Mass Disasters Research Articles

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 < 0.01 (for male subjects was =0.925, p < 0.01. For females was =0.905, p < 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.

The Korean War Identification Project: 30 years of expanding scope and complexity in the accounting of American war dead

AbstractThe Korean War claimed approximately 36,500 American service member casualties in its 3 years, of which nearly 7600 are still unaccounted for. The Korea 208 (K208) Project began in 2011 to more strategically address the highly commingled nature of 208 boxes of human remains that were repatriated from North Korea to the United Nations Command in the early 1990s and subsequently turned over to the Central Identification Laboratory, Hawaii (now Defense POW/MIA Accounting Agency [DPAA]) for analysis and identification. The K208 was further expanded by the recovery of remains from Joint Recovery Operations (JROs) in North Korea between 1996 and 2005, which revealed, among other issues, the presence of non‐U.S. casualties and crossover of elements between these two assemblages. More recently, 55 boxes of human remains (known as the K55) were repatriated from North Korea in 2018 with many of the same commingling and assemblage crossover issues originally presented by the K208. Additionally, there has been an increased push to disinter more than 800 unknown Korean War service members buried at the National Memorial Cemetery of the Pacific (also known as the Punchbowl) in Honolulu, which represent casualties recovered from both North and South Korea that had undergone prior analysis in the 1950s and 1960s. Subsequent examination has revealed that many Punchbowl remains are commingled despite being thought to have been originally buried as discrete individuals. Because of these developments, the K208 Project has grown in complexity and scope, thus changing its name to the Korean War Identification Project (KWIP) in 2017. Now under its purview are the original accessions from the K208 and JROs as well as the K55 and Punchbowl, representing the largest identification project within the DPAA. A robust and defensible identification process begins with an initial triage of the remains, followed by a systematic process of segregation, consolidation, and corroboration leading to identification. This unique case of highly commingled human remains, involving thousands of missing persons from varied proveniences, highlights the challenges and successes of a multi‐disciplinary approach involving historians, anthropologists, odontologists, and DNA and isotope specialists at the forefront, while also working with family members towards resolution. As of December 31, 2020, the KWIP has identified a total of 591 service members and continues to seek ways to innovate and improve both the quantity and quality of its work.This article is categorized under: Forensic Anthropology > Anthropology in Mass Disaster & War Crime Contexts Forensic Biology > Forensic DNA Technologies Forensic Medicine > Historical Perspectives

Identification of dental sexual dimorphism in deciduous teeth using craniometry and odontometry: A cross sectional study

Sex determination is an important aspect in identification of individuals especially in cases of identifying victims of mass disasters, organised crimes etc. Odontometry is the measurement and study of tooth size. Cranial anthropometry is the measurement of skull dimensions and is considered to be a versatile technique in the investigation of the craniofacial skeleton because of its validity and practicality. To assess tooth crown area of the deciduous molar teeth, to assess head size, to evaluate the extent of sexual dimorphism using head and dental dimension: This study was done in 150 boys and 150 girls. Maxillary and mandibular arch impressions were made, casts were made with dental stone. A vernier calliper was used for obtaining the measurements. Mesiodistal width and buccolingual width of all the molars were measured in millimetres, tooth crown area (TCA) was calculated. Head dimensions were measured using Martin spreading calliper, Cephalic Index (CI) was calculated. Statistical analysis was done using unpaired “t” test, and logistic regression analysis was performed.: The highest tooth crown area was shown by mandibular left second deciduous molar for both boys and girls (p<0.05). Boys showed higher cephalic index compared to girls (p<0.05). The highest percent dimorphism was obtained for maxillary left first deciduous molar.Tooth crown area and head size can serve as a valuable aid for sex determination in pediatric population.

Sexual dimorphism based on the sternum bone morphometry in human fetuses: a pilot study

The recognition and determination of sex from fragments and remnants of human skeletons has been, until now, a complex task for forensic experts and anthropologists. For the former, it becomes crucial in cases of mass disasters, catastrophes, such as terrorist acts and wars. The study with bones of the pelvis, skull, femur and other long bones has significantly contributed to analyze the determination of sex in these situations. The study of sternum dimorphism can become one more element that may collaborate with this type of knowledge. The present study sought to investigate, in human fetuses, the sexual dimorphism of the sternum, based on its perimeter measurements, which were treated using statistical methods. For this purpose, three different observers used a digital pachymeter with a precision of 0.01mm and the average of the measurements obtained was calculated. Differences in average were evaluated using the t-test and Mann-Whitney test, as well as discriminant analysis. Findings from measurements of the sternum in human fetuses did not seem to us to be a reliable indicator of sex determination. We hope that further studies with a larger number of samples and the use of other possible techniques will also collaborate with the subject.

The Spanish National Technical Board for Mass Disasters

The Spanish National Technical Board for Mass Disasters

The importance of forensic odontology in identifying the victims of mass disasters

The article presents the issues related to the identification of victims thanks to odontological expertise. The development of genetics gives forensics a great tool, which is the analysis of the genetic profile of DNA, which categorically enables the identification of human remains. However, this type of test is not possible in all cases. It is only applicable for the preservation of soft tissues, otherwise the preserved dentition will be an excellent identification material. The method is often used when identifying bodies exposed to high temperatures and in advanced decomposition. The development of odontological expertise would be impossible without the contribution of eminent dentists, such as Adolf Zsigmondy. By developing the first graphical tooth marking system, he paved the way for today's TDS and UNS systems. A good dentition classification system is an indispensable tool for odontologists and dentists working on the identification of cadavers and is directly related to the need to use comparative materials, also key in the effective identification of cadavers, and sometimes human remains. These are data obtained from dental offices, in the form of comprehensive information about patients - their dental treatment cards, orthodontic casts, fragments of dentures and crowns, X-rays, etc. and enriched through dental databases. As a result, the odontological expertise and its development enable the effective identification of about 60% of the corpses examined with the help of this procedure, when DNA material cannot be used for this purpose.

Validation of the InnoXtract™ DNA extraction method for bone, teeth, and rootless hair

Forensic casework samples often include human hairs, teeth, and bones. Hairs with roots are routinely processed for DNA analysis, while rootless hairs are either not tested or processed using mitochondrial DNA. Bones and teeth are submitted for human remains identifications for missing persons and mass disaster cases. DNA extraction from these low templates and degraded samples is challenging. The new InnoXtract DNA extraction method utilizes magnetic beads that are optimized to bind small DNA fragments, as small as 100 base pairs, to purify high-yield DNA from compromised samples. This validation study evaluates InnoXtract's ability to obtain amplifiable DNA from samples such as rootless hairs and skeletal remains. Studies performed include sensitivity, stability, repeatability, reproducibility, non-probative samples, and comparison to standard organic extractions. Sensitivity studies demonstrate average yield recoveries ranging from 53% to 100% and 73% to 85% for the InnoXtract hair and bone methods, respectively. Studies demonstrate consistent results across a range of sample types, such as insulted and un-insulted bone and teeth, as well as hair shafts from donors of various ages, gender, race, and hair characteristics. The InnoXtract bone method outperformed organic extraction. The method was successfully automated on a MagMAX™ Express-96, with recoveries over 70% relative to the manual version. InnoXtract has the potential as an automated high-throughput, high-yield bone extraction method with 6h of total extraction time for up to 96 samples. The validation study results demonstrate that the InnoXtract kits produce high-yield and high-quality DNA from compromised bone, teeth, and hair shaft samples.

It’s (not) just a matter of terminology: Everyday understanding of “mass panic” and alternative terms

Although the idea of mass panic is quite common in reports on accidents involving crowds, most experts consider it to be erroneous. In a nutshell, they argue that panic and animalistic behavior of humans are not the main causes of crowd accidents, but that it is rather an organizational issue. However, few of the existing studies have addressed the question of what lay people associate with the term. With our mixed-method study, we sought to shed light on people’s underlying ideas and assumptions about mass panic. Additionally, we were interested in how these ideas change using two alternative terms, namely “mass accident” and “mass disaster”. Results showed that participants in the questionnaire (N = 282) and interview (N = 17) study indeed strongly associated the term “mass panic” with irrational and selfish behavior, and less with orderly behavior. In addition to the organizers, people in the crowd were seen as responsible for such accidents. Besides, most actions judged appropriate to defuse the situation were related to the advice “Don’t panic”. Deviating from the concept, however, it was indicated that helping behavior can be found in critical situations. The questionnaire in which participants only saw one of the three terms revealed no change in the everyday understanding with the alternative terms. Nevertheless, interviewees found their own “mass panic explanation” insufficient but also had no alternative ideas of what causes such accidents. Therefore, replacing the problematic concept of mass panic requires not only alternative terms, but also the dissemination of scientific explanations.

Dear friends of the International Journal of Mass Emergencies and Disasters

Dear friends of the International Journal of Mass Emergencies and Disasters

The Role of Health Systems in Emergency Response Planning

Abstract The history of mankind is pervaded by many events that have had an incredible influence on the further development of civilization. Unfortunately, many historical milestones have also been marked by unimaginable disasters that have sometimes threatened the very existence of the human race. One of the most important links in the chain of readiness in emergencies and disasters is the national health system with all its institutions at the primary and secondary levels of healthcare. Their capacities and capabilities for adequate response can be significantly enhanced by the development and implementation of appropriate Emergency Response Plans (ERPs). The necessity of ERPs is considered for several important elements: to protect lives, property and the environment; to mitigate the consequences caused by emergencies and disasters and ensure the con-tinuity of general health services; to create a system and network to respond to and recover from the consequences of emergencies and disasters; to use of available resources optimally; and to provide additional resources if needed and improve the cooperation between sectors and agencies. The overall quality of a healthcare system is also measured by its readiness to respond to mass casualty events, emergencies and disasters. The lack of an ERP, a poor ERP, or a nonunderstandable or inaccessible plans leads to partial preparedness that can cause unimaginable consequences to overall health and loss of life of the population.

Stature Estimation from Finger Length by Regression Equation

Background: Estimation of stature from mutilated body parts, as in mass disasters and in many heinous crimes, has always intrigued the Forensic Pathologist and investigating agencies. Every part of human being grows in correlation to each other. Many authors have conducted various studies to find the correlation amongst various body parts and found positive correlation. The present study has correlated the length of all fingers with the stature of the individual. Methodology: The study was carried out on 150 healthy voluntary subjects (75 male and 75 female) of age 18-25 years. Instruments like Stadiometer and Vernier caliper was used for height and finger length measurements respectively. Result: Mean values of stature and finger length were larger in males as compared to females. Positive and strong correlation was found between stature and right index finger length in females and left middle finger length in males whereas right and left middle finger length in total subjects showed statistically significant correlation (P-value < 0.05). Conclusion: The findings of the study can be useful only when an intact finger is examined. As very less information is available related to correlation between finger length and stature of individual, there is need of more research from different geographical locations.

Methods of forensic facial reconstruction and human identification: historical background, significance, and limitations

Facial reconstruction is the most frequently used method for human identification in forensic examinations. It is a complex and time-consuming technique and an actively growing field with a wide array of applications. The methods of forensic facial reconstruction are helpful in those cases where other methods of identification are not applicable. Identification of the dead is always a challenging task for forensic teams in cases involving terrorists' attacks and mass disasters where the corpses are fragmented, decomposed, and skeletonized. In such cases, only the skeletal remains and few other clues are available to establish the identity of a person. The progress of facial reconstruction was initiated in the nineteenth century, reconstructing the facial profiles of some famous and rich people. Various novel techniques for facial reconstruction have been devised in the recent past. We conducted literature search, using databases PubMed, Scopus, Web of Science, and ScienceDirect for analyzing different methods developed and practiced till date for human facial reconstruction. We outline the brief history along with a discussion regarding the different methods of forensic facial reconstruction and their limitations. We also discuss future recommendations and preferences for further research in the field of forensic facial reconstruction and human identification.

Prediction of Stature Using Fingers' Lengths

Estimation of stature is of paramount importance in verifying the identity of an individual from the bodily remains, often after any kind of mass disaster, explosion, etc. This study aimed at predicting the stature of students using their finger’s lengths. A total number of 300 students (153 females and 147 males) of Madonna University, Nigeria, was evaluated, age ranging from 18 to 25 years. All the subjects had complete fingers. Stature was measured with stadiometer while Fingers lengths were measured using a straight line ruler, all in centimeters. The data were analyzed using SPSS (Statistical Package for Social Sciences), and the differences were tested using Z-test. The association between stature and Fingers Length was determined using Pearson chi-squared test. The results showed significant difference in the length of the fingers in both right and left hands of males and females respectively (p<0.01). From the result the middle fingers ranked highest for both male and female while the little fingers ranked least. A good correlation was found between the right middle finger and the height in the females and between the left middle finger and height in males. This shows that as the height of females increases, the middle finger of the right hand also increases significantly compared to the left hand middle finger (p<0.01), conversely, as males increase in height, their left hand middle finger tends to increase in length than the right hand middle finger (p<0.01). Linear regression equation was derived to predict stature from the finger’s lengths for male and female respectively. It was observed that amongst all the fingers, the middle fingers right-females and left-males, tend to correlate better with stature than every other finger, and therefore have the possibility of predicting stature than other fingers.

Semi-supervised automatic dental age and sex estimation using a hybrid transformer model.

Teeth-based age and sex estimation is an important task in mass disasters, criminal scenes, and archeology. Although various methods have been proposed, most of them are subjective and influenced by observers' experiences. In this study, we aimed to develop a deep learning model for automatic dental age and sex estimation from orthopantomograms (OPGs) and compare to manual methods. A large dataset of 15,195 OPGs (age range, 16 ~ 50years; mean age, 29.65years ± 9.36 [SD]; 10,218 females) was used to train and test a hybrid deep learning model which is a combination of convolutional neural network and transformer model. The final performance of this model was evaluated on additional independent 100 OPGs and compared to the manual method for external validation. In the test of 1413 OPGs, the mean absolute error (MAE) of age estimation was 2.61years by this model. The accuracy and the area under the receiver operating characteristic curve (AUC) of sex estimation were 95.54% and 0.984. The heatmap indicated that the crown and pulp chamber of premolars and molars contain the most age-related information. In the additional independent 100 OPGs, this model achieved an MAE of 3.28years for males and 3.79years for females. The accuracy of this model was much higher than that of the manual models. Therefore, this model has the potential to assist radiologists in automated age and sex estimation.

Applications of X-Chromosome Short Tandem Repeats for Human Identification: A Review

The forensic DNA profiling technique has tremendously contributed to forensic human identification, an important aspect in forensic investigations. In instances whereby comparison samples are unavailable, utilization of short tandem repeats of X chromosome (X-STRs) may prove useful to resolve complex kinship investigations involving missing persons and mass disasters. Despite such evidential values, the use of X-STRs during investigations remains scarce in many Southeast Asian countries including Malaysia, requiring concerted efforts for establishing forensic statistical support for its diverse populations (especially the admixture populations), standardizing core loci and procedure, improving the knowledge among practitioners as well as developing suitable standard operating procedure for incorporating X-STRs analysis in the overall DNA profiling framework. Hence, this review paper aims to highlight the developments, applications and population data of X-STRs, as well as its challenges and future insights for forensic casework.

Operation Whakaari: the forensic pathology response to the Whakaari/White Island volcanic eruption

White Island/Whakaari is an active volcano situated approximately 48km off the east coast of the North Island. The island is a popular tourist destination. On 9 December 2019 a large eruption occurred while 47 people were visiting the island. The eruption resulted in 22 fatalities (including 2 missing persons) and 25 survivors. This presentation will detail the forensic pathology response to this mass disaster including the management of possible chemical contamination of the deceased, the range of injuries sustained, the retrieval of the deceased from the island, and lessons learned.

A Study On Odontometric Assessment Of Mandibular Canine For Sexual Dimorphism

Introduction: Gender identification from the skeletal remains is an important part and procedure of forensic sciences. In forensic investigations the tooth especially canine gives excellent evidence in determining the gender because of many physical characters of it. Sexual dimorphism of mandibular canine provides an immense usage in forensic investigation. The aim of the study was to assess the dimensions of mandibular canines, as an adjunctive tool in determination of gender and dimorphism pertaining to the age group of 21-32 years. Materials and methods: The study was performed on 80 subjects in general population (40 males and 40 females). Following parameters were considered in the study; mesiodistal width of right and left mandibular canine, intercanine arch width and right and left MCI. All the measurements were taken on dental casts and tabulated for statistical analysis. Results: Mesiodistal dimension and intercanine values were utilised to determine the mean for the right and left mandibular canine. Assessment of the Standard Mandibular canine index showed more sexual dimorphism with right mandibular canine. Conclusion: The accuracy of determining gender using the mesiodistal parameter of mandibular canine turns out to be satisfactory and justifies usage as tool in forensic sciences. Keywords : Mandibular Canine, Canine Index, Sexual Dimorphism, Mass Disaster.

Validation of Gender Identification by “Alu” Insertion on Y Chromosome for Forensic Mass Disaster

Background: Gender determination of human samples is critical in forensic identification. The most popular forensic kit AmpliFlSTR® is based on Short Tandem Repeat (STR), and gender determination is performed on a single copy Amelogenin gene with X and Y homologous chromosomes. This method is not sufficiently sensitive for degraded and a small number of samples and requires a lengthy time. Furthermore, this method needs fragment analysis by a genetic analyzer and an analytical kit for sample preparation, which is costly and not available for public support in developing countries. Aim: Thus, it is urgent to have an alternative, quick, and cost-effective gender identification method during mass disasters. Objective: We proposed to use an alternative PCR method with a single AluSTYa primer and compare it with our designed primer to identify male and female DNA samples in mass disasters when identification is crucial. Method: In the current research, we scanned 16 samples from the fire incidence area known as Mohammadpur slum of Dhaka city in different time frames, where bodies were partially burnt. Patients were admitted to the burn unit of Dhaka Medical College, Dhaka. Thirty-six unknown samples from the healthy cohort were included from the Dhaka University campus for comparison. Modified Alu primer was used in addition to known commercial AluSTYa primers. Results: This study revealed that our designed primer and commercial AluSTYa primer could identify Alu insertion by a simple PCR method into a non-recombinant Y homologous region. The results showed the high quality of DNA extracted from the burnt specimens and a 100% difference in the number of bands in X and Y chromosomes by a simple, robust, and cost-effective PCR and agarose gel electrophoresis method for gender identification. Conclusion: This method can be applied to mass disaster incidents where rapid gender identification of unknown persons is urgent for forensic purposes.