Mass Disasters Research Articles

Effect of Carcinomas on Autosomal Trait Screening: A Review Article.

This review highlights the effect of carcinomas on the results of the examination of autosomal genetic traits for identification and paternity tests when carcinoid tissue is the only source and no other samples are available. In DNA typing or genetic fingerprinting, variable elements are isolated and identified within the base pair sequences that form the DNA. The person's probable identity can be determined by analysing nucleotide sequences in particular regions of DNA unique to everyone. Genetics plays an increasingly important role in the risk stratification and management of carcinoma patients. The available information from previous studies has indicated that in some incidents, including mass disasters and crimes such as terrorist incidents, biological evidence may not be available at the scene of the accident, except for some unknown human remains found in the form of undefined human tissues. If these tissues have cancerous tumours, it may affect the examination of the genetic traits derived from these samples, thereby resulting in a failure to identify the person. Pathology units, more often, verify the identity of the patients who were diagnosed with cancer in reference to their deceased tumorous relatives. Genetic fingerprinting (GF) is also used in paternity testing when the alleged parent disappeared or died and earlier was diagnosed and treated for cancer.

Evaluation of the sex-determining features of upper and lower extremity morphometric measurements in the newborn

Somatometric measurements are frequently used for identity determination in forensic investigations. Especially in the aftermath of mass disasters, the need arises to determine the age and sex of fragmented body remains, requiring data related to extremities. The literature often highlights the limitations of studies concerning sex determination during the prepubertal period. Therefore, our study aims to identify and evaluate morphometric measurements of upper and lower extremities in the neonatal period for sex determination. The study was conducted on 399 newborns (196 females, 203 males; 326 Turkish, 73 Syrian) without any external anomalies or pathologies. Initially, length and width parameters were measured for the upper and lower extremities of the newborns. Subsequently, index values were determined to examine the proportional relationship between the upper and lower extremities. The obtained data were statistically analyzed and compared based on sex and groups. According to the results, all parameter and index values obtained from the upper and lower extremities, except for the leg/thigh length index, showed no statistically significant difference between sexes. The study's neonatal extremity measurements are believed to contribute to fields such as forensic sciences, fetopathology, anatomy, obstetrics, and pediatrics concerning growth, development, and sex determination.

ABO Blood Grouping and Rhesus Factor Determination From Dental Pulp Tissue: A Forensic Research.

Introduction Collection of blood samples from mass disaster victims and blood grouping is a challenging task. This can be attributed to various reasons. From the forensic odontology perspective, teeth and bones are one of the noteworthy remainsthat can be derived from such sites. Aims and objectives The aim of our study is to detect ABO blood groups and Rhesus (Rh) factor from extirpated pulp tissue of the extracted teeth at zero, three, and six months' time interval by absorption-elution technique. Materials and methods The study consisted of 90 freshly extracted teeth as suggested by a biostatistician. Thirty teeth were analyzed immediately and 60 teeth were stored in vials without any preservative at room temperature. The pulp tissue was extirpated and studied at zero months, three months, and six months to determine blood groups and Rh factors. The extraction socket blood was tested to identify the blood group of that patient and used as a control reference. The blood grouping was done at respective time periods through the absorption-elution method and matched with the control. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 24 software (IBM Corp., Armonk, NY). The chi-square test and Kruskal-Wallis test were done. A p-value< 0.05 was considered statistically significant. Results Pulp showed the highest sensitivity for blood groups at zero months but it could be identified up to six months, although the sensitivity and specificity gradually decreased. ABO blood grouping showed higher sensitivity than the Rh factor as time progressed. Conclusion In cases where teeth are the only remains in a forensic condition, the dental pulp can be an authentic source for blood group detection.

Record-matching of STR profiles with fragmentary genomic SNP data.

In many forensic settings, identity of a DNA sample is sought from poor-quality DNA, for which the typical STR loci tabulated in forensic databases are not possible to reliably genotype. Genome-wide SNPs, however, can potentially be genotyped from such samples via next-generation sequencing, so that queries can in principle compare SNP genotypes from DNA samples of interest to STR genotype profiles that represent proposed matches. We use genetic record-matching to evaluate the possibility of testing SNP profiles obtained from poor-quality DNA samples to identify exact and relatedness matches to STR profiles. Using simulations based on whole-genome sequences, we show that in some settings, similar match accuracies to those seen with full coverage of the genome are obtained by genetic record-matching for SNP data that represent 5-10% genomic coverage. Thus, if even a fraction of random genomic SNPs can be genotyped by next-generation sequencing, then the potential may exist to test the resulting genotype profiles for matches to profiles consisting exclusively of nonoverlapping STR loci. The result has implications in relation to criminal justice, mass disasters, missing-person cases, studies of ancient DNA, and genomic privacy.

Management of unidentified and unclaimed bodies: a comparison of model from four countries in the Asia Pacific Region.

Managing mass fatality incidents or disasters involving multiple deaths are not uncommon among forensic practitioners. In fact, management of unidentified or unknown bodies is also a vital component of the day-to-day mortuary work practice. The unidentified and subsequently unclaimed bodies have always been a "silent mass disaster," a problem that needs to be tackled within the forensic community and raises the global issue of ethics, law, and human rights. Unidentified bodies' in Malaysia make up an average of 4.02% of all death cases where a total postmortem examination was performed which is comparable with other developing countries within 4-10% which can go up to 25%. Moreover, unstandardized procedures in all mortuaries in different states and districts in Malaysia have worsened the scenario even with guidelines in place. This study aims to address the issues surrounding unidentified and unclaimed bodies including body disposal from a social and legal perspective using case study methodology by comparing four different countries in the Asia Pacific Region through document analysis and interview methods. One of the major findings is evident in 3 out of the 4 models, whereby there is a considerable gap in consolidating the missing person report and information to match with the unidentified bodies received in forensic institutions in an attempt to enhance the identification process which ultimately intends as a closure for the family members. It is also timely to think out of the box beyond dental records and DNA profiling to improve the identification rate for skeletonized remains through means of anthropology biometrics comparison. With the limited literature published surrounding this domain, it is hoped that the suggestions and recommendations to standardize the management of unidentified and unclaimed bodies can benefit many forensic institutions and public mortuaries in this region.

Odontoma and other congenital dental anomalies: Implications for forensic identification.

Forensic odontology plays a crucial role in establishing the identity in mass disasters and criminal cases with high accuracy. Dental anomalies and features help in such situations. Congenital and developmental dental anomalies can be easily documented to establish distinctive and individualistic characteristics of an individual. The location, number of teeth involved, and the type of anomaly vary between individuals. Similarly, dental malformations also assist greatly in the identification process. Many types of dental anomalies have been studied in the past for their individualistic characteristics in forensic examinations. One such dental anomaly is odontoma, which is a benign odontogenic malformation. This malformation may also help in the identification of the deceased, when recorded and examined accurately. An odontome is a malformed teeth-like structures consisting of enamel, dentin, and pulpal tissue, formed due to the growth of completely differentiated epithelial and mesenchymal cells. If antemortem (AM) dental records incorporate information regarding odontomes and other dental anomalies, including in radiographs, orthopantomograms or microradiographs, positive identification may be established by comparison of these records with postmortem (PM) records. In the present communication, a rare case of compound composite odontoma in the anterior mandible with multiple denticles has been discussed with a brief overview of congenital and developmental dental anomalies. The authors emphasize the importance of such rare dental anomalies and malformations which may be used for identifying the deceased in mass disasters and forensic identification.

Operational Health Pavilions in Mass Disasters: Lessons Learned from the 2023 Earthquake in Turkey and Syria.

The massive earthquake that hit Turkey and Syria in February 2023 killed tens of thousands of people, and most of the deceased have not yet been identified. Many victims were pulled from the rubble hours or days later, injured and in need of assistance, treatment, and food, and many have not yet been connected with their families. Armed forces, volunteers, technicians, and health workers must cooperate in synergy in these situations to ensure effective interventions and to improve resilience. Based on the lessons learned from the response efforts to this recent natural catastrophe, this brief report proposes, for the first time, an organisational model structured around five functional pavilions that can be safely set up at the edge of a disaster area. Each pavilion should run its own activities to make a vital contribution to the overall coordinated emergency response. Looking to the future, it is extremely important to apply a technical approach that leads to maximum operational synergy at a disaster site and during the first phase of a sudden-onset emergency.

Analytical Study of Mandible: Prerequisite for Sex Determination.

Human skull consists of various bones. One of them is mandible which is quite resistant, tough and shows systemic differences in form between individuals of different sex. It resists putrefaction also. There are characteristic features in the mandible that help us to differentiate sex in case of unknown victims like in mass disasters or in case fragmentary remains of the skeleton are found. Analysis of mandible with regard to its features is of great assistance in the determination of sex. A total of 80 dry mandible bones were collected. Morphological and morphometric parameters were studied to determine their sex. A total of nine parameters, i.e., three non-metric and six metric parameters were observed for each mandible. Data was collected for each parameter. Among 80 dry mandible bones, 55 were males and 25 were females. 81.2% males bones had a square chin whereas, 80% females had a rounded chin. Gonial flare was everted in 89% males and inverted in 68% females. Mandible exhibits significant sexual differences. Various morphological and morphometric parameters are essential for sex determination in case of mandible bone.

Evaluation of Blood Group in Co-relation with the Dermatoglyphics Patterns among Medical Students: A Cross-Sectional Study

INTRODUCTION: Dermatoglyphics is the scientific study of naturally occurring epidermal ridges and their configuration on the digits, palms, and soles apart from flexion crease and secondary folds. Fingerprint scans are now-a-days used in the biometric systems, validating electronic registration, cashless transactions, library access and forensic purposes. The aim of this study was to investigate the correlation between dermatoglyphics patterns and blood groups. MATERIALS AND METHODS: This is a cross-sectional study designed to study the dermatoglyphics pattern in correlation with blood group among 200 medical students from November 2022 to April 2023. Data analysis was done using SPSS version 16 and Chi-Square test was used. RESULTS: The major type of blood group among the participants was blood group O (38.5%) followed by blood group B (37%), blood group A (17.5%) and blood group AB (7%). Rh positive was the dominant Rh factor (95.5%) while Rh negative was 4.5% only. The general distribution of dermatoglyphics pattern showed that the dominant pattern of finger print was loop type (52%) in both the genders, followed by whorls pattern (36.5%) and arch pattern (11.5%). Based on Chi- Square test it was observed that the dominant type of finger print was whorls type in blood group O and B while, arch type of finger print was common in blood group B. CONCLUSIONS: Finger prints of each individual is unique. Hence, it can be effectively used for corroborative identification of an individual in mass disasters as well as in other forensic and anatomical applications.

Comparison of Gravoply plate barcode embedding in Complete Denture Prosthesis (CDP) to lamination barcode embedding for forensic identification purposes

Background: Mass disasters often occur in Indonesia, thus require the rapid identification of victims. Teeth can be one of the primary identifiers besides fingerprints and DNA. It includes dentures worn by the victim. The Denture Marking System is a technique for labeling dentures to prevent it being swapped to another. Labeling usually uses embedded barcode, made from laminated paper or gravoply plate. Purpose: To compare Gravoply plate barcode to lamination barcode embedded in prothese for forensic identification. Methods: The type of research is a true experimental study with a posttest-only control group design. The sample size used in this study is 20 CDP samples divided into two test groups, one is Gravoply plate barcode and another one is laminated photo paper barcode. Results: 10 sampels of gravoply plate barcode can be read correctly, meanwhile 6 of laminated photo paper barcode showed incorrect reading and only 4 of total samples had correct result. Chi-Square test obtained p value (p&lt;0,05) means there is significant difference between two embedding techniques. Conclusion: Embedding barcode in denture protheses for forensic identification is better using Gravoply plate rather than laminated photo paper.

Possibilities of using territorial defense armities to protect the site of a mass disaster

This paper presents the most important issues concerning the use of the Territorial Defense Forces for the task of securing the site of a mass disaster. It discusses the concept and features of a mass disaster, the organization and tasks of Territorial Defense Forces, and the participation of soldiers from this formation in securing the site of a mass disaster. The aim of the article is to present the most important aspects of the participation of Territorial Defense Forces soldiers in securing the site of a mass disaster, mass events. Although the TDF issues have been present and developed in various publications in recent years, there has been no work analyzing the participation of this formation in the activities of securing a mass catastrophe of such events. In the work, classical research methods were used, including the study of sources, their analysis, criticism, heuristics and inference. Established in 2016, the Territorial Defense Forces constitute a valuable new type of the Armed Forces, which can be very useful in activities related to securing the site of a mass disaster, which is part of the crisis management system. Territorial Defense Forces soldiers can be used to help and safeguard, interrupt an incident, mitigate its effects, prevent bystanders from reaching the crash site, which has a significant impact on securing traces and evidence against their loss or distortion. The great advantage of the formation is its territoriality, because in the event of a summons to the site of a mass disaster, it can appear very quickly and, in cooperation with the relevant services, promptly take effective action.

Research Progress and Hot Spot Analysis of the Propagation and Evolution Law of Prefabricated Cracks in Defective Rocks.

The generation of rock mass disasters in underground engineering essentially arises from the disruption of the original three-dimensional stress equilibrium of the rock mass caused by excavation and other activities, leading to the redistribution of stress fields. During the excavation process, the engineering rock mass undergoes complex dynamic stress equilibrium processes involving loading and unloading. This equilibrium process promotes the nucleation, initiation, and propagation of pre-existing cracks in the surrounding rock, resulting in changes in the internal structure of the rock mass and a weakening of its strength. Eventually, this localized cracking extends to global failure. In order to understand the current status better and study the development trends in the study of crack propagation and evolution in defective rock, this study conducts a bibliometric analysis of 288 articles from the Web of Science Core Collection database using CiteSpace software (version 6.1.R4). The results indicate an increasing trend in the annual publication output, characterized by two phases of emergence and rapid development. The countries of China, the United States, and Iran have the highest publication output in this field. The most frequently cited journals include INT J ROCK MECH MIN, ENG FRACT MECH, and ROCK MECH ROCK ENG. This study provides a comprehensive analysis of the current status and development trends in the research on the propagation and evolution of pre-existing cracks. This study enhances the comprehension of crucial aspects of crack propagation and evolution in rock materials with defects. Moreover, it opens up new possibilities for future investigations and holds promising implications for researchers and practitioners in the field.

Rivaling efficacy of special stains in the identification of Barr bodies

Background: Gender determination becomes the first priority in process of identification of a person by a forensic investigator in case of mass disaster, crime investigations, and ethnic studies. Demonstration of nuclear sex plays a vital role in determining the gender of an individual. Barr bodies (BB) are known to arise from the inactivation of the X chromosome in a female somatic cell. They are basophilic structures with varying morphology measuring approximately 0.8 × 1.1 microns in the nucleus during interphase. Various nuclear stains such as Thionine, Papanicolaou, Feulgen, Cresyl-violet, Giemsa, Aceto-orcein, and acridine orange &amp; Routine stains can validate Barr bodies. Aim To evaluate the efficacy of Feulgen, Giemsa, and H&amp;E stains in the demonstration of Barr bodies. Materials And Method Buccal smears were prepared from 25 males &amp; 25 females. These smears were stained by Feulgen, Giemsa &amp; Routine staining methods. The Barr body identification was determined by the presence of a darkly stained condensed area on nucleoplasm. The frequency of Barr body was examined by observing 100 nuclei per smear under a binocular light microscope at 100 magnification. For all BB-positive cases, Barr Body Index(BBI) was calculated and compared for the different stains used. Result Buccal cytological smears stained with Feulgen, Giemsa, and Routine stains. Samples with a presence of Barr bodies ≤2 were recorded as male and those with &gt;2 were recorded as female under microscopic findings. The percentage of Barr bodies in Feulgen-stained slides ranged from 30.2 - 37.9 among females and 0 - 0.1 in males, Giemsa slides ranged 14.2 - 22.2 from among females and 0 - 0.3 in males, while with Routine stained slides ranges recorded were10.2 - 14.9 in females and 0 - 0.5 in males. The sensitivity of Feulgen, Giemsa, and Routine stain for detecting sex accurately was 100% and specificity was 100%, 98%, and 94% respectively. Conclusion Feulgen stain proved to be better than Giemsa and routine stain for visualizing Barr Bodies.

Assessment of Morphological Variations of the Coronoid Process, Condyle, and Sigmoid Notch as an Adjunct in Personal Identification Using Orthopantomograms Among the North Indian Population.

The aim of this study is to assess morphological variations of the coronoid process, condyle, and sigmoid notch as an adjunct in personal identification using orthopantomograms among the North Indian population. The study sample (n=240) was distributed into four age groups: Group I: 30 males and 30 females aged 10-19 years, Group II: 30 males and 30 females aged 20-29 years, Group III: 30 males and 30 females aged 30-39 years, and Group IV: 30 males and 30 females aged 40-59 years. All were subjected to panoramic radiographs. The different morphological forms of the coronoid process, condyle, and sigmoid notch were evaluated. The results showed that across all age groups, angular condyles were the most common kind of condyle in males, followed by round and convex types. The present study found that the coronoid process typically takes on a triangle shape across all ages and sexes. Additionally, the vast majority of cases were triangular on both sides, and this was true across both sexes. It was found in this study that the sigmoid notch most commonly took the form of a larger notch, followed by a rounder notch. Using panoramic photos to portray the different morphologies of the coronoid process, condyle, and sigmoid notch can be a much simpler and faster method of identifying an individual, especially in the event of a mass disaster, so long as antemortem data are kept. The method of radiographic identification of individuals has recently gained prominence due to its efficacy. Radiographs like these can be invaluable in forensic dentistry, where they can help unearth previously hidden evidence if premortem records are retained. As a potential approach for individual identification among our population, panoramic radiographs were used to investigate the varying morphological forms of the coronoid process, condyle, and sigmoid notch.

Forensic dentistry: a systematic review

Introduction: It was verified that the identifications carried out by forensic dentists in mass disasters reach about 70% of the identifications in the world. With the population increase in recent decades, mass disasters have increased, both in natural catastrophes and by anthropic action, making it imperative to increase the numbers of forensic identification methods, to accelerate the recognition of fatal victims and the teeth are the only elements that can be used for identification. Objective: It was to highlight the importance of professional specialist in forensic dentistry and their diligence in the investigative process, to increase the diligence of greater richness of details and optimized work for the recognition of the bodies. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to April 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles with different dates up to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 119 articles were found, 38 articles were evaluated and 32 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 32 studies that did not meet GRADE. the function of the forensic dentist in investigations of charred victims is notorious. The analysis performed by a professional with specific training in the field of dentistry is essential, and the importance of medical records, photographs, and radiographs for proper identification must also be considered. However, it is necessary to increase and improve the activities of forensic dentists in the work of recognition of charred bodies, being imperative to a set of factors for the elucidation of cases so that the identifications are complete. It is concluded that it is necessary to use several methods to optimize the practice of forensic dentistry, from cases of identification through the oral cavity, which was the beginning of the history of forensic identification in the field of dentistry, to the nowadays, its rise in history was analyzed for an effective elucidation of recognition of charred bodies.

Lime and odour: A preliminary investigation into the effect of hydrated lime on the volatiles emitted from human remains

The location of human remains is performed primarily through the aid of cadaver detection dogs, which rely on the malodour produced through decomposition of decaying bodies. Malefactors will attempt to conceal these putrefactive odours through chemical additions such as lime, which is also wrongly believed to accelerate decomposition and prevent the identification of the victim. Despite the frequency of lime in forensic applications, to date no research has been performed to determine its effect on the volatile organic compounds (VOCs) released during human decomposition. This research was therefore conducted to ascertain the effects of hydrated lime on the VOC profile of human remains. Two human donors were used in a field trial at the Australian Facility for Taphonomic Experimental Research (AFTER): one donor was covered with hydrated lime, and the other had no chemical additions acting as a control. VOC samples were collected over a period of 100 days and analysed using comprehensive two-dimensional gas chromatography coupled with time-of-flight mass spectrometry (GC×GC-TOFMS). The volatile samples were accompanied by visual observations of how decomposition progressed. The results showed that lime application decreased the rate of decomposition and decreased total carrion insect activity. Lime increased the abundance of VOCs during the fresh and bloat stages of decay, however the abundance of compounds plateaued during active and advanced decomposition and were much lower than those detected from the control donor. Despite this suppression of VOCs, the study found that dimethyl disulfide and dimethyl trisulfide, key sulfur-containing compounds, were still produced in high quantities, and can thus still be used to locate chemically altered human remains. Knowledge of the effects of lime on human decomposition can inform the training of cadaver detection dogs, and ensure a greater chance at locating victims of crimes or mass disasters.

Application of Dental Age Estimation: A Review

Age estimation is a vital method in odontopediatrics, legitimate pharmaceutical, anthropology, pediatrics, orthodontics, and forensic sciences, and is conducted for vast variety of reasons. Its use is expanding in both civil and criminal things and is also to identify person in mass disasters and natural calamities. A number of anthropologists have examined the age frameworks, wherein age is frequently a major establishing guideline. Dental-age assessment is considered most a precise, solid, and quick strategy of age assurance, particularly in developing children and is considered exceptionally critical in numerous fields of study.

DESIGN AND PROTOTYPE OF AN AUTOMATED POSITIVE SUCTION MECHANICAL VENTILATOR UNDER AN ECONOMIC AND SOCIAL PROJECT ANALYSIS IN LOW-INCOME PATIENTS

The design and prototype of a low-cost portable positive pressure mechanical ventilator for use in cases of mass disasters and resource-limited environments are described. The ventilator provides breaths by compressing a conventional valve bag mask (AMBU) using a pivoting lever, eliminating the need for a human operator for the AMBU. An initial prototype was constructed using acrylic, with measurements of 285 x 350 x 250 mm and a weight of 4.1 kg (9 lb). It is powered by a 12V DC battery-operated electric motor and features an adjustable air volume of up to a maximum of 750 ml. Control is achieved through a human-machine interface using a 16x2 LCD screen displaying RPM and percentage speed data, which are adjusted using an easy-to-use potentiometer. The prototype also includes an overvoltage safety control mode and pilot lights to indicate the equipment's status. Iterations of the device will include a controllable inspiration-to-expiration time ratio, a pressure relief valve, and a battery bank system that allows for 4 hours of autonomy. The prototype manufacturing cost is only $820. Through this ventilator prototype, it is demonstrated that the lever-driven AMBU compression strategy is a viable option to achieve a low-cost, low-consumption portable technology that provides essential ventilator features at a fraction of the cost of existing technology

Estimation of age from digital chest radiographs in district Mandi, Himachal Pradesh

In forensic investigations estimation of age is a crucial part. Age estimation assists in narrow downing the search possibilities in the case of unidentified bodies and living individuals, it can also help in the determination of preparators and deciding the penalty for any criminal liability. Different body parts are often investigated at the crime scene, so estimating the age using different areas of the body is important. Hence, we conducted this study for age estimation from costal cartilage calcification. Only posterior-anterior (PA) digital chest radiographs are taken, and the first rib of the left side is evaluated. The degree of calcification and age showed a positive correlation; similarly, the value of Spearman’s rho showed significant results (for the whole sample =0.914, p &lt; 0.01 (for male subjects was =0.925, p &lt; 0.01. For females was =0.905, p &lt; 0.01). The degree of calcification is useful in estimating age groups and becomes more determined with advancing age. Prediction of age using the radiological method gives the advantages of ease, inexpensiveness, rapidity, and high accuracy. In developing countries, this type of study will be very useful because infrastructure and lack of sources are major issues. The article provides a non-destructive method of age estimation in a forensic context that may act as a preliminary method of age estimation in mass disasters and dismembered bodies when a thoracic cage is only present.

A Hole in the Safety Net: Failures of the Initial COVID-19 Pandemic in Kentucky

Introduction:The COVID-19 pandemic hit Kentucky in March of 2020. While around the world the pandemic had already reared its head and strained international hospital systems at their core, Kentucky hospitals remained wholly underprepared. University of Kentucky Hospital is a relatively resource rich hospital. However, utilization of these resources was severely misplaced and inefficiently distributed. This led to unnecessarily large upfront costs in an attempt to prepare for large volumes of patients that never actually came, as well as risk stratifying patients in a costly and unproductive way.Method:We reviewed the initial response to the COVID-19 pandemic from the University of Kentucky as well as specifically within the emergency department. This included all system-wide preparations as well as emergency medicine-specific COVID-19 protocols regarding risk stratification of patients, testing, and delivering results.Results:Initially the number of patients that would need to be hospitalized with COVID-19 as well as how to risk stratify or treat them was completely unknown. This led to multiple large issues within University of Kentucky's response to the pandemic. A 400-bed field hospital was constructed out of University of Kentucky’s football field and subsequently deconstructed two months later before ever being used, costing the hospital $6.7 million dollars. Lack of tests and knowledge about the disease in combination with over ordering labs and CT scans in an attempt to risk stratify. There was no reliable way to obtain COVID-19 testing or deliver the results and this led to increased non-sick patients presenting to the ED just for information.Conclusion:The COVID-19 pandemic highlighted many shortcomings of our hospital system and its preparedness for a pandemic or mass disaster. The silver lining of these failures was the implementation of system wide improvements in throughput and preparation within our emergency department.