1. Help families plan for after-death care. Helping families be ready to make timely decisions about where their loved one should go is the best thing you can do to address space issues. A Decedent Affairs Coordinator may be one of the best investments you can make and can help families make after-death decisions so decedents can be picked up by a funeral home right away.
   
   
2. Maximize your existing space. Make sure you are storing decedents in the right way, on the right trays, etc. The King County MEO often places 2 decedents on one cart to increase capacity. Additionally, you may want to use tiered racks, or replace the racks you currently use with more appropriate sizes. Carts meant for transport or meant for the living may not be the best to use for decedents. Additional morgue staff can also help with decedent intake, release, and inventory so existing space is utilized as efficiently as possible.
   
   
3. Add space in a way that is based on your actual needs. It's better to increase capacity a little and have it for the long term. Based on our experience working with hospitals, most do not have adequate day-to-day morgue space and planning for surge capacity is needed, especially if a hospital has NO capacity. However, if you typically have two bodies, don't plan for 90. It is better to think about doubling or tripling the capacity you currently have.
   
   Our graduated storage suggestions:

• Stop-gap measures. Cooling blankets, pop-up cold space tents, and even air conditioning units can be used to manage an emergent situation. These are short-term solutions and don't increase your regular capacity.
  
  
• Small mortuary coolers. These are self-contained units that can hold two to four decedents at a time. They cost less than $10,000 and some are even on wheels. This can both help you handle a surge, but also help you plan for longer-term needs.
  
  
• Refrigerated units. These come in a variety of sizes and features. Keep in mind any refrigerated unit placed on your campus will need 24/7 security.
  
  
  • Refrigerated containers (CONEX boxes, etc.) are 20' to 40' containers which can hold 15 to 45 decedents.
    
    Advantages: Not as expensive as a larger vehicle and don't require as much space. You can typically buy a used one, unequipped, for less than $10,000. May be able to run on an internal generator but best to have a regular power source.
    
    Disadvantages: May need to be hooked up to a power system, so cannot be separate from a building. Used ones tend to have a lot of wear. The need to equip racking, a lift, a ramp, and proper flooring significantly increases the overall cost and requires more time to become fully operational.
    
    
  • Refrigerated semi-trailers are up to 53' and can hold 60 to 90 decedents, if properly equipped.
    
    Advantages: Not as expensive as a purpose-built semi-trailer. They can be connected to power by a shoreline. They can be moved, and the turn around to purchase them is usually quick.
    
    Disadvantages: They are very large, somewhat expensive, and require a CDL license and tractor truck to move. They depend on diesel fuel (unless hooked up to power by a shoreline), and when the emergency has ended, they are not versatile for other uses. The need to equip with racking, lifts, and other accoutrements can increase the cost and time to become fully operational.
    
    
  • Purpose-built refrigerated semi-trailers are constructed and equipped specifically for morgue operations; they are typically 53' and generally come with racking and other accessories.
    
    Advantages: They can be connected to power by a shoreline and can be moved. They can be rented or purchased, with a relatively fast turnaround time. They can come fully equipped, so time to become fully operational is minimized.
    
    Disadvantages: They are the most expensive option, whether renting or purchasing. They are large and require a CDL license and tractor truck to move. They depend on diesel fuel (unless hooked up to power by a shoreline). When the emergency has ended, they are not versatile for other uses.

More information about refrigerated unit options, including costs, vendor information, equipment concepts, and other specifications can be obtained from King County Emergency Management by sending an email with the request to rcecc.logs@kingcounty.gov.

1. Balance reliance on others with having an in-house plan. While outside vendors and funeral homes usually handle most decedent transportation, as things get busier, their response times lag. Be aware that many hospitals may be relying on the same vendor. Investing in a van, and setting it up to carry decedents, may be a good investment. Transportation staff do not need Commercial Drivers Licenses (CDLs) but need to have knowledge about how to lift and move decedents.
   
   
2. Make sure you have the right equipment for moving decedents. Using a body board can help to effectively move decedents. Additionally, if decedents are stored on a tiered racking system, a lift may be helpful. Options range from a hand-cranking forklift to a hydraulic lift.

Most of the steps listed above have been done by our office:

• Our investigators work with families to identify funeral homes so they can be moved right away.
  
• We have had permanent racking systems installed in our morgue, almost doubling our capacity. Even so, increased jurisdictional deaths have put pressure on this increased capacity.
  
• We purchased a hydraulic lift to assist in moving decedents in and out of the racking system.
  
• We purchased refrigerated containers (CONEX boxes) for additional fatality surge management.

If a surge in decedents overwhelms all the good faith efforts of hospitals, King County can partner with hospitals to bring additional resources to bear:

1. King County could work with non-traditional transportation providers to move decedents.
   
   
2. King County MEO CONEX boxes could be opened to decedents who are not typically under MEO jurisdiction.
   
   • Jurisdiction would be assumed by King County MEO, and hospitals would provide all documentation including attempts to reach family.
     
   • Additional support and security staff would be brought on manage CONEX morgue operations.
     
     
3. King County could elevate the need to the State, through the State Emergency Operations Center.
   
   • Mutual aid resources from other counties or state assets could be called upon for additional support and resources.
     
   • Assistance from other states could be requested.
     
   • National Disaster Mortuary Operational Response Teams (DMORT) or other federal assets could be called on to assist if the disaster threshold is met.