Medico-legal governance of mass fatality incidents: A scoping review of forensic organisational models, operational vulnerabilities and lessons learned.

Mass fatality incidents place forensic medicine at the intersection of death investigation, public health, criminal justice, emergency management and institutional risk governance. Although disaster victim identification (DVI) is supported by international standards, the literature remains fragmented across case reports, technical guidance, discipline-specific accounts and after-action lessons. This scoping review mapped the medico-legal organisational evidence on mass fatality management, with particular attention to forensic governance models, operational vulnerabilities and transferable lessons for preparedness and quality assurance. Searches identified 2253 records in PubMed/MEDLINE, Scopus and Web of Science. After removal of 477 duplicates, 1776 records were screened; 93 reports were sought and retrieved for eligibility assessment; and 50 sources were retained for synthesis, including 39 core forensic-organisational sources and 11 supportive/contextual operational sources. The evidence converged on eight interdependent domains: pre-event governance and readiness; scene recovery and preservation of identity evidence; mortuary throughput; ante-mortem/post-mortem information governance; integration of primary identifiers and specialist teams; family assistance and ethical-cultural communication; occupational safety and psychological burden; and after-action learning. The review shows that mass fatality management should not be understood as a purely technical identification exercise. It is a high-risk medico-legal process whose reliability depends on command structures, interoperable documentation, chain-of-custody controls, workforce protection, family communication and post-incident audit. On this basis, we propose a descriptive Forensic Mass Fatality Governance Matrix as a non-scoring, audit-oriented framework for forensic units, hospitals and risk-management offices seeking to convert DVI standards into locally testable preparedness systems.