Tool

Fatality Management Document Portal & Resource Hub for NYC Hospitals

April 8, 2021

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: April 8, 2021

BCP Protocol Reactivated and Updated Guidance

Effective January 19, OCME, in coordination with NYCEM, reactivated the Body Collection Point (BCP) Protocol for In-Hospital Deaths due to the increased volume of fatalities seen across NYC. OCME has increased the Medical Examiner Transport Team (METT) operations; however, due to the increased caseload across NYC (for both in-hospital and residential deaths), OCME cannot ensure an immediate response for non-medical examiner cases. For these reasons, hospitals are encouraged to request a BCP should the pick-up of unclaimed cases be needed to maintain morgue capacity. Please refer to this Terms of Use document which outlines the roles and responsibilities of all parties in regard to BCPs.

BCP Requests

To request a BCP, hospitals should contact their affiliated association:

These liaisons will work directly with facilities to complete the BCP request form and work with OCME and NYCEM to have a unit deployed within 48 hours.

BCP Management

  • All hospitals have already been assigned or will be assigned a BCP coordinator to assist with management of the refrigerated trailer
  • BCPs can be used to store claimed cases (those with death certificates claimed by a funeral director in eVital) and unclaimed cases (those with death certificates NOT yet claimed by a funeral director in eVital). BCPs can be used for both COVID-19 and non-COVID-19 cases. Additionally, please note the following:
    • Unclaimed cases in BCPs will NOT be eligible for pickup by METT and will only be removed when the entire BCP is retrieved
    • Claimed cases in BCPs can be released directly to funeral homes
  • Medical Examiner cases and fetal remains should NOT be stored in BCPs (these cases should continue to be stored in facilities’ fixed morgues)

BCP Retrieval

At this time, OCME can only retrieve BCPs with unclaimed cases (not claimed cases). Additionally, decedents can be stored in BCPs for no longer than three weeks. There are two options for BCP retrieval:

  1. Scheduled retrieval date
  2. Contact your BCP coordinator (BCP_Coordinators@ocme.nyc.gov) if you are ready for retrieval prior to your scheduled date
    • Facilities should request retrieval (even of partially full BCPs) when oldest decedent crosses two-week threshold, or work with BCP coordinator for best process (e.g., remove individual cases that have crossed two-week threshold from BCP and request individual case retrieval from fixed morgue)
    • There is no minimum decedent count required for BCP retrieval along as all paperwork and other requirements (e.g., placement in disaster bags) are met

If a facility requires a BCP retrieval, the following paperwork items must be faxed to OCME (646-500-5762) for each decedent within the BCP:

  1. Manifest
  2. Face Sheet
  3. Death Certificate
  4. Preferred Item: Clinical Summary Worksheet

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 (evital@health.nyc.gov) for questions about your facility’s eVital users or for other eVital- or death certificate-related questions

Morgue Census Survey

Effective March 4, 2021, OCME is no longer requiring that the morgue census survey be completed on weekends. Please continue to complete the survey by 3:00 p.m. every Monday – Friday. It is 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. See here for a detailed guide which was developed to help clarify each question included in the daily survey.

Family Communication and Management

OCME has created this document to help hospitals communicate with families regarding decedents who may be transferred to OCME’s custody.

Hospital Planning Resources

See below for resources available to hospitals to update fatality management plans and prepare for future incidents.

OCME Hospital Toolkit – Updated January 20, 2021

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.

Document Repository

Please see below for various guidance and resources related to fatality management operations.

Death Certificates

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 evital@health.nyc.gov.

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.

Behavioral Health

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.