GNYHA, in collaboration with the New York City Office of Chief Medical Examiner (OCME), New York City Emergency Management (NYCEM), and the New York City Department of Health and Mental Hygiene (DOHMH) Bureau of Vital Statistics (BVS), has created this document portal and resource hub to house all documents and guidance related to fatality management operations in New York City (NYC). The page was created during the initial COVID-19 patient surge and is frequently updated with the most up-to-date guidance and current operations.
Last Updated: January 20, 2021
*NEW* Updates, Guidance, and Action Items
Restart of Routine NYC Fatality Management Hospital Calls
Due to the recent increase in fatalities and morgue utilization across NYC, NYCEM, OCME, GNYHA, and other NYC response partners are restarting routine fatality management calls with hospitals. The calls will convene weekly on Thursdays from 1:00pm – 2:00pm, with the first call to be held on January 21. The call will enable response partners to share updated guidance and resources related to fatality management operations with hospitals’ fatality management teams and enable hospital staff to ask questions. All staff involved in fatality management operations are invited to participate, including fatality management executive sponsors, operation leads, alternate leads, emergency managers, morgue managers, and admitting. Please email HealthMedicalESFList@OEM.NYC.GOV for any questions or to receive the call invite.
Morgue Decompression Strategies
NYC continues to experience increases in COVID-19 cases and hospitalizations, with slight upticks in fatalities. GNYHA, OCME, NYCEM, and DOHMH BVS are seeking to coordinate closely with hospitals to use decompression strategies to maintain low morgue census. While body collection points (BCPs) or refrigerated trailers are available, they should only be used as a last resort. See below for guidance on how hospitals can maintain a low decedent census in their fixed morgues.
- OCME Retrieval of Unclaimed Cases from Hospitals: In recent weeks, OCME has increased the availability of Medical Examiner Transport Teams (METT) which retrieve unclaimed decedents directly from hospitals. As a reminder, unclaimed decedents are those where a funeral director has not claimed the death certificate (even if family is involved and attempting to make arrangements). Additionally, there continues to be NO seven-day waiting period for OCME case retrievals from hospitals, meaning hospitals can immediately send necessary paperwork to OCME (including face sheets, clinical summary worksheets, and death certificates). Cases will be picked up upon successful completion of all necessary paperwork. Hospitals should fax all case paperwork to OCME’s normal fax number (646-500-5762).
- Hospital Protocols for Claimed Cases: To maintain a low morgue census, hospitals should review their protocols for claimed cases. If a decedent cannot be retrieved from the hospital morgue within a reasonable amount of time (i.e., 72 hours), hospitals should consider transfer to OCME custody. OCME staff can assist the family and funeral director with decedent retrieval. Internal hospital triggers can also help guide actions. Hospitals with small, fixed morgues may want to aggressively decant once half (50%) of morgue spaces are full, hospitals with larger facilities may consider a higher trigger like 75%.
- Death Certificates: Hospitals must create and certify death certificates prior to funeral directors claiming death certificates or OCME retrieving unclaimed decedents. While hospitals are required to create and certify death certificates within 24 hours, faster registration—ideally within eight hours—is strongly encouraged to enable speedier case retrieval by funeral directors or OCME.
- See here for guidance from DOHMH BVS on how to run reports in eVital to identify incomplete death certificates
- This guide provides instructions on how to properly complete death certificates and ensure there are no unregistered cases at your facility
- Please contact eVital (email@example.com) for questions about your facility’s eVital users or for other eVital- or death certificate-related questions
Morgue Census Survey
Due to the increase in fatalities and need for visibility on weekend operations, OCME is now requiring all hospitals to complete the morgue census survey seven days/week. Please continue to complete the survey by 3:00 p.m. It’s important for accurate information to be entered into the survey as OCME creates the Daily Citywide Hospital Morgue Report based on the survey results to provide a citywide picture of in-hospital decedent volume and morgue capacity.
Hospital Planning Resources
See below for resources available to hospitals to update fatality management plans and prepare for future incidents.
OCME Hospital Toolkit – Updated
OCME has updated their Hospital Toolkit which contains guidance for NYC hospitals to manage fatality surges due to COVID-19. This planning document should be used when updating fatality management plans for future waves.
OCME Hospital Fatality Management Plan Template
OCME created and distributed a hospital fatality management plan template which hospitals may choose to use when updating their internal plans. Any changes or updates to plans should be submitted to OCME.
Lessons Learned and Recommendations Document
GNYHA has created multiple lessons learned documents that describe what occurred during the initial patient surge and how best to prepare for future surges. The lessons learned document for fatality management includes challenges, innovations, and a timeline of events, as well as short- and long-term recommendations.
Special Considerations Document
GNYHA’s special considerations document helps hospitals update their plans by highlighting specific issues such as creating interdepartmental fatality management teams and surging mortuary space.
Human Remains Pouches/Body Bags
Hospitals are strongly encouraged to build their internal stockpile of ruggedized disaster body bags. A sample specifications sheet can be found here.
At the height of the COVID-19 patient surge, OCME adjusted its operations to accommodate for the high volume of fatalities. OCME has since transitioned back to normal day-to-day decedent retrieval operations, with the exception that there is still NO seven-day waiting period for case pickup.
Each decedent requiring OCME pickup will need to have the following information faxed to OCME at their normal number (646-500-5762):
- Case Face Sheet
- Case Clinical Summary Worksheet
- Requires notification to the Public Administrator for any decedent without next of kin (NOK)
- Death Certificate (DC)
- For verification purposes, please send a signed and registered copy of the DC
- City Burial cases (where the family specifically requests City Burial) will require:
- Burial Permit
- A letter from the NOK authorizing this disposition type. If NOK are not available, please select Claim Only.
There is currently no seven-day waiting period for case pickups. Cases will continue to be picked up upon successful completion of all necessary paperwork.
Long-Term Decedent Storage
OCME established a long-term storage operation for all decedents at the height of the fatality surge. Each case will be evaluated on a case by case basis, however, currently there is no time limit for how long OCME will hold decedents in Long Term Storage to ensure that families can fulfill their final disposition wishes.
Materials from Past Webinars/Events
See below for materials from past webinars and events hosted by GNYHA and City agencies.
December 9 Fatality Management Webinar
On December 9, GNYHA, in collaboration with OCME and NYCEM, held a Fatality Management Webinar for all New York City hospitals due to the recent increase in COVID-19 cases and fatalities across NYC. During the webinar, GNYHA, OCME, and NYCEM provided feedback on recently submitted fatality management plans, recent additions to Sit Stat 2.0 to capture key contacts involved in fatality management, logistics and processes around resource requests (including body collection points), and facility-level challenges and concerns. See here for a recording of the event and here for a PDF version of the full slide deck.
August 27 Fatality Management Forward Planning Symposium
GNYHA, in collaboration with OCME and other City agencies, held a Fatality Management Forward Planning Symposium for all NYC hospitals on August 27. Hospitals were provided a variety of materials to update their internal fatality management plans and updates regarding changes to fatality management operations in the event that a future wave occurs. See here for a recording of the event and here for a PDF version of the full slide deck.
Please see below for up-to-date guidance on various aspects of fatality management operations.
All decedents requiring OCME retrieval must have completed death certificates filed and registered appropriately in the eVital system. A method and place of disposition must be entered for the death certificate to be registered.
- See here for guidance from the Bureau of Vital Statistics on how to run reports in eVital that can help identify incomplete death certificates.
- This guide provides instructions on how to properly complete death certificates and ensure there are no unregistered cases at your facility.
- Hospitals with questions may also e-mail firstname.lastname@example.org.
The Department of Health and Human Services Assistant Secretary for Preparedness and Response’s Healthcare and Public Health Sector released a COVID-19 update in May that included behavioral health resources. The COVID-19 pandemic can cause high levels of stress and anxiety, especially in the mortuary fields. This resource provides guidance on managing stress among mortuary and death care workers.