Rai B, Anand SC. Role of forensic odontology in tsunami disasters. Internet J Forensic Sci ; Collaboration of forensic odontology for identification postmortem. Rev Bras Odontol ; Hereditary and environmental dental findings in identification of human remains. Coll Atropol ; Lumbosacral transitional vertebra: Clinical and forensic implications. Singapore Med J ; Warnick A. Mass disaster management: The organization of a mass disaster dental identification team.
Alpha Omegan ; Kafas P. Methods for human identification in forensic dentistry: A review. The Internet J Forensic Sci ; Body identification guidelines. J Am Dent Assoc ; The A. J Forensic Sci ; A comparative morphologic study of Carabellicusp between Chinese and Japanese students.
Shanghai Kou Qiang Yi Xue ; Slavkin HC. Sex, enamel and forensic dentistry: A search for identity. Dead bodies should not be removed in a hurry lest it should destroy evidence on the scene. Role of police, role of the hospital, Triage a French word thus means a process of giving priority to patients based on the severity of their condition and chances of survival, so as to treat successfully as many patients as possible when resources are insufficient to treat all the patients simultaneously.
Every accidental death has its preventive aspects and often these lie in the hands of the forensic pathologist. The recent upsurge of terrorism for political purposes in many parts of the world has brought with it the use of the home-made bomb.
Targets have usually been buildings, vehicles and aircraft. Often there is no intension to harm people and then warning of the planting of the bomb is usually given, the warning is sometimes insufficient or the location of the bomb is given in accurately and people are injured and killed and sometimes bomb is deliberately planted to so as to hurt people. The medical community having disaster management adequate knowledge and their common problems arises when mass casualty arrives in hospital.
The disaster management plan ultimate aim is to save life of patients and provide them best medical care as soon as possible. It should be a continuous process. Should evoke appropriate and prompt response. Plan should be based on valid knowledge must foresee what is likely to happen.
Disaster Victim Identification
It should be tested. It is primarily team work of the civil administration and its agencies especially the police on one hand a multi-disciplinary medical task force usually comprising of clinicians, nurses, para medical staff, odentologists, radiologists, forensic Pathologist, Forensic scientists, mortuary assistants and funeral officials, etc. Over the past couple of decades many countries have established Protocols for the management of disasters, often with the setting up of Disaster Victim Identification [DVI] teams.
Over the past two or three decades, many countries have established protocols for the management of the disasters, often with the setting up of disaster victim identification [DVI] teams. These teams usually include police, pathologists, dentists, radiologists, forensic scientists, mortuary assistants, embalmers and funeral directors, with provision for fingerprinting, forensic toxicology and DNA analysis. A mass disaster, another term sometimes used synonymous with a Mass Fatality Incidents [MFI] is considered technically to be any incident resulting in the death more than one person; the practical definition of an MFI is the actual number of deceased determined to be an MFI on a local level and should be defined by the death investigation team.
There are two main authorities overseeing death investigation in the USA, the medical examiner and the coroner. The goal of each system is the same, namely determination of the cause and manner of death for an individual dying in sudden, suspicious or traumatic circumstances. The forensic pathologist brings a necessary expertise to an MFI, in every death investigation during an MFI identification and investigation.
For all decedents the same questions apply the cause of the death and the identity of person; the core training and daily experience of the forensic pathologist makes him or her well suited to answer these questions.
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It is up to the forensic pathologist to ensure that professional protocols and procedures are followed, decedents properly identified and the accurate cause and manner of death assigned. It is not always possible to separate out these individual causes, it is the job of the forensic pathologist to try, even in the face of extreme adversity.
It should be remembered throughout that flexibility and adaptation are key to a successful operation. In , the Royal College of Pathologists published a definitive guide for pathologists to the problems of mass disasters, which is strongly recommended as a standard set of procedures. In many advanced countries, especially Britain the armed services have permanent aviation pathologists who deal with all service aircraft crushes anywhere in the world who are often available to deal with or attend as advisers any civil air disaster.
After tsunami disaster, Indian government also constituted the National Disaster Management Authority under the chairmanship of the Prime Minister with a vice chairman and five members in Sudden occurrence, extensive damage of both life and property and lack of preparedness and delayed response. Panic and anxiety. Lack of timely and correct information and disruption of communications. Sometimes bureaucratic delay in decision making. In most advanced and developing countries like India, each region now has a mass casualty plan covering medical and hospital services, fire service and police.
This is covering every aspect of transfusion, drugs, casualty transport, emergency surgery and anaesthesia. The plans are clinically oriented but often completely ignore provision for the dead or they have some cursory statement at the end such as mortuary accommodation will be provided with obviously no thought given to how several hundred corpses are to be accommodated will be provided.
Through clinical planning is of course vital especially in rail disasters, multiple motor crashes and urban bomb outrages it has to be appreciated that, in many air crashes, there are few if any survivors and that all the clinical planning may be redundant, leaving a massive and unprepared crisis in relation to the dead. It is essential that forensic pathologists should ensure that, in the area for which they are responsible, there is cooperative preplanning that includes adequate provision for collection, accommodation, and examination and disposal large numbers of dead victims.
Naturally the pathologist is usually no position to do this alone, but he is often the person with the most foresight and professional knowledge to act as the stimulus and catalyst between the major agencies responsible for overall planning. These are usually the police, military and the local health administration. When a mass casualty plan does exits, but the serious omissions in respect of dealing with the dead or where no such plan exits, the forensic pathologist should energetically stimulate the responsible authorities into making a compressive plan. Communications between such groups as police, pathologists, mortuary and laboratory technicians, radiographers and dentists also need to be established in advance.
The authority aim is a relief-centric approach to a holistic multidisplinary and multisectoral approach. Because the circumstances differ so much from incident to incident, it is impossible to try and anticipate every contingency and draw detailed planes to cope with them [Walsh. Hence, protocols need be simple and flexible.
Isolation , demarcation and protection of the site by security cordon and entry of the team through some predetermined route. Involvement of by-standers and other officials need be checked. Secure the disaster site. Prepare a sketch plan of the site showing parts of wreckage and position of the bodies. Take photographs of the site. Locate each body and label it with Mass causality card giving serial number.
Mutilated bodies and fragmentary remains should also be labelled and numbered. Maintain the relationship between clothing and personal effects found at the scene and the respective remains. Transport bodies to mortuary as soon as possible. The greatest problem encountered in protecting the scene was the unauthorized attendance of police personnel and high ranking officials coming along to help. This occurred especially in the more high-profile cases, which were attended by great deal of publicity.
Another problem is such visitors either contaminated or destroyed valuable evidence or got in the way. The left behind material initially thought to be valuable trace evidence, which was consequently, needlessly examined. A forensic pathologist as an investigative team member has a pivotal role in such situations. After emergency medical teams have satisfied themselves that all living survivors have been removed for treatment, the position of very corpse or body fragment must be marked, numbered and photographed.
They must then be removed to a temporary mortuary close to the site, which has adequate lighting, and water connections, and communications facility a part of this building can be used as an autopsy hall. A team must be constituted comprising a forensic pathologist, forensic scientist and dentist to undertake meticulous medico legal investigation. While management of mass disasters is done systematically in most western countries, the situation is unfortunately far from satisfactory in India. Identification exercised as the major priority.
For each unknown remains, as well as for multiple remains, prepare photographs, diagrams, and tables for comparison between the unknown and known features examine for comparison with medical records eyeglasses, including frames and lenses. Look for contact lenses. Review reports of missing persons, statements of witness and relatives in mass disaster situations and content of passenger manifests provided by representatives of airlines following aircraft accidents.
Examine, describe, record, and photograph the clothing and other physical evidence. Describe the size, colour, condition and type of each garment. Record the descriptions of laundry marks, labels, and name tags. Examine personal effects, such as rings, watches belt buckles, and bracelets for engraved markings. Determined if keys found on the remains provide access to the home or vehicle of the missing person. Obtain finger prints for comparison, remove and examine dentures if present. Examine teeth for comparison with ante mortem dental records and x-rays. Age can be determined by examination of ground sections of teeth.
Examine denture for name and identification number. Examine skeletal remains to determine race, sex, age, evidence of prior disease or injury, etc. Obtain blood for grouping, Rh typing, sex chromatin, karyotyping and DNA finger printing. Skiagrams of skull can be compared with films obtained during life.
Occupation marks, moles, tattoos, oparetion scars, congenital defects, pre-exiting disease, old injuries and fractures, absence of organs and nails, plates etc. Compare hair with known hair. Confirm gross pathological findings by microscopic examination. Determine the age of ante mortem injuries. Retaine tablets or capsules found in stomach. Preserve blood for alcohol, drugs, co, etc.
Body Recovery: this stage starts once the person has been declared dead and properly tagged. The first thing that needs to be decided at this stage is whether the existing mortuary facilities are sufficient or a new, temporary set-up is required. Visual recognition may not be helpful because of severe disfigurement due to trauma, burning, decomposition, etc.
Belongings can be helpful and may include clothing, jewellery and personal documentation. Clothing found on a body can be of great value in establishing identity but must not be accepted as a positive proof in isolation. It is secondary evidence must not always be assumed that the item belongs to the deceased or will be recognized by relatives and documents carry potential value but again being secondary evidence should not in their own be used to assume the identity of the deceased.
May contribute or confirm identification. Medical or post-surgical condition is the more positive will be the identification of the body. Comparison of x-rays taken in life may be used when there is some abnormality. Has proven to be very helpful, especially when fire or putrefaction has destroyed the soft tissues. When this method is applicable dental records are need.
Is another method of personal identification with well-established criteria for reliability. Fingers or finger prints may be destroyed in the event of fire or severe mutilation. For this reason, heel print records also some recommended, the heel being relatively better protected from fire or decomposition by shoes or boots by Western people. Has been shown to be of great value in identifying a wide range of human fluids and tissues, chiefly because DNA molecules remain highly stable in stains, are present virtually all human cells and are extremely polymorphic.
In case of survivors, establishing a system of Triage to determine priority for evacuation is the need of the hour. Colour coded tokens may be hung around the neck of injured.
UCO: Forensic Science Institute
The colours recommended are included: Category I[Red]-requiring resuscitation and emergency lifesaving surgery, Category II[Yellow]- -requiring possible resuscitation surgery, and early surgery, Category III[Green] —less serious injury not endangered by delay, and Category IV[Black]-survival not likely. Difficulties in Forensic Services : the forensic services encountered great difficulty in identification, display, handling, storage, recording and disposal of large number of dead bodies during the tsunami disaster in and Khaedrinath in Evidence of organic diseases like coronary occlusion, cerebrovascular accident, etc.
Evidence of poisoning due to alcohol psychotropic drugs affecting higher mental faculties. Explosion injuries with evidence retained explosive material suggest sabotage. Forensic Science Institute The Forensic Science Institute at the University of Central Oklahoma is a world-class institute dedicated to quality forensic science education, training and research for professionals and students.
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