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Self-reported Preparedness to Respond to Mass Fatality Incidents in 38 State Health Departments

Merrill, Jacqueline PhD, MPH, RN; Zhi, Qi MPH; Gershon, Robyn R. DrPH, MHS, MT

Journal of Public Health Management and Practice: January/February 2017 - Volume 23 - Issue 1 - p 64–72
doi: 10.1097/PHH.0000000000000472
Research Articles

Context: Public health departments play an important role in the preparation and response to mass fatality incidents (MFIs).

Objective: To describe MFI response capabilities of US state health departments.

Design: The data are part of a multisector cross-sectional study aimed at 5 sectors that comprise the US mass fatality infrastructure. Data were collected over a 6-week period via a self-administered, anonymous Web-based survey.

Setting: In 2014, a link to the survey was distributed via e-mail to health departments in 50 states and the District of Columbia.

Participants: State health department representatives responsible for their state's MFI plans.

Measures: Preparedness was assessed using 3 newly developed metrics: organizational capabilities (n = 19 items); operational capabilities (n = 19 items); and resource-sharing capabilities (n = 13 items).

Results: Response rate was 75% (n = 38). Among 38 responses, 37 rated their workplace moderately or well prepared; 45% reported MFI training, but only 30% reported training on MFI with hazardous contaminants; 58% estimated high levels of staff willingness to respond, but that dropped to 40% if MFIs involved hazardous contaminants; and 84% reported a need for more training. On average, 76% of operational capabilities were present. Resource sharing was most prevalent with state Office of Emergency Management but less evident with faith-based organizations and agencies within the medical examiner sector.

Conclusion: Overall response capability was adequate, with gaps found in capabilities where public health shares responsibility with other sectors. Collaborative training with other sectors is critical to ensure optimal response to future MFIs, but recent funding cuts in public health preparedness may adversely impact this critical preparedness element. In order for the sector to effectively meet its public health MFI responsibilities as delineated in the National Response Framework, resources to support training and other elements of preparedness must be maintained.

Supplemental Digital Content is Available in the Text.

Columbia University Medical Center, New York, New York (Dr Merrill); and Department of Biostatistics and Epidemiology (Dr Gershon), Phillip R. Lee Institute for Health Policy Studies (Ms Zhi), University of California, San Francisco California.

Correspondence: Robyn R. Gershon, DrPH, MHS, MT, Department of Biostatistics and Epidemiology, Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, Ste 280, San Francisco, CA 94118 (

The study was funded by a National Science Foundation award #1066115. The authors thank the National Association of County & City Health Officials and the Association of State and Territorial Health Officials, in particular Gerrit T. Bakker, Senior Director, Public Health Preparedness, for advisement and assistance on development and distribution of the survey and for insightful review of the findings.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

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