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Dr. Vivek Kumar
WHO has defined disaster as an occurrence
that :
A. causes damage,
B. ecological disruption,
C. loss of human life or
D. deterioration of health and health services
on a scale sufficient to warrant an extraordinary
response from outside the affected community or area.
MASS DISASTER
Mass disaster is commonly defined as the death of more
than 12 victims in a single event.
It is the number of deaths that exceeds the capacity of the
local death investigation system to handle it.
In certain parts of the World, nature is frequently
responsible for mass disaster with flood, hurricanes,
volcanoes or earthquakes killing thousands of
people.
 In these enormous disasters, when whole
communities are wiped out, there can be very little
detailed investigations.
MASS DISASTER
Classified into…….
Natural:
disease epidemic
mass poisoning (food/liquor).
• Industrial
• Civil disturbances
• Warfare
Man made:
EXAMINATION OF THE BODIES OF THE
VICTIMS BY FORENSIC EXPERT IS NECESSARY
FOR 3 MAIN REASONS:
(i) To identify each dead body and to establish the cause
of death for legal purposes so that a death certificate
can be issued
(ii) To discover evidence relating to the investigations of
the disaster itself like obtaining sample for
toxicological analysis where appropriate
(iii) To find out the cause of the disaster itself e.g. bomb
or detonator fragments that may be embedded in the
bodies of the victims.
In many disasters, the extent of damage to bodies and
their clothing by traumatic forces or by fire is such that
specialized examination of the bodily remains is
necessary to establish the identity.
 It is therefore considered highly desirable that from
the onset very close contact could be established
between the police and the pathologist, to carry out
postmortem examination.
MANAGEMENT OF MASS
DISASTER :
1. Coordination
2. Infectious disease risk
3. Body recovery
4. Storage of dead bodies
5. Identification of dead bodies
6. Information management
7. Long term storage and disposal of dead
bodies
8. Communication and the media
9. Support to families and relatives.
FIRST PHASE (AT THE ACCIDENT SITE)
Isolation, Demarcation and Protection of the site.
Visitors should not be allowed to visit.
Survivors to be rescued.
All possible means should be
used to save life without
unduly endangering rescuers
from the various continuing
dangers that may exist e.g.,
fire.
When no further lives can be saved, situation
should be taken under your control
Evidence should be preserved which may
contribute both to their identification and to the
investigation of the accident itself
 The first task should be to
(I) LOCATE BODIES
(ii) Label them with a
number
(III) PHOTOGRAPHING THEM
IN SITU
(IV) PREPARING A PLAN OF THE
DISASTERS
showing the main
pieces of wreckage
 number of the
bodies and their
location
(v) Exact location of body at a disaster site
may prove to be very important, whatever the
disaster
(vi) Work of identification of the bodies should
be undertaken
(vii) For accident reconstruction from
evidence, bodies are labeled, photographed
and a record made of their precise position
(viii) Record each body and
place it in a suitable container
for transfer to the mortuary.
 Make sure that things
belonging to one body are not
assigned to another.
 Polythene sheeting can be used
for covering it.
 It should be semitransparent to
see the numbered label
attached to a body without
need for further labeling to
facilitate carrying
 (x) Counselling room: The
counsellors to be there for
counselling of relatives of the
victims and if not possible at
the site then near the mortuary
counselling should be carried
out.
(ix) Media room: A
temporary room may be
constructed and news
regarding the victims may be
provided to the press as well
as relatives periodically
SECOND PHASE (IN THE MORTUARY)
In the mortuary, accommodation and in particular
refrigeration are likely to be problems following any
major disaster.
Bodies should be dispersed to numerous small
mortuaries but preferably a building of suitable size to
be designated a temporary mortuary, for a coordinated
investigation, where there is sufficient space and light
can be used.
"field mortuaries"
 In certain types of mass disaster, where identification
is not so difficult, only external examination may be
required for identification.
But in case of aircraft accidents, a full autopsy is
required from the point of view of accident
investigation itself, then better facilities such as a
properly equipped autopsy room becomes essential.
It is ideal to have in close proximity an autopsy room,
refrigerated mortuary accommodation, an area for
embalming and a separate room for interviewing
relatives and viewing bodies.
 If necessary a suitable room for use as a
communication headquarters.
The procedures in the mortuary should
be a team work involving at least –
 a pathologist and
 a police officer,
 usually a forensic odontologist and
 occasionally other specialists such as a radiologist,
when appropriate to the particular circumstances and
conditions of the bodies.
It is always important to count the number of bodies
recovered.
This is easy enough when there has been little or no
mutilation and fragmentation.
 But when the traumatic forces of the accident is
severe, then the human remains recovered may far
exceed the number of persons killed
(I) PRIMARY IDENTIFICATION:
Primary identification
is mainly done by :
a.Visual identification
b. By photographs
(a) Visual identification:
 Is the standard method used by police to establish the identity of a
dead body.
 Visual identification of facial features can be reliable when a body
is intact or little damaged externally
 The effect of burns in a disaster reduces its value considerably
(b) Photographs:
 of distinctive clothing, personal possessions or physical
characteristics may be recognized if facial features are damaged.
 Initial and subsequent photography is essential to make a
photographic record to relate body, site and cadaver numbers.
 After initial photography clothing and jewellery must be
removed from the body, examined and catalogued.
(II) EXAMINATION OF CLOTHING:
Evidence of vomit, blood or stains upon clothing may
prove useful.
Any marks on clothing like manufacturer's label or
laundry marks also prove valuable.
 Examination of clothing is necessary to find out any
damage to clothing due to the accident sequence or
bomb explosion
(iii) External examination: To determine:
(a) sex
(b) height
(c) weight
(d) hair colour
(e) location and abundance of hair
(f) colour of eyes and skin
(g) any anatomical, surgical and traumatic scars
(h) tattoos or birth marks
(i) abnormalities such as congenital or acquired
(iv) Injury sustained during the accident related
to cause of death
(v) In case of blast injuries, trace evidences may be
preserved
(vi) Radiographic examination:
(a) Ideally, complete set of skeletal X- rays should be
taken for each victim
(b) In case of suspicion of damage, full skeletal
radiography is required
(c) Radiographs are helpful in identification in case of
extremely burnt body and they are also helpful in
revealing the presence of articles embedded deeply in
charred muscle that may be overlooked
(d) A permanent record of bone injuries are obtained
that reduces the time spent in assessing and recording
these during autopsy
(vii) Full internal autopsy:
Evidence relevant to identification will be collected such
as:
(a) surgical absence of internal organs
(b) presence of postsurgical states like gastroenterostomy
(c) evidence of preexisting disease
(d) any internal injury
(e) precise cause of death
(viii) Histological examination:
certain organs and tissue will be collected for routine
histological examination
Tissue specimens containing metal fragments for
chemical analysis should be deep frozen
Histological examination may reveal a disease relevant to
consideration of impaired function if the body is that of
operating crew, then medico legal problems for
compensation arise
(ix) Fingerprints:
They should be taken after the autopsy when all
possible evidence has been collected from examination
of the body.
Fingerprints are of limited value in identification of
victims of aircraft accidents due to nationality of most
of passengers being in question
After powdering, the
fingerprints were then
transposed onto paper
Finger skin was
removed by
“degloving”
(X) DENTAL EXAMINATION:
At the end of the autopsy,
dentist should make an
examination of the jaws
and teeth
value of dental evidence in
identification has become
widely recognized
If an ante mortem radiograph of the relevant part of the
dentition is available,
it may prove to be of greatest possible value for
comparison with the postmortem radiograph of the
fragments recovered.
(XI) DNA TECHNIQUES
Because of the rapid decomposition and subsequently
muscular alterations, a sampling of the femoral shaft
(recommended for DNA analysis) was carried out by the
anthropologist.
Another possibility for DNA sampling was the extraction
of two sound teeth, preferably two premolars or canines,
because of the presence of a lot of pulp material inside
these teeth.
(xii) Other means of identification such as:
(a) Multivariate analysis of race in cranium and
cephalic index
(b) Identification of scars of parturition and other pubic
symphyseal changes in skeletal remains of female
(c) Neutron activation analysis of hair are also used.
Last task to be performed in the mortuary is the
examination of any fragments of bodies and, matching
of those fragments with the bodies from which they
originated.
THIRD PHASE(COMPARISON OF RECORDS AND
IDENTIFICATION)
Identification of bodies depends upon accurate
information about those who are believed to be
involved.
When the persons killed are of the country in which the
disaster occurs, it is probable that normal police
communication system is the best for collection of
required information.
During recent years, the need for practical record forms
in the context of a mass disaster has come to be
appreciated, Australian Police, Interpol has produced a
disaster victim identification form.
The forms, which have evolved from 15 years of
practical experience consists of four different coloured
forms and a white one.
Two of the coloured forms are for the males, other two
for the females; white form is for missing persons.
One of the coloured forms is for external feature of the
body and the other is for autopsy findings.
 They are kept in transparent envelop upon complete and
since they are coloured, on single sheets paper, the
subsequent exercise of matching records and 'proving', the
identification of body is much more simplified.
In India no such form are available and all the information
related to identification should be recorded in a
postmortem report.
In some disaster the pathological examination of bodies
of victims, can achieve beyond proving evidence leading
to identification and confirmation of an obvious cause of
death.
 Comprehensive pathological investigation can help a
great deal to reconstruct the accident, sometimes to the
extent of revealing the cause
Routine toxicological tests on the tissues of human bodies
also reveal a cause of death (like CO poisoning in
disaster).
Injuries in passengers and their correlation with damage
to seat structures and other solid structures is also helpful
in knowing the relative safety of different parts of
aircrafts/other vehicles and how to improve them to
prevent such disasters.
CONCLUSION
Adequate victim identification management goes
through strict methodology and protocols.
This requires adopting and applying standard operating
protocols.
Such a huge operation requires a multidisciplinary
team
The expertise in relation to disaster victim
identification is enhanced when team members
working together in an interdisciplinary way, share
mutual respect are professionally trained and skilled,
and have multi functional capacities.
 National Centre for Disaster Management was
established in 1995 in the Indian Institute of
Public Administration (IIPA) by the Ministry of
Agriculture.
The Centre was upgraded as the National
Institute of Disaster management (NIDM) on 16th
October 2003 following the transfer of the subject
of disaster management to the Ministry of Home
Affairs.
 The Institute was inaugurated by Shri Shivraj
Patil Union Home Minister on 11th August, 2004.

IMPROVING THE EFFECTIVENESS OF DISASTER MANAGEMENT IN
INDIA
 headed by the Prime Minister of India, is the Apex Body for Disaster
Management in India.
 The setting up of the NDMA and the creation of an enabling environment for
institutional mechanisms at the State and District levels is mandated by the
Disaster Management Act, 2005.
THANK YOU

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Mass disaster in Forensic Medicine

  • 2. WHO has defined disaster as an occurrence that : A. causes damage, B. ecological disruption, C. loss of human life or D. deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area.
  • 3. MASS DISASTER Mass disaster is commonly defined as the death of more than 12 victims in a single event. It is the number of deaths that exceeds the capacity of the local death investigation system to handle it.
  • 4. In certain parts of the World, nature is frequently responsible for mass disaster with flood, hurricanes, volcanoes or earthquakes killing thousands of people.  In these enormous disasters, when whole communities are wiped out, there can be very little detailed investigations.
  • 8. • Industrial • Civil disturbances • Warfare Man made:
  • 9. EXAMINATION OF THE BODIES OF THE VICTIMS BY FORENSIC EXPERT IS NECESSARY FOR 3 MAIN REASONS: (i) To identify each dead body and to establish the cause of death for legal purposes so that a death certificate can be issued (ii) To discover evidence relating to the investigations of the disaster itself like obtaining sample for toxicological analysis where appropriate (iii) To find out the cause of the disaster itself e.g. bomb or detonator fragments that may be embedded in the bodies of the victims.
  • 10. In many disasters, the extent of damage to bodies and their clothing by traumatic forces or by fire is such that specialized examination of the bodily remains is necessary to establish the identity.  It is therefore considered highly desirable that from the onset very close contact could be established between the police and the pathologist, to carry out postmortem examination.
  • 11. MANAGEMENT OF MASS DISASTER : 1. Coordination 2. Infectious disease risk 3. Body recovery 4. Storage of dead bodies 5. Identification of dead bodies 6. Information management 7. Long term storage and disposal of dead bodies 8. Communication and the media 9. Support to families and relatives.
  • 12. FIRST PHASE (AT THE ACCIDENT SITE) Isolation, Demarcation and Protection of the site. Visitors should not be allowed to visit. Survivors to be rescued.
  • 13. All possible means should be used to save life without unduly endangering rescuers from the various continuing dangers that may exist e.g., fire.
  • 14. When no further lives can be saved, situation should be taken under your control Evidence should be preserved which may contribute both to their identification and to the investigation of the accident itself
  • 15.  The first task should be to
  • 16. (I) LOCATE BODIES (ii) Label them with a number
  • 18. (IV) PREPARING A PLAN OF THE DISASTERS showing the main pieces of wreckage  number of the bodies and their location
  • 19. (v) Exact location of body at a disaster site may prove to be very important, whatever the disaster (vi) Work of identification of the bodies should be undertaken (vii) For accident reconstruction from evidence, bodies are labeled, photographed and a record made of their precise position
  • 20. (viii) Record each body and place it in a suitable container for transfer to the mortuary.  Make sure that things belonging to one body are not assigned to another.  Polythene sheeting can be used for covering it.  It should be semitransparent to see the numbered label attached to a body without need for further labeling to facilitate carrying
  • 21.  (x) Counselling room: The counsellors to be there for counselling of relatives of the victims and if not possible at the site then near the mortuary counselling should be carried out. (ix) Media room: A temporary room may be constructed and news regarding the victims may be provided to the press as well as relatives periodically
  • 22. SECOND PHASE (IN THE MORTUARY) In the mortuary, accommodation and in particular refrigeration are likely to be problems following any major disaster. Bodies should be dispersed to numerous small mortuaries but preferably a building of suitable size to be designated a temporary mortuary, for a coordinated investigation, where there is sufficient space and light can be used.
  • 24.
  • 25.  In certain types of mass disaster, where identification is not so difficult, only external examination may be required for identification. But in case of aircraft accidents, a full autopsy is required from the point of view of accident investigation itself, then better facilities such as a properly equipped autopsy room becomes essential.
  • 26. It is ideal to have in close proximity an autopsy room, refrigerated mortuary accommodation, an area for embalming and a separate room for interviewing relatives and viewing bodies.  If necessary a suitable room for use as a communication headquarters.
  • 27. The procedures in the mortuary should be a team work involving at least –  a pathologist and  a police officer,  usually a forensic odontologist and  occasionally other specialists such as a radiologist, when appropriate to the particular circumstances and conditions of the bodies.
  • 28. It is always important to count the number of bodies recovered. This is easy enough when there has been little or no mutilation and fragmentation.  But when the traumatic forces of the accident is severe, then the human remains recovered may far exceed the number of persons killed
  • 29. (I) PRIMARY IDENTIFICATION: Primary identification is mainly done by : a.Visual identification b. By photographs
  • 30. (a) Visual identification:  Is the standard method used by police to establish the identity of a dead body.  Visual identification of facial features can be reliable when a body is intact or little damaged externally  The effect of burns in a disaster reduces its value considerably
  • 31. (b) Photographs:  of distinctive clothing, personal possessions or physical characteristics may be recognized if facial features are damaged.  Initial and subsequent photography is essential to make a photographic record to relate body, site and cadaver numbers.  After initial photography clothing and jewellery must be removed from the body, examined and catalogued.
  • 32. (II) EXAMINATION OF CLOTHING: Evidence of vomit, blood or stains upon clothing may prove useful. Any marks on clothing like manufacturer's label or laundry marks also prove valuable.  Examination of clothing is necessary to find out any damage to clothing due to the accident sequence or bomb explosion
  • 33. (iii) External examination: To determine: (a) sex (b) height (c) weight (d) hair colour (e) location and abundance of hair (f) colour of eyes and skin (g) any anatomical, surgical and traumatic scars (h) tattoos or birth marks (i) abnormalities such as congenital or acquired
  • 34. (iv) Injury sustained during the accident related to cause of death (v) In case of blast injuries, trace evidences may be preserved
  • 35. (vi) Radiographic examination: (a) Ideally, complete set of skeletal X- rays should be taken for each victim (b) In case of suspicion of damage, full skeletal radiography is required
  • 36. (c) Radiographs are helpful in identification in case of extremely burnt body and they are also helpful in revealing the presence of articles embedded deeply in charred muscle that may be overlooked (d) A permanent record of bone injuries are obtained that reduces the time spent in assessing and recording these during autopsy
  • 37. (vii) Full internal autopsy: Evidence relevant to identification will be collected such as: (a) surgical absence of internal organs (b) presence of postsurgical states like gastroenterostomy (c) evidence of preexisting disease (d) any internal injury (e) precise cause of death
  • 38. (viii) Histological examination: certain organs and tissue will be collected for routine histological examination Tissue specimens containing metal fragments for chemical analysis should be deep frozen Histological examination may reveal a disease relevant to consideration of impaired function if the body is that of operating crew, then medico legal problems for compensation arise
  • 39. (ix) Fingerprints: They should be taken after the autopsy when all possible evidence has been collected from examination of the body. Fingerprints are of limited value in identification of victims of aircraft accidents due to nationality of most of passengers being in question
  • 40. After powdering, the fingerprints were then transposed onto paper Finger skin was removed by “degloving”
  • 41. (X) DENTAL EXAMINATION: At the end of the autopsy, dentist should make an examination of the jaws and teeth value of dental evidence in identification has become widely recognized
  • 42. If an ante mortem radiograph of the relevant part of the dentition is available, it may prove to be of greatest possible value for comparison with the postmortem radiograph of the fragments recovered.
  • 43.
  • 44. (XI) DNA TECHNIQUES Because of the rapid decomposition and subsequently muscular alterations, a sampling of the femoral shaft (recommended for DNA analysis) was carried out by the anthropologist. Another possibility for DNA sampling was the extraction of two sound teeth, preferably two premolars or canines, because of the presence of a lot of pulp material inside these teeth.
  • 45. (xii) Other means of identification such as: (a) Multivariate analysis of race in cranium and cephalic index (b) Identification of scars of parturition and other pubic symphyseal changes in skeletal remains of female (c) Neutron activation analysis of hair are also used. Last task to be performed in the mortuary is the examination of any fragments of bodies and, matching of those fragments with the bodies from which they originated.
  • 46. THIRD PHASE(COMPARISON OF RECORDS AND IDENTIFICATION) Identification of bodies depends upon accurate information about those who are believed to be involved. When the persons killed are of the country in which the disaster occurs, it is probable that normal police communication system is the best for collection of required information. During recent years, the need for practical record forms in the context of a mass disaster has come to be appreciated, Australian Police, Interpol has produced a disaster victim identification form.
  • 47. The forms, which have evolved from 15 years of practical experience consists of four different coloured forms and a white one. Two of the coloured forms are for the males, other two for the females; white form is for missing persons. One of the coloured forms is for external feature of the body and the other is for autopsy findings.
  • 48.  They are kept in transparent envelop upon complete and since they are coloured, on single sheets paper, the subsequent exercise of matching records and 'proving', the identification of body is much more simplified. In India no such form are available and all the information related to identification should be recorded in a postmortem report.
  • 49. In some disaster the pathological examination of bodies of victims, can achieve beyond proving evidence leading to identification and confirmation of an obvious cause of death.  Comprehensive pathological investigation can help a great deal to reconstruct the accident, sometimes to the extent of revealing the cause
  • 50. Routine toxicological tests on the tissues of human bodies also reveal a cause of death (like CO poisoning in disaster). Injuries in passengers and their correlation with damage to seat structures and other solid structures is also helpful in knowing the relative safety of different parts of aircrafts/other vehicles and how to improve them to prevent such disasters.
  • 51. CONCLUSION Adequate victim identification management goes through strict methodology and protocols. This requires adopting and applying standard operating protocols. Such a huge operation requires a multidisciplinary team The expertise in relation to disaster victim identification is enhanced when team members working together in an interdisciplinary way, share mutual respect are professionally trained and skilled, and have multi functional capacities.
  • 52.  National Centre for Disaster Management was established in 1995 in the Indian Institute of Public Administration (IIPA) by the Ministry of Agriculture. The Centre was upgraded as the National Institute of Disaster management (NIDM) on 16th October 2003 following the transfer of the subject of disaster management to the Ministry of Home Affairs.  The Institute was inaugurated by Shri Shivraj Patil Union Home Minister on 11th August, 2004.
  • 53.  IMPROVING THE EFFECTIVENESS OF DISASTER MANAGEMENT IN INDIA  headed by the Prime Minister of India, is the Apex Body for Disaster Management in India.  The setting up of the NDMA and the creation of an enabling environment for institutional mechanisms at the State and District levels is mandated by the Disaster Management Act, 2005.