Handling the deceased
in large disasters

Why preparedness in normal times matters

• No time right after a disasterDecide locations, supplies and procedures in normal times
• Protect the dignity of the deceasedCareful handling supports bereaved families
• Families' deep griefExplanation and compassionate support are essential
• Staff also face severe stressPrepare for critical incident stress

Overall response flow

1. Discovery and recoveryRecord the location, date/time and circumstances of discovery
2. TransportAssign a number and carry with personal effects
3. Reception at the temporary morgueReception, number control and keeping in the morgue
4. Police inquest, medical examination and identificationCarried out by police, physicians and dentists
5. Family viewing and handoverExplanation, accompaniment and paperwork
6. Cremation (temporary burial if unavoidable)Prioritize arranging wide-area cremation

Main agencies and roles

• PolicePolice inquest, identification and contacting bereaved families
• Physicians and dentistsMedical examination and identification by dental findings
• MunicipalityOpening and running the morgue, supplies and cremation
• Fire service and volunteer fire corpsAssisting recovery and transport during rescue operations
• Funeral directors and related organizationsCoffins, dry ice, transport and placing in the coffin

Confirm role assignments in advance through the local disaster management plan and agreements.

Organizing the team for the deceased

• Overall coordinatorDirects overall operations and coordinates with agencies
• Recovery and transport teamAccompanies search teams to record and recover
• Morgue operations teamReception, keeping the deceased and equipment management
• Family support teamWaiting area and accompanying viewings
• Missing persons teamReceives reports and records ante-mortem information
• Cremation and burial teamPermits, wide-area cremation and temporary burial
• Information and public relations teamCompiles counts and issues unified announcements
• Place under headquartersIntegrate into the disaster headquarters chain of command

Source: Philippines DILG/LGA field manual on management of the missing and the dead, p.26–27

Initial steps on deployment

1. Send an advance teamAssess the site situation early
2. Pre-deployment briefingPurpose, methods, roles and required supplies
3. Register arrival at headquartersCheck in and wait for assignment
4. Receive maps and safety equipmentSite maps, helmets, etc.
5. Rescue comes firstSearch for the deceased after rescuing survivors
6. Do not disturb the sceneRecord the deceased and belongings as found
7. Open an information deskInformation center on site or at headquarters
8. Report dailyDaily report of dead, missing and identified

Source: Philippines DILG/LGA field manual p.36, 51–53 / NDMA Guidelines Annexure-K

Site assessment checklist

• Extent of damageSize of the site and scale of damage
• Number and condition of the deadNumber of deceased, injuries and decomposition
• Expected duration of workTime needed for recovery and identification
• Specialist agenciesCapacity for medical examination, dental and DNA analysis
• Recovery methodTeams needed and number of teams
• Means of transportHow to move the deceased and body parts
• Storage locationSecuring morgues and refrigeration
• Number of missing personsNumber of missing persons reported

Source: Philippines DILG/LGA field manual p.51 (Box C)

Who transports

• PolicePoint of contact; directs recovery and transport and conducts the police inquest
• Self-Defense ForcesSearch, recovery and transport on disaster deployment
• Fire service and volunteer fire corpsRecover the deceased found during rescue
• MunicipalityProviding vehicles and running the morgue
• Funeral directors and hearse associationTo morgues and crematoriums under agreements

From discovery to the temporary morgue

1. Ensure safetyWatch for secondary hazards such as aftershocks, tsunamis and collapse
2. Notify the policeReport location and situation, and follow instructions
3. Record the circumstances of discoveryPhotos, GPS location, date/time and situation
4. Attach number tagsSame number on the body and the bag
5. Place in a body bagDo not remove items worn; include belongings
6. Carry out on a stretcherFour or more people; watch your footing
7. Load into the vehicleSecure one at a time; do not stack
8. Hand over at the temporary morgueCheck number and records at reception

How to transport

• Stretcher / cloth stretcher (by hand)4–6 people on rubble or mud
• BoatWhen found in flooded areas or on water
• HelicopterFrom areas isolated by cut-off roads
• VehicleTrucks, vans and hearses
• Vehicle requirementsScreened with covers or sheets; waterproof cargo bed
• Transport with respectOne at a time, no stacking, careful driving

Using transport vehicles

• Do not use ambulancesPrioritize transporting the injured
• No emergency drivingNo sirens or high speed
• Cover company names and license platesPrevent stigma against vehicle owners
• Use enclosed vehiclesKeep cool during transport; do not freeze
• Agree in advance on repurposingCheck restrictions on vehicle use
• Clean before returningHealth department checks and certifies cleanliness
• Especially food refrigeration trucksA certificate protects the operator's reputation
• Hearses once identifiedTransport carefully in dedicated vehicles

Source: PAHO/WHO “Management of Dead Bodies in Disaster Situations” (Japanese edition) p.16–17, 35

Challenges (from past disasters)

• No transport routesVehicles blocked by rubble, mud and flooding
• Shortage of vehicles and fuelNot enough drivers, fuel or vehicles
• Morgues full or far awayLong waits with no destination decided
• Missing recordsUnknown discovery location or number delays identification
• Severe stress on transport staffBurden of carrying acquaintances or children
• Public exposureSeen by media and residents

Improvements

• Sign transport agreements in normal timesWith the hearse association, haulers and construction companies
• Plan routes and morguesDesignate multiple candidates per district
• Keep field kits readyTags, body bags, record forms and stretchers
• Digitize recordsShare photos and locations on the spot
• Joint training among agenciesPolice, Self-Defense Forces, fire service and municipalities
• Protect transport staffRotation, briefings and aftercare

Choosing a temporary morgue

• Large indoor spaceGymnasiums, warehouses, etc.
• Separate from evacuation sheltersFully separate circulation routes
• Vehicle accessLoading entrance and parking
• Cooling and ventilationTemperature control in summer
• Power, water and toiletsAlso prepare generators
• ScreeningShield from media and outside view

Example morgue layout

Separate the routes for bringing in the deceased and for families, so the deceased cannot be seen from the waiting area. Keep the staff rest area away from the deceased.

Sorting on arrival

• Classify on arrivalBy sex, age group, build, etc.
• Keep by categoryPlace in separate sections
• Narrows the searchExample: narrowed from 150 to 4–5
• Those recognizable by face firstSend to inquest in order of ease of identification
• Photograph on arrivalRecord before the condition changes
• Avoid duplicate examinationsExample: same dental exam done 4 times
• Assign cleaning staffTable hygiene and accident prevention
• No adhesive labelsExample: peeled off from water or body fluids

Source: PAHO/WHO “Management of Dead Bodies in Disaster Situations” p.35–38, 144–145

Temporary storage (refrigeration)

• A race against timeIn heat, faces hard to recognize within 12–48 hours
• Refrigeration first2–4℃ is optimal
• Refrigerated containersUp to about 50 bodies with racks
• Secure power and fuelRefrigeration needs a lot of power
• Do not freezeDiscoloration and drying hinder identification
• Do not stack while frozenFaces deform permanently
• Without refrigerationLay out neatly in cool shade under a roof
• Always bag before storageEach in its own body bag

Source: ICRC/WHO “Management of Dead Bodies after Disasters: A Field Manual for First Responders (2nd ed.)” Ch. 7 p.23–24 / PAHO/WHO p.21, 35, 50–51 / NDMA p.18–19

Placing in the coffin and handling coffins

• Place in the coffin after medical examinationPlace in a body bag, then into the coffin
• Coffin sizeApprox. outer dimensions L180 × W48 × H41cm
• Does it fit the cremator?Some coffins will not fit. Check with the crematorium
• Match the numbersCoffin label, belongings bag and the deceased
• Belongings on top of the coffinPlace in a numbered bag
• Care with items placed in the coffinAvoid lighters, glasses, fruit, etc.
• Assemble coffins in a separate roomKeep apart from the holding area
• Candles and incenseFire risk. Do not use as a rule

Source: Wide-area cremation plan, annex “Guidance on handling the deceased and guidelines for proper treatment of the deceased” 2(4)(5)

Morgue equipment (additional)

• Floor protection sheetsPlus vinyl tape to join them
• Lighting and generatorsLow exhaust odor and noise
• Partition screensShield from evacuees and bereaved families
• Notice boardsPost number lists and progress
• Communication and mobilityPortable radios and bicycles
• Washing suppliesBuckets, towels and hangers
• Number of photos3 if identified, a dozen or more if unidentified
• Measuring tools3m tape measure, 30cm ruler, penlight

Source: Tokyo Metropolitan Government “Police Inquest and Medical Examination Activity Manual” p.19, 69–70

Personal protective equipment

• GlovesDouble gloves; carry spares
• MaskAgainst odor and dust
• GownPlus a waterproof apron
• BootsPuncture-resistant
• GogglesProtect eyes from splashes
• DisinfectantFor hands and equipment

Check for tears before putting on, and do not touch the contaminated outside. Replace immediately if torn, and decide in advance where to take it off. Check each other in pairs.

Equipment and supplies

• Body bags, coffins and sheetsBody bags: 1.2–1.5 times the expected death toll
• Dry iceReplace daily; sign supply agreements
• Number tags, record forms and camerasKey to preventing mix-ups
• Lighting, generators, stretchersAble to work during power outages
• Flower table, incense, partitionsA place for families to pray

Infection prevention

• Always wear PPEDouble gloves, mask, gown, rubber boots
• Hand washing and hand sanitizingAfter work, before breaks and meals
• Disinfect equipment and floorsE.g. 0.1% sodium hypochlorite
• Double-bag if infection is suspectedSeal to prevent leakage of body fluids
• Routine vaccinationsHepatitis B, tetanus, etc. (consult a doctor)
• No eating or drinking in work areasKeep rest areas away from the deceased

The deceased and infection: myths and facts

• Do dead bodies spread epidemics?Not usually after natural disasters
• Who is more likely to spread diseaseSurvivors, not the deceased
• Hasty mass burialNo public health justification
• Spraying disinfectant or limeUnnecessary. Does not prevent disease
• Mass vaccination of residentsUnnecessary. Hygiene and public information are key
• Water contaminationPrevented by normal water treatment and disinfection
• Withholding informationCauses distrust and confusion
• ExceptionsDeaths from infectious diseases such as cholera or Ebola

Standard precautions for workers, such as gloves and hand washing, are still required.

Source: ICRC/WHO Management of Dead Bodies after Disasters: A Field Manual for First Responders (2nd ed.), Ch. 3 p.7–9, FAQ p.35–36 / PAHO/WHO p.66–67, 89

Handling body fluids

• Put on PPE firstDouble gloves, goggles, gown
• Soak up with absorbent materialAbsorbent sheets, solidifier, newspaper
• Wipe from the outside inDo not spread the contamination
• Disinfect with hypochloriteAbout 0.1%. Leave for a while, then wipe
• Seal waste in double bagsDispose of as infectious waste
• Prevent leaksLine the body bag with absorbent sheets
• If it gets on your skinWash at once with soap and running water, and report

If it gets in your eyes or mouth, rinse with plenty of water and see a doctor.

Placing the deceased in a body bag

1. Prepare and bow2–3 people, wearing PPE
2. Check and attach tagsSame number on both the body and the bag
3. Open the bag fully alongsideAlign the head end
4. Move level, together with the sheetCall out to each other; do not drag
5. Lay face upDo not remove worn items
6. Expel air and sealClose the zipper and write the number outside
7. Record and disinfectLedger entry, photos, hand sanitizing

Do not wash or change clothing until the police inquest and medical examination are complete.

Zoning and numbering at the recovery site

1. Divide the site into zonesUse fixed landmarks such as buildings
2. Sketch the zonesMark zone numbers and recovery locations
3. Assign a code to each teamA, B, C, etc. for each team
4. Number in order of recoveryRecord as A-1, A-2…
5. Mark the recovery locationUse flags or paint
6. Do not examine in detail on siteCheck only pockets for ID
7. Documents in a clear bagSame number, readable without opening the bag
8. Keep presumed identity separateClearly mark as “presumed”

Source: PAHO/WHO Management of Dead Bodies in Disaster Situations p.32–34, 147

Unique ID numbers and handover records

• Built from 3 elementsLocation + team name + serial number
• Do not use numbers aloneCauses duplication and confusion
• Standardize the format in advanceAgree on a system among agencies
• Do not write directly on bagsWriting fades. Use tags
• Record every handoverWho handed over, who received, date and time
• List personal effects item by itemPack with the same number as the deceased
• Two copies of the ID labelOne with the deceased, one kept on file
• Final handoverTo whom, when, approved by, destination

Source: ICRC/WHO (2nd ed.) Ch. 4 p.11–12, Ch. 7 p.23, Annex 3 p.49 / Philippines field manual p.58–59, 70

Vacuum-sealed body bag (proposal)

• Expel air and sealOdor and decomposition control when cooling is impossible due to power outages
• Material and thicknessPEVA or PVC, 0.3–0.5mm
• Size rangeInfant, adult, and large adult
• Valve at the foot endAway from the head, to preserve dignity
• With a personal effects pouchKept separate from the main bag to prevent contamination
• Electric and manual pumpsHave both in case of power outages
• Protection during suctionFace shield against body fluid spray
• Start suction slowlyExtension tube keeps workers at a distance

Strength, seal and safety testing is required before field use.

Source: Japan Disaster Prevention Education and Training Center, “Proposal for a custom body compression bag (VacSeal)”

Handling body parts (partial remains)

Treat body parts with the same dignity as a whole person.

• One number and one bag per partGive each find its own number
• Do not match on siteDo not assume they are the same person
• Record location, date and time of recoveryKeep photos and locations in the ledger
• Identification is for specialistsDNA, etc. done by police and physicians
• Explain carefully to familiesOther parts may be found later

Handling worn items and personal effects

Clothing, jewelry and personal effects are important clues for identification.

• Do not remove worn itemsLeave clothing, rings, watches and glasses in place
• Record with photosOverall view, patterns, engravings, etc.
• Effects in a bag with the same numberRemove only on police instruction
• Two people check valuablesRecord cash, bankbooks, etc. with a witness
• Receipt upon returnEnsure handover to the family

Tagging rules

• ① BodyWrist or ankle
• ② Body bagOutside, at the head end
• ③ CoffinHead end and side
• ④ Personal effects bagWrite the same number

• Use waterproof paper and permanent markers
• Secure with cable ties so tags do not come off
• Never change or reuse numbers
• Always link numbers to the ledger and photos

Sample body ID tag (tag)

Make at least 2 identical copies (one for the body, one for the bag) and use them in waterproof paper or laminated pouches. Numbers follow “municipality–location–serial number.”

Police inquest and medical examination flow

1. MunicipalityArrival and receptionNumber check and records
2. PolicePhotographyFace, full body, clothing
3. PolicePolice inquestClothing, effects, external exam
4. PhysicianMedical examinationCause and estimated time of death, certificate
5. Police and dentistsIdentificationDental, fingerprints, DNA
6. MunicipalityKeeping and viewingLaid out by number; families view the deceased
7. Police and municipalityHandoverCheck documents and belongings

Flow at the examination site

The deceased move one way with no backtracking, and never cross the families' route. The two meet only in the viewing room. After the viewing, families are guided to the handover desk.

Procedures and documents

1. PhysicianPostmortem certificateIssued by the examining physician
2. PoliceHandover of the deceasedTo bereaved families after the police inquest. Sign the receipt form
3. Bereaved familiesDeath notificationSubmit to the municipality with the postmortem certificate
4. MunicipalityCremation permitIssued by the municipality (also burial and reburial permits)
5. CrematoriumCremationPermit stamped as cremated
6. Bereaved familiesInterment and burialSubmit the stamped permit

If unidentified, the mayor arranges cremation, keeps the remains and issues a public notice. In disasters, national notices may allow special procedures.

Role of municipal staff at the examination site

• Reception and number managementCheck numbers against records on arrival
• Help with records and photosKeep the ledger as instructed by police
• Supplies managementRestock body bags, coffins and dry ice
• Guiding familiesAccompany and explain in the waiting area
• Care in preliminary checksLet families check photos and belongings first
• Contact point for proceduresGuidance on death notification and cremation permits

Police inquest and medical examination teams

• Police inquest teams of 7As a rule, 3 teams per police station
• Police inquest team rolesLead, records, photos, fingerprints, witness
• Medical examination teams of 5–7Medical examiner, support physicians, assistant, admin
• Dental teams2 or more per team for identification
• Shown by armbandIdentifies examining physicians
• Verify support physiciansCheck photo ID
• Reception works with policeMunicipal staff follow the reception team
• Two numbering seriesBodies with a head, and partial remains

Source: Tokyo Metropolitan Government, “Police Inquest and Medical Examination Activity Manual” p.17–19 (Tokyo standards)

Unidentified deceased

• Post informationList location found, clothing and effects
• Keep photosKey clues for later inquiries
• Police investigation takes about 2 daysIf unidentified, transferred to the municipality
• Investigation continues after transferMayor notified if identified
• Cremation after about 1 weekAbout 1 week after transfer, as a guide
• Create and keep recordsCremation ledger and cost documentation
• Keep remains and belongingsTo storage with a processing slip
• No claimant after 1 yearTo an ossuary, etc. as an unidentified person

Source: Tokyo Metropolitan Government, “Police Inquest and Medical Examination Activity Manual” p.17, 23, 34 / Wide-area cremation plan, Annex 2(5)

Register of the Deceased

• Discovery and recoveryDate, place, transporter, morgue position
• Condition of the deceasedSex, age, clothing, worn items, photos
• Police inquest and identificationExamining physician, DNA, method, name
• Bereaved families and dispositionContact, handover, cremation, grave marker

Grave Marker Register

• Location recordsLatitude, longitude, photo number
• Linked to the registerName shown automatically from body ID number (Excel)
• Patrol inspection logDigging, subsidence, flooding, damage
• Reburial managementPlanned/done, reburial date, crematorium

• Register of the Deceased (printable)Word · A4 portrait · 1 sheet per person · 13KB
• Grave Marker Register (printable)Word · A4 landscape · with patrol inspection log · 14KB
• Register of the Deceased and Grave Marker Register (data entry)Excel · auto totals · cross-referenced · 86KB

Basic photo set

• Full body, frontFrom the side, at mid-height
• Whole face, frontFill the frame with the face
• Distinctive featuresTattoos, scars, birthmarks, etc.
• Clothing and jewelryPhotograph each item separately
• Include a rulerTo show size
• Check sharpnessBlurry photos are unusable
• Always show the numberUnique ID number in every photo
• Extra shots if time allowsUpper body, lower body, side of face

Source: ICRC/WHO Management of Dead Bodies after Disasters: A Field Manual for First Responders (2nd ed.), Ch. 5 p.14

Items to record at recovery

• Unique ID numberOn every record and photo
• Sex and age groupInfant, child, adolescent, adult, elderly
• Condition of the deceasedIntact, decomposed, skeletonized, burned
• Visible featuresTattoos and scars visible without undressing
• Physical featuresHeight, hair color and length, deformities
• Dental featuresGold teeth, crowns, dentures
• Circumstances of recoveryLocation, date and time, finder, GPS
• Presumed identityInclude the basis for the presumption

Source: ICRC/WHO (2nd ed.) Ch. 5 p.16, Annex 1 Dead body identification form p.40–42

Key points for recovery and management

• Treat with respectBow, speak to them, handle with care
• One number to the endUse the recovery number until handover
• Record the circumstances of recoveryLocation, date and time, clothing, effects
• Keep belongings with the deceasedStore in a bag with the same number
• Preserve condition in the morgueControl room temperature. Replace dry ice daily

Dealing with odor ①　Reducing odor

• Cool to slow decompositionDry ice: 10kg/day in winter, 30kg/day in summer
• Seal in body bagsDouble-bag to prevent body fluid leaks
• Ventilate thoroughlyBeware of CO2 poisoning from dry ice
• Use deodorizers and activated carbonClean up spills immediately
• Protect workersActivated carbon masks. Rest areas upwind
• Change and bathe after workOdor is also a psychological burden

Dealing with decomposition odor (2): protecting workers

• Activated-carbon masksReplace odor masks regularly
• Rest where there is no odorUpwind, in a separate building, or outdoors
• Do not take work clothes homeChange on site and wash separately
• Bathe and wash your hairRemove the odor from hair and skin
• Swap out when it gets hardDo not push through nausea or headaches
• Memories brought back by smellA natural reaction. It is fine to talk to someone

How to apply dry ice

• Handle it wrappedWrap in newspaper or towels; use work gloves
• From the chest to the abdomenThroat to lower abdomen. The stomach and intestines decompose quickly
• Only the area directly below is cooledIt works only directly beneath where it is placed
• 20kg on the first dayThorough cooling at the start is most effective
• Cover it from viewCover with towels or sheets
• Ventilate when using large amountsPay close attention to ventilation
• Top up during long-distance transportAdd more dry ice during transport as well

The international manual (ICRC/WHO) prioritizes refrigeration (2–4℃) and warns that dry ice carries risks of CO2 poisoning and frostbite. Always ventilate when using it.

Source: Wide-area cremation plan, annex “Guidelines for the proper handling of the deceased” 2(5)a, 2(7)c

Room temperature and CO2 standards for morgue rooms

• Rooms used only for keeping the deceasedBelow 18℃ is acceptable; CO2 5,000ppm
• Rooms where staff work18–28℃; CO2 5,000ppm
• Rooms that bereaved families enter18–28℃; CO2 3,000–3,500ppm
• Ventilation guidelineOpen diagonally opposite windows every 20–30 minutes
• Keep tasks shortLimit dry ice work to about 15 minutes
• Do not lean into the coffinPutting your face inside risks fatal accidents
• Open the coffin only brieflyNo more than 2–3 minutes at a time, with staff present
• Take care during overnight vigilsCO2 collects near the floor. Ventilate regularly

Source: MHLW Environmental Health Division (October 29, 2025), Appropriate handling of the deceased by businesses, etc., p.8–9

Supporting families and handing over the deceased

• Explain the procedure and what to expectTell them the identification process and waiting times
• Describe the condition before viewingHelp them prepare themselves emotionally
• Do not rush; listenAvoid easy words of encouragement
• Return documents and belongings reliablyPostmortem certificate, cremation permit, receipt
• Connect them to support servicesInformation on funerals and counseling services

Before the viewing

• A quiet, private placeSo they can wait apart from other families
• Tell them what to expectExplain the process and waiting times
• First identify by photos and belongingsHave them check these before viewing directly
• Describe the condition in advanceHonestly, in gentle words
• The family decides on viewingWho will view the deceased. Do not press them
• Assign a staff member to accompany themKeep the same staff member throughout

Identification by photographs

How to photograph

• Include the ID tag in the shotShow the body ID number in every photo
• From overall to detailShoot the whole first, then distinguishing features
• ClothingColor, pattern, brand, size label
• Personal belongingsWallet, keys, phone, amulets, etc.
• AccessoriesRing engravings, watch, glasses
• On a plain sheetAdd a ruler; lightly clean off dirt

Physical features (surgical scars, tattoos, etc.) are photographed and managed as instructed by the police.

Identification file

Compile photos of belongings and clothing into one file per body ID number.

• A-0001-1Jacket
• A-0001-2Trousers, shoes
• A-0001-3Wallet, keys
• A-0001-4Mobile phone
• A-0001-5Ring, watch
• A-0001-6Glasses, amulet

How to show the photos

• Use a private roomStaff accompany them; do not rush
• Start with belongings and clothingShow face photos only when necessary
• Show one photo at a timeUsing files in number order
• Warn before distressing photosThe family chooses whether to look
• Record possible matchesPhoto number, viewer, relationship
• Keep photos strictly controlledDo not allow photographing or taking them out

Bringing families to the deceased

1. Preliminary check with photos and belongingsConfirm the numbers they recognize
2. Confirm their wish to viewThe family decides who will view
3. Explain the condition of the deceasedGently describe visible areas and injuries
4. Prepare the deceasedClean the face and arrange with a sheet
5. Guide them to the viewing roomStaff accompany them, slowly
6. Remove the cover at their signalFace first. Staff do this quietly
7. Do not rush; wait nearbyAdvise on touching with hygiene in mind
8. Record the identification resultViewer, relationship, date and time in the register

Speaking with families

• Use namesIntroduce yourself, then say “Mr./Ms. ○○”
• Slowly, in a low voiceShort phrases; do not say too much at once
• Do not fear silenceBeing there supports more than words
• Answer questions honestlyIf you do not know, say “I will check”
• Accept their angerDo not argue or make excuses
• Show respect for the deceasedRefer to the deceased by name too, “Mr./Ms. ○○”

Example phrases

Rather than encouragement or comparison, accept their feelings as they are.

During and after the viewing

• Do not set a time limitWait quietly nearby
• Advise on touchingMind hygiene; provide gloves, etc.
• A place to rest and drinksDo not send them home right after viewing
• Next steps in writingExplain handover, cremation and procedures
• Do not let them leave aloneConfirm a companion and contact details
• Refer them to support servicesGrief care, support organizations
• Watch for changes in their conditionUnsteadiness, hyperventilation, uncontrollable crying

Return belongings carefully, together with a receipt.

Notifying death or missing status

• Gather information beforehandThe circumstances of the deceased and who to tell
• Confirm who you are speaking toWhether they are the right person to tell first
• Individually, with two staffAvoid announcements to groups
• Ask them to sit downThe staff member delivering the news sits too
• Do not bring belongingsDo not take personal effects with you
• Brief and directDo not give false hope
• Be aware of those aroundWatch children and changes in condition
• Say unknown when it is unknownDo not declare death before confirmation

Source: PAHO/WHO Management of Dead Bodies in Disaster Situations p.107–108, 114

Accompanying families during identification

• Supportive attitude“Let us help you search”
• Do not make them talkAt first, stay nearby and listen
• When they break down in tearsStay with them until their breathing settles
• When they seem about to collapseHave them sit and clench their fists
• For those who blame themselvesListen fully, then say “You don’t need to blame yourself”
• A parting word“Keep talking about Mr./Ms. ○○”
• For childrenDo not ask them to identify the deceased
• Families of missing personsUnderstand both the hope for survival and the urge to search

Source: Fujishiro, “Support for bereaved families during identification of the deceased,” Japanese Journal of Traumatic Stress 10(1) p.58–62 / ICRC/WHO 2nd ed. Chapter 9 p.29

Checks and explanations at handover

• Verify the person collectingConfirm identity and relationship to the deceased
• Do not hand over on their word aloneOnly after obtaining objective evidence
• Check valuables item by itemGet a signed receipt of collection
• Always hand over the postmortem certificateAdvise them to get a cremation permit via the death notification
• Warn against losing documentsDo not lose the permit or postmortem certificate
• Advise early cremationAdd dry ice and proceed promptly
• Note contact detailsAlso ask about joining a joint funeral
• Foreign nationalsNotify the consulate after police inquest and medical examination

Source: Tokyo Metropolitan Government “Manual for police inquest, medical examination and related activities” p.23–24 / Wide-area cremation plan annex 2(6)

Missing persons inquiry desk

• Open earlySet up by the municipality with the police
• Away from the temporary morgueInterview in a quiet private room
• Get consent firstConsent to interviews and information sharing
• In person as a ruleSame staff member on return visits
• One number per casePrevent confusion from duplicate reports
• Receipts for items receivedIssue when accepting photos or records
• Use only for the intended purposeUse solely for identification
• Keep in regular contactUpdate on the search and identification

Source: Philippines DILG/LGA field manual p.42, 71–72, 83 / NDMA Guidelines p.25–26 / ICRC/WHO 2nd ed. Chapter 10

Ante-mortem interview items

• Basic informationName (incl. aliases, nicknames), date of birth
• Last seenPlace, date/time, circumstances, witnesses
• Physical featuresHeight as a range. Scars, tattoos
• Surgery, medical devicesSurgical history, artificial joints, pacemaker
• Dental informationTreatment history, dentures, regular dentist
• Clothing, belongingsColor, brand, size, engravings
• Recent photosSmiling, with teeth visible
• Personal itemsCombs, toothbrushes, etc. are DNA sources

Left and right are often confused, so always confirm the side. Record numbers (height, age) as ranges, e.g. “165–170cm”.

Source: ICRC/WHO 2nd ed. Annex 2 p.45–48 / NDMA Annexure-I p.78–85 / PAHO/WHO p.18, 29–30, 47–49

Media relations and public information

• Single point of contactOnly the spokesperson makes announcements
• The first 24 hoursCommunicate the realistic situation quickly
• Families firstRelease names only after notifying families
• Facts and figuresNo speculation or personal opinions
• When you do not knowHonestly admit it
• Do not release personal informationNo photos or records; no filming at the morgue
• Regular announcementsDead, missing and identified counts daily
• Inquiry line24-hour service for families

Source: PAHO/WHO p.3, 6–7, 113, 155 / ICRC/WHO 2nd ed. Chapter 11 p.33–34 / NDMA p.31–33

Deceased foreign nationals

• Notify the consulateEmbassy or consulate, after police inquest and medical examination
• Coordinate with the Ministry of Foreign AffairsCoordinate with home-country authorities
• List of foreign fatalitiesOrganize and report both identified and unidentified
• Interview using international formsINTERPOL DVI forms
• RepatriationFollow quarantine and diplomatic rules
• Language supportArrange interpreters for explanations
• Respect religion and customsE.g. burial (not cremation) for Muslims

Source: NDMA Guidelines p.28, Annexure-K / Philippines field manual p.27, 33–37, 69, 94 / Tokyo Metropolitan Government manual p.24

Handover to funeral directors

1. Request under the agreementPersonnel, vehicles, coffins, dry ice
2. Arrange date, time and placeDesignate the morgue exit for removal
3. Match number and nameTwo people read aloud to confirm
4. Check and hand over documentsPostmortem certificate, cremation permit
5. Convey the family’s wishesReligion, attendance, handling of belongings
6. Get a signed receiptCompany, staff name, vehicle number
7. Record in the registerEnter action, date/time, recipient
8. Get reports of arrival and cremationConfirm arrival at and completion by the crematorium

How wide-area cremation works

1. Check crematorium damageStatus of furnaces, operation and cremation staff
2. Request support from the prefectureWhen regular crematoriums cannot cope
3. The prefecture decides to implementPut the whole area under wide-area cremation
4. Inform residentsSeek understanding via permit counters and public notices
5. Allocate crematoriumsPrefecture coordinates by available capacity
6. Confirm with receiving crematoriumsArrival times, number of cremations, time required
7. Transport with a dispatch formTo the receiving crematorium by emergency vehicle
8. Report on progressCrematoriums: daily reports; municipalities: request status

Source: Tokyo Metropolitan Government “Manual for police inquest, medical examination and related activities” p.30–33 / MHLW notice Kenei-hatsu 0730 No.1 (2014)

Transport and delivery to the crematorium

• Use dedicated vehiclesHearses, etc. are preferable for the families’ feelings
• Under traffic restrictionsTransport by emergency vehicle
• Loading and unloading staffSecure several people separate from transport staff
• Leave with time to spareArrive before the crematorium booking time
• Keep companions to a minimumConsider the many families waiting for cremation
• Bring documentsDo not forget the cremation permit, etc.
• Time required1 hour 30 minutes to 2 hours per coffin
• Coordinate with the crematorium in advanceWaiting area, bone collection, sutra chanting

Source: Wide-area cremation plan annex 2(7)(8) / Tokyo Metropolitan Government manual p.33

Lessons from the Great East Japan Earthquake

• About 2,100 in Miyagi PrefectureTemporary burial began about 10 days after the disaster
• Unexpectedly early reburialExhumation within months, adding to the burden
• Strong resistance from bereaved familiesPrior explanation and consensus-building are essential

Source: Japan Disaster Prevention Education and Training Center materials

Selecting temporary burial sites

• High, dry, stable groundWell-drained and diggable
• Away from water sourcesDo not contaminate wells, rivers or groundwater
• Avoid flood-prone areasOutside projected tsunami and flood zones
• Out of public viewAway from shelters and hospitals
• Within 1 hour by carFrom the temporary morgue and crematorium
• Public land, permits, explanationPermit under the Graves and Burial Act and explanation to residents

Allow about 1.5m wide × 3m long per deceased person. Secure working space for heavy machinery, and select several candidate sites and sign agreements in normal times.

Distance guidelines for temporary burial sites

• From wells and drinking water sources200m or more (some sources say 250m)
• From springs and waterways30m or more
• From agricultural drainage channels10m or more
• Clearance above the water tableAt least 1.2m below the grave floor (1.5m in sandy soil)
• Depth of soil cover90cm–1.2m (to deter animals)
• Spacing between the deceased0.4–0.5m. Lay in a single layer
• Surrounding buffer zoneKeep at least 10m wide
• Permanent markersGrave markers engraved with the unique ID number

Distances vary with geology. Confirm with local health and environment departments.

Source: ICRC/WHO Management of Dead Bodies after Disasters: A Field Manual for First Responders (2nd ed.), Chapter 7 p.24, Chapter 8 p.27–28, Annex 7 p.59

Sample temporary burial site layout

Separate plots for the identified and unidentified, and keep work routes apart from family routes. Screen the perimeter and use a single entrance.

Burial procedure (steps)

1. Prior checksPostmortem certificate, permits, bereaved family consent form
2. Notify the scheduleTell families the date, time and place
3. TransportCheck the seal; transport by authorized emergency vehicle
4. Excavation1.5–2m deep with heavy machinery
5. BurialLay coffins in a single layer; do not stack
6. Grave markers and location recordsNumbered grave markers, map and GPS
7. Completion and disinfectionMoment of silence. Disinfect equipment and workers

This assumes later reburial (exhumation and cremation).

Pit depth and dimensions (per deceased person)

Not where water seeps in. Adjust dimensions to the ground and coffin size.

Supplies for burial

• Heavy machinery and dump trucksBackhoe; hauling excavated soil
• Shovels and pickaxesFor hand digging and shaping pits
• Ropes and strapsFor lowering coffins
• Slaked lime (if used)Helps with odor. Not required by international guidelines
• SheetingBlue tarps, screening
• Grave markers and surveying toolsNumbered stakes, tape measure, string line
• Recording toolsRegister, map, GPS, camera
• Lighting, generators, tentsNight work, rain, rest areas

Precautions when using slaked lime

International guidelines (ICRC/WHO) state that spreading slaked lime or disinfectant is not necessary. If you use it, note that it is a strong alkali (calcium hydroxide).

• Where to applyPit floor, around the coffin, on top of soil cover
• PurposeHelps with disinfection and odor control
• Wear PPEGoggles, gloves, mask
• Do not confuse with quicklimeQuicklime heats up with water and is dangerous
• Avoid windy daysPrevent it from scattering
• If it gets in the eyesRinse with plenty of water and see a doctor

Managing the burial site

• Control accessFencing, locks, single entrance
• Appoint a site managerPost contact details on site
• Patrol regularlyAnimal digging, subsidence, flooding
• Record locationsPlot map, GPS, photos
• Keep the register in duplicateStore paper and electronic copies separately
• Accommodate family visitsSet up a flower offering area and post visiting hours

Keep protecting the records and the site until reburial is complete.

Exhumation (reburial) procedure

1. Reburial permit and planReburial permit under the Graves and Burial Act; schedule
2. Contact familiesConfirm consent and whether they wish to attend
3. Verify location and numberCheck against the register, map and grave marker
4. Site preparationScreening, access control, PPE
5. Excavate with heavy machineryStop about 30cm above the coffin
6. Hand-dig to remove the coffinCheck the number and lift gently
7. Transfer and disinfectionIf damaged, move to a new bag and coffin
8. Transport, cremation and recordsUpdate register, backfill, disinfect

Key cautions for exhumation

Avoid summer; work during cooler times of day.

• Toxic gas and oxygen deficiencyNever enter a pit alone. Ventilate
• Pit collapseUse gentle slopes and shoring
• Body fluids and strong odorDouble bags, absorbent sheets, waterproof gear
• Contact with heavy machineryAssign a signaler and standardize signals
• Preventing mix-upsTwo people read the number aloud to confirm
• Mental health care for workersRotate in short shifts. Follow-up care

Cremation procedure after exhumation

1. Secure a crematoriumCoordinate wide-area cremation with neighboring municipalities
2. Check permit documentsReburial permit, cremation permit
3. Recheck number and identityCheck against the register. Repeat medical examination if needed
4. Replace body bag and coffinDisinfect; keep the same number
5. Contact familiesDate, crematorium, wish to attend
6. Transport in dedicated vehiclesWork with funeral directors and the hearse association
7. Cremation and collecting the remainsRespect religion and customs
8. Hand over remains and recordReceipt. Mark the register as “reburied”

• Tabletop exercisesSimulate opening a temporary morgue and temporary burial site
• Field exercisesCheck layout and transport at candidate facilities
• PPE and body bag practicePractice donning/doffing, bagging and filling in tags
• Family support drillsPractice what to say through role-play
• Pre-deployment critical incident stress educationLearn possible reactions and how to cope

What is critical incident stress?

• PhysicalInsomnia, loss of appetite, headaches, severe fatigue
• EmotionalAnxiety, helplessness, guilt, anger
• CognitiveTrouble concentrating. Scenes and smells come back
• BehavioralMore drinking and smoking. Avoiding people

If reactions last several weeks or more, or get worse, refer to professional support.

Mental health care: before and during operations

• Brief before deploymentTell people what the scene is like in advance
• Use shifts to avoid long hoursSet time limits and ensure breaks
• Buddy system (pairs)Watch out for each other
• Rest area, food, fluidsAway from the deceased
• Look after less experienced staffDo not assign them alone

Mental health care: after operations

• Short meeting at the endThanks, information sharing, health check
• Self-careSleep, meals, someone to talk to
• Stress checkAfter operations and, for example, 1 month later
• Counseling services and professionalsMake it easy to seek help across the organization

Do not force people to talk about their experiences or feelings. Create a space where those who want to talk can.

Critical incident stress in municipal staff

Their situation

• They are disaster victims tooWorking while their own family and home are affected
• Unfamiliar tasksRecovering and managing the deceased is far from routine
• Grief and anger of bereaved familiesAbsorbing emotions that have nowhere else to go
• Deceased acquaintances and childrenFacing people they know from the community
• Long working hoursNo one to relieve them, so no rest
• Hard to take a breakResidents are watching, so they can't show weakness

Warning signs

• Sleeplessness, nightmaresTrouble falling asleep, waking at night
• Unable to eatLoss of appetite, nausea
• IrritabilityQuick to anger, easily tearful
• Mistakes, forgetfulnessPoor concentration, slow decisions
• Withdrawal, isolationAvoiding people, not talking
• More drinking and smokingDrinking to sleep
• Working without restFeeling guilty about resting
• Scenes and smells come backSudden distressing memories

Mindset

• Know what you will see beforehandGet briefed on the scene before going in
• Reactions are naturalIt happens to anyone. It is not weakness
• Don't carry it aloneIt's OK to share with colleagues
• Set limits on time and roleDecide when your shift ends
• Don't expect perfectionFocus on what you did accomplish
• It's OK to ask to be relievedSpeak up when it gets hard

Self-care

• Sleep, eat, drinkGet at least some sleep, food and fluids
• Rest away from the sceneTake breaks somewhere else
• Breathe out slowlyBreathe in for 4 seconds, out for 6–8 seconds
• Bathe and change clothes to mark the endSeparate work from daily life
• Talk to someone you trustWhen you want to, as much as you can
• Don't rely on alcoholIt makes sleep lighter and slows recovery

If it lasts 2 weeks or more or gets worse, consult a professional.

Peer care

• Check in with each other in pairsWatch out for each other
• Ask specific questions“Are you sleeping? Are you eating?”
• Listen without judgingDon't press for details
• Encourage breaks and rotationSay “Let's take a short break”
• Role of managersAppreciation, managing work hours
• Refer to professionalsConsult early about anyone you're concerned about
• Consider staff families tooSupport families' safety and daily lives

Looking out for colleagues also protects yourself.

Worker assignment and health management

• Care for young staffUnder-21s should avoid working with the deceased
• Drink extra fluidsNeeds can be 3–4 times the usual amount
• Eat and drink outside the work areaNo uncovered containers
• Debrief on the last dayShare experiences as a team
• Meet again 1 week laterCheck on each other's well-being
• Refer to professionalsSeek help early for lasting reactions

Source: PAHO/WHO Management of Dead Bodies in Disaster Situations p.22–23, 111–112

Preparedness checklist

• Candidate facilities for a temporary morgue designated
• Agreements in place with facility managers and funeral directors
• Partner agency contacts and roles confirmed
• Transport routes, vehicles and transport agreements set
• Stock levels of PPE and equipment known
• Numbering system and record forms (registers, tags) prepared
• Wide-area cremation procedure confirmed
• Candidate temporary burial sites selected
• Joint exercises held at least once a year
• Critical incident stress support system in place

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Summary

• SitesDesignate temporary morgues and temporary burial sites in normal times
• EquipmentStockpile PPE, body bags and tags
• TrainingHands-on joint training with partner agencies
• Mental health careSystems that protect staff themselves

Protecting the dignity of the deceased, the hearts of families, and the well-being of staff is an essential part of disaster response.

1. PAHO/WHO “Management of Dead Bodies in Disaster Situations” (Japanese edition)Pan American Health Organization / World Health Organization
2. Management of Dead Bodies in Disaster SituationsPAHO/WHO (English edition)
3. Management of Dead Bodies after Disasters: A Field Manual for First Responders (2nd ed.)ICRC, WHO, IFRC, et al.
4. Management of the Dead in the Aftermath of DisastersNational Disaster Management Authority of India (NDMA)
5. Management of the Dead and Missing Persons Field ManualPhilippine Department of the Interior and Local Government, Local Government Academy (2021)
6. Common guidelines on handling the deceased in disasters (police inquest and medical examination operations manual)Tokyo Metropolitan Government (August 2017)
7. Principles for handling the deceased and guidelines on proper handling of the deceasedWide-area cremation plan, annex
8. Notice Ken-Ei-Hatsu 0730 No. 1 (July 30, 2014)Ministry of Health, Labour and Welfare (MHLW), Health Service Bureau, notice from the Director of the Environmental Health Division
9. Guidelines for businesses on the proper handling of the deceasedMinistry of Health, Labour and Welfare (MHLW), Environmental Health Division (October 29, 2025)
10. Supporting bereaved families when identifying the deceasedTomihiro Fujishiro, Japanese Journal of Traumatic Stress, Vol. 10, No. 1
11. Managing the deceased after large-scale natural disasters (temporary burial)Japan Disaster Prevention Education and Training Center, Sunny Kamiya
12. Proposal for a custom vacuum-sealed body bag (VacSeal)Japan Disaster Prevention Education and Training Center, Sunny Kamiya

• Training slides (16:9)PowerPoint · 97 slides · 2.4MB
• Training slides (4:3)PowerPoint · 97 slides · 2.4MB
• Training slides (A4 portrait)PowerPoint · 97 slides · for printing · 2.4MB
• Register of the Deceased (printable)Word · A4 portrait · 1 sheet per person · 13KB
• Grave Marker Register (printable)Word · A4 landscape · with patrol inspection log · 14KB
• Register of the Deceased and Grave Marker Register (data entry)Excel · auto totals · cross-referenced · 86KB

The registers contain names, addresses and family contact details. Limit who can view them and protect them strictly, for example with passwords.