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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.<\/jats:p>","DOI":"10.1177\/00258024261486205","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:14:51Z","timestamp":1788491691000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Medico-legal governance of mass fatality incidents: A scoping review of forensic organisational models, operational vulnerabilities and lessons learned"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7712-4305","authenticated-orcid":false,"given":"Gianmarco","family":"Sirago","sequence":"first","affiliation":[{"name":"Policlinico of Bari, University of Bari"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7880-3450","authenticated-orcid":false,"given":"Massimiliano","family":"Esposito","sequence":"additional","affiliation":[{"name":"Kore University of Enna, Piazza dell'Universit\u00e0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Sessa","sequence":"additional","affiliation":[{"name":"Pegaso University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Salerno","sequence":"additional","affiliation":[{"name":"University of Catania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biagio","family":"Solarino","sequence":"additional","affiliation":[{"name":"Policlinico of Bari, University of Bari"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Dell'Erba","sequence":"additional","affiliation":[{"name":"Policlinico of Bari, University of Bari"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Ferorelli","sequence":"additional","affiliation":[{"name":"Policlinico of Bari, University of Bari"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_3_3_2_2","volume-title":"Disaster Victim Identification Guide. 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