The doctors, dentists and anthropologists striving to identify Maui's victims

Inside a temporary morgue near the Maui County coroner's office, a team of specialists — including forensic pathologists, X-ray technicians, fingerprint experts and forensic dentists — labour 12 hours a day to identify the charred remains of the victims of this month's cataclysmic wildfire.

They are members of the federal Disaster Mortuary Operational Response Team programme, or DMORT, deployed when a mass fatality incident overwhelms local authorities.

The team's breadth of experience underscores the difficulty of the task it faces. The number of victims is unknown, hundreds remain on lists of those missing, and in some cases the inferno has consumed all but the barest remnants of the bodies.

The work is vitally important, with families desperate to know the fate of their relatives — and to have a chance to say goodbye. The death toll in the devastated town of Lahaina has surpassed 100, but only a handful have been officially identified, emphasising the long road ahead.

"It's so important for families to get their loved ones back — that's our mission, and when we make that happen, it's a great day," said Frank Sebastian, 68, the commander of the Maui DMORT and a retired medical examiner from the Seattle area.

There are 10 regional DMORTs around the United States, comprised of more than 600 civilian members, that spring into action for disasters as varied as airplane crashes, hurricanes and mass attacks such as the Sept 11, 2001, hijackings.

While the work can be emotionally taxing, DMORT members already confront death in their day jobs as funeral directors, medical examiners and coroners. They are better equipped than most to compartmentalise their feelings and concentrate on the mission at hand.

"I deal with things that most people don't understand or couldn't process on a daily basis," said Kathryn Pinneri, a long-time DMORT member and pathologist who runs the forensic services department in Montgomery County, Texas.

Maui challenges

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The U.S. Department of Health and Human Services, which oversees DMORTs, has deployed three dozen members to Maui, including logistics staff and mental health specialists.

The agency also transported one of three Disaster Portable Morgue Units — some 22.5 tons of supplies and equipment to set up a fully functioning mortuary, including examination tables, x-ray machines and fingerprinting equipment.

Work is divided into two buckets: "postmortem" — analysing remains — and "antemortem" — gathering information from surviving relatives.

Each day, search-and-rescue teams combing Lahaina bring suspected remains to the temporary morgue. Remains are typically assigned a "tracker" to stay with them through the entire process, according to Pinneri.

The remains then move from station to station, depending on their form. A human body, for instance, would be fingerprinted and have features such as hair colour, height, weight and tattoos recorded. An X-ray might pinpoint useful details such as a hip implant; a dental examination can be compared to dental records.

Skeletal remains would be examined by forensic pathologists and anthropologists for clues. DNA samples have become a crucial tool; Sebastian said the Maui team has partnered with a company that can process DNA in just hours.

A separate group, known as a "Victim Identification Centre" team, is helping to collect details from surviving relatives for possible matches: DNA swabs, the names of victims' dentists and whether fingerprint records might exist.

Fires present particular challenges. For instance, intensely burned bone fragments may no longer have usable DNA strands, according to Paul Sledzik, a forensic anthropologist and former DMORT commander. Dental records may have been destroyed in the blaze.

The Maui wildfire is what experts call an "open" disaster, in which the number of victims, and their identities, is uncertain and potentially unknowable, he said. In a "closed" disaster, those factors are known, such as a plane crash in which the airline has a list of passengers and crew.

"That's going to be a challenge in Hawaii, resolving the list of missing people," Sledzik said.

'Overwhelming'

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The federal DMORT programme was established in 1992, after USAir Flight 405 crashed on New York's Long Island, killing 27.

For years, teams responded to major transportation accidents, cemetery floods and natural disasters. But the Sept. 11, 2001, attacks represented a pivot point, when DMORT teams helped city authorities sift through thousands of remains.

"I think it was September 11 when people really began to realise how important this function was," said Dawn O'Connell, assistant US secretary for preparedness and response for HHS. "We had hundreds of team members deployed for months."

"We do this work for the families," said Sledzik, who commanded a team dispatched to the Sept 11 crash site near Shanksville, Pennsylvania. "We never use the term closure, because I've worked with enough families to know that doesn't exist, but we hope to provide them with the knowledge that their loved ones are gone."

In the wake of the attacks, cities and states began implementing mass fatality management plans, with some creating their own versions of DMORTs, Sledzik said. But federal teams remain essential for disasters in remote locations or those with fewer resources.

The missions can vary widely, and every disaster brings its own obstacles, team members said. DMORTs were sent to Puerto Rico in 2017, when Hurricane Maria killed nearly 3,000 people on the island. In 2020, teams were dispatched to New York as the city's hospital morgues and funeral homes were inundated with the dead at the height of the Covid-19 pandemic.

David Hunt, a funeral director in Indiana who commands two regional DMORTs, had to negotiate with the US military following the catastrophic 2010 earthquake, when his mission was to identify and repatriate American victims.

"When I look back on it, I'm just a small-town funeral director, and just to be involved in some of these historical events... sometimes it's overwhelming," said Hunt, recalling how it felt to stand on the grounds of the World Trade Centre in 2001.

Wildfires represent a relatively new response area for DMORTs; teams responded to the 2018 Camp fire that killed 85 in California and the 2020 Oregon wildfires.

But climate change, which scientists say will exacerbate wildfires, hurricanes and other natural disasters, may increase the frequency of mass fatality incidents.

"As we're starting to see this era of 'polycrisis,' making sure we have enough DMORT team members that we can deploy is going to be really important," O'Connell, the senior HHS official, said.

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