunities for support and assistance.
• Recognizing the efforts being made.

Plans should be established regarding how victims will be memorialized. Examples of issues that may be addressed include:

• Guidelines regarding planned memorials and activities to honor victims.
• How spontaneous memorials on the premises will be addressed.
• Policies related to attendance at funerals and other memorial events.
• Identifying the appropriate time and way to signal closure of the mourning period.
• Including the whole community in planning memorials and other key events.

Lesson Learned: Proceed With Caution When Planning Memorials and Tributes for Victim(s)

Research has shown that constructing or conducting memorials may result in recurring trauma and may require ongoing funding for maintenance. When considering memorials or tributes the community must consider the cultural norms of the community, family preferences, and the long-term implications for how the memorial will be viewed by students and the community 5, 10, or 15 years after the incident. Memorials should never interfere with the teaching and learning environment.

Source: U.S. Department of Education. (2007). Responding to and Recovering from an Active Shooter Incident That Turns into a Hostage Situation. Lessons Learned From School Crises and Emergencies, 2, 6. Retrieved from http://rems.ed.gov/docs/LL_Vol2Issue6.pdf

Often after a tragedy, people from across the country, and even the world, want to express their condolences through cards, memorabilia, gifts, and cash donations. These donations pressure an organization into making quick decisions about handling the gifts. Having a plan in place to manage donations can help relieve this pressure. Your local or State government may have a donations management plan and may be available to assist.

Consider:

• Establishing outreach messages to discourage inappropriate donations.
• Determining how to advise interested parties about preferred forms of donation.
• Setting up procedures for accountability and receipt of funds and materials.
• Establishing managing and disseminating donations received.

Following the 2012 tragedy at Sandy Hook Elementary School in Newtown, CT, volunteers struggled to manage the overwhelming flow of donations. The town received enough teddy bears to give two to every community member. The town established a task force of more than 800 volunteers to sort the gifts, open mail, and answer the thousands of emails and phone calls offering assistance.

After meeting with town officials, the Red Cross, and other stakeholders, a donations coordinator was identified. Volunteers started working in their living rooms with a couple of cellphones and their own laptop computers.

Next, a local businessperson offered office space and other companies donated computers, Wi-Fi, phones, and other equipment and set up a call center. The Newtown Volunteer Task Force established a Web site, a Facebook page, a Twitter account, and a toll-free telephone number.

The town established a partnership with Adventist Community Services, a faith-based group that has done similar work after hurricanes and other natural disasters. This group has warehouse facilities and experience collecting, organizing and distributing donated goods.

Sources: CBS News New York Affiliate and Huffington Post

Establishing a routine and striving to achieve a “new normal” can help those impacted by an incident to recover. While things will never be quite the same, they will come to realize a new equilibrium can be achieved. During this phase:

• Work toward restoring the academic or worship environment.
• Continue mental health support.
• Regularly communicate with families and loved ones.
• Meet as needed with key stakeholders to identify questions, quell rumors, and provide accurate and timely information.
• Maintain structure and stability.
• Routine is good!

You can use the following resources to learn more about planning for recovery.

Online Resources:

Helping Children Cope with Disaster.  

National Association of School Psychologists. Tips for crisis and safety, helping children cope, and related topics.

National Education Association Health Information Network. Reference Center.

Practical Information on Crisis Planning: A Guide for Schools and Communities.

Psychological First Aid (PFA) for Students and Teachers.

Tips for Helping Students Recovering from Traumatic Events.

Tips for Talking With and Helping Children and Youth Cope After a Disaster or Traumatic Event: A Guide for Parents, Caregivers, and Teachers.

Training:

FEMA IS-29a: Public Information Officer Awareness  

International Critical Incident Stress Foundation (ICISF): Crisis intervention training.

You should now understand planning considerations for managing the recovery process following a mass casualty incident.