Mass Fatality Incidents Research Articles

Advances in postmortem fingerprinting: Applications in disaster victim identification.

Postmortem fingerprinting is the fastest and most reliable way to scientifically identify unknown decedents from mass fatality incidents. In disaster victim identification (DVI), fingerprints, DNA, and dental examinations are the three primary methods of identification. Additional secondary identifiers such as comparative medical radiography, scars, marks, and tattoos can also be used if viable antemortem information can be located. As DNA technology continues to evolve, RAPID DNA may now identify a profile within 90 min if the remains are not degraded or comingled. When there are true unknowns, however, there is usually no DNA, dental, or medical records to retrieve for a comparison without a tentative identity. It is imperative to understand how to properly collect postmortem prints following various postmortem changes, which databases are available to search against, and what additional resources are available prior to any such event occurring. With advances in technology, automated fingerprint searching is faster than ever before. Mobile devices can now search all the major databases within a matter of minutes from a cell phone or tablet utilizing a peripheral fingerprint scanner. Preliminary research into the application of WD-40® when utilizing optical-capacitive scanners has shown to greatly increase the efficacy of capturing usable fingerprints. This additional step allows for the digital capture of fingerprints in even complicated settings, both in daily cases and DVI incidents. This article outlines all the available ways to obtain postmortem fingerprints in complex cases, and how they can be applied to efficiently and effectively used in the DVI process.

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.

Contributions and advances of forensic genetics in mass fatality incidents

Disaster victim identification is crucial for humanitarian and legal reasons. Forensic genetics plays an important role in these situations which often become a challenge for the different professionals involved due to their complexity. The establishment of guidelines and recommendations makes it easier to follow standardised protocols that make it possible to guarantee the reliability of the identification final result. Likewise, advances in forensic genetics contribute to speeding up the response, providing new analysis strategies and bioinformatic tools. This article aims to provide an overview of how forensic genetics and its advances can contribute in these situations, as well as some keys to understanding the work of forensic genetics laboratories in the identification of corpses in events with multiple victims.

A Review of Mitochondrial SNP Determination using Allele-Specific PCR in Forensic Identification

Allele-specific polymerase chain reaction (AS-PCR) is a rapid and cost-effective single nucleotide polymorphism (SNP) genotyping method compared to multiplex or real-time PCR. The SNPs occurring in mitochondrial DNA (mtSNPs) is the most abundant polymorphism in humans and can be used in human identification involving mass fatality incidents. Nevertheless, the application of AS-PCR has yet to be widely applicable in forensic investigations because this method requires further development due to its limitations. This review aims to relate the applications of AS-PCR, the combination of AS-PCR with other PCR techniques and improvements imposed on this technique in past studies. A narrative literature review was carried out over 70 studies related to the mtDNA, SNP, AS-PCR, and forensic DNA. The findings suggested that AS-PCR with new adaptations in technology such as incorporating additional mismatch, choosing allele-specific primer with either common forward or reverse, gel free real-time AS-PCR analysis, and usage of fluorescence probes can improve the specificity of SNP genotyping in forensic applications. This review concludes that AS-PCR and its combination with other improvised techniques can be applied in human identification to successfully analyze degraded or low quantity samples. Nevertheless, development of more SNP loci is required to implement AS-PCR in human identification to match the current gold standard STR typing method.

Dental hygiene students' matching accuracy when comparing antemortem dental radiographs and oral photographs to simulated postmortem WinID3® odontograms.

Matching dental antemortem (AM) and postmortem (PM) data for human identification is especially challenging when the workforce is limited. Dental hygienists have served mass fatality incidents (MFIs) due to dental-related expertise. However, forensics within dental hygiene education and research on transferable skills is limited. This qualitative balance design study assessed senior dental hygiene students' match accuracy of simulated cases varying in dental identifiers based on AM full mouth series (FMS) radiographs and oral photographs to PM WinID3® odontograms to demonstrate possible disaster victim identification (DVI) transferable skills gained during formal education. A convenience sample of senior dental hygiene students (n=31) was presented information on WinID3® interpretation, then presented with 5 mismatched cases and asked to visually interpret each to make 10 total matches; five based on AM FMS with simulated PM WinID3® odontograms and five based on AM photographs with PM WinID3® odontograms. Match accuracy scores ranged from 41.9% to 58.1% for cases with 1-10 identifiers, and 77.4% to 93.5% for cases with 11-40 identifiers. Accuracy when matching AM radiographs to PM odontograms versus AM photographs to PM odontograms was compared and revealed no statistical differences in match accuracy depending on image type (p=0.388 to 1.000). Results of this pilot study suggests transferable match accuracy skills resulted from the participants' dental hygiene formal education. These baseline skills with additional specialized training support the rationale for dental hygienists serving on DVI teams. More research is needed in education and practice when preparing dental hygienists for forensic-based service.

Importance of sexual dimorphism of the maxillary sinus and mandibular inter coronoid distance of Vijayawada City population in Andhra Pradesh: An original research

Background: Mass fatality incidents occur due to environmental, medical, vehicle, industrial, or terrorist events that can involve large numbers of victims. Identification of these victims is of utmost importance in these situations. Cone-beam computed tomography (CBCT) may be helpful in some forensic contexts, offering several advantages for postmortem forensic imaging. Aim: The research study aims to evaluate the sexual dimorphism of the maxillary sinus and inter coronoid distance to estimate sex by using CBCT. Materials and Methods: In 40 CBCT scans of 20 males and 20 females, maxillary sinuses height, width and inter coronoid distances of mandible were measured for forensic analysis. In high quality, reconstructed images of bilateral maxillary sinuses, height, and width were measured, and in mandible, inter coronoid was measured in axial view. Results were tabulated and analyzed using an unpaired t-test and discriminant function analysis used to compare differences in the measured parameters between males and females. Results: Mean values of inter coronoid in males and females are (♂ =88.1, ♀ =78.1). The maxillary sinus right side height and width (♂ =32.2, ♀ =24.6) (♂ =19.7, ♀ =19.6) left side height and width (♂ =32.7, ♀ =23.6) (♂ =18.1, ♀ =17.8), respectively. A statistically significant (P

Postmortem Computed Tomography: An Overview for Forensic Nurses Involved in Death Investigation.

The traditional invasive autopsy has been considered the "gold standard" for death investigation worldwide. However, this has now been challenged by a new minimally invasive approach that utilizes cross-sectional radiological imaging to investigate the death. Globally, postmortem computed tomography is the most commonly used modality and is becoming increasingly available throughout the world. Forensic nurses working in association with coroners and medical examiners' offices, as well as mass fatality incidents, now need to update their knowledge base to understand these innovative techniques, the advantages and disadvantages to their use, and how they impact on medicolegal death investigation and the care of the deceased and bereaved. Using the example of the coroner system of England and Wales, this article provides a comparison between the traditional invasive autopsy and postmortem radiological alternatives and presents the impact postmortem radiology is now having on death investigation.

Using nutrient foramina to differentiate human from non-human long bone fragments in bioarchaeology and forensic anthropology

Long bone shaft fragments can be found isolated in archaeological and forensic contexts, such as in mass fatality incidents. When diagnostic morphological landmarks are not visible, the assessment of a human or non-human origin of a bone fragment can be challenging. Further methods need to be developed. In long bones, the presence of a nutrient foramen on fragments that do not show any diagnostic landmarks can make the assessment of the origin of the bone still possible. In this paper, human long bones were compared to those of the following species: chicken (Gallus gallus domesticus), duck (Cairina moschata), sheep (Ovis aries), pig (Sus scrofa domesticus), and deer (fallow deer, Dama dama, and roe deer, Capreolus capreolus). Macroscopic evaluation of location, direction and appearance, and micro-CT scanning in order to measure angle and shape of canal entrance, were applied in this study to differentiate human from non-human nutrient foramina on long bone shafts. Observations regarding the location and direction of nutrient foramina were proven to be different between human and non-human bones; however, these two features might not be exploitable in cases of highly fragmented bones. The foramina appearance was the most reliable for the origin identification, although the shape of the canal entrance and its angle at the cortical bone, obtained from micro-CT scans, were also useful parameters. For a correct identification of a fragment, one parameter may not be enough and it is advisable to employ as many features as possible. This research demonstrates that nutrient foramina have potential as a reliable bone feature for the distinction between human and non-human fragmented and incomplete long bones.

Ambient temperature storage of tissue samples (bovine) in readily available media during mass fatality incidents

The possibility of using readily available media such as salt and alcohol to preserve tissue samples in non-tropical climates has been previously reported. This present study is a proof of concept trial to investigate the efficacy of salt, alcohol and FTA card for the preservation of soft tissue samples in a tropical hot and humid environment. Using bovine flesh as proxy, salt and commercial liquors such as whiskey and vodka were found to be effective in preserving the tissue samples at ambient temperatures over a 3 month period.

The value of peer support groups following disaster: From Aberfan to Manchester

This article reviews the nature of post-disaster peer support groups and highlights their role in addressing collective grief and trauma following mass fatality incidents. With reference to best practice guidelines for responding to collective trauma events the article highlights the functions of peer support in promoting social support, connectedness and self/community efficacy. Different types of UK-based peer support group are described – from independent user-based action groups to facilitated talking groups as part of wider community support networks. The establishment and delivery of the Manchester Attack Support Group Programme (following the 2017 Manchester Arena terror attack) is discussed as a contemporary example of a network of facilitated talking groups. It complements the participation of bereaved people and survivors in other independent and self-determined peer-based activities such as the Manchester Survivors Choir and terrorism-related campaigns.

Baggage scanners and their use as an imaging resource in mass fatality incidents

Disaster victim identification following a mass fatality incident is focussed on identifying the deceased and returning them to their families as quickly as possible, while gathering as much information as practical to aid investigators in establishing the cause of the incident. Ante-mortem data is gathered and compared with the post-mortem data obtained in order to positively identify the deceased. This paper presents results from a study concerned with the first part of the process of identifying the deceased—the triage or Primary Survey and how this can be done without access to hospital facilities such as conventional X-ray imaging or computed tomography. In particular, this study focuses on the imaging undertaken prior to the opening of the body bag by a multidisciplinary team, and how this imaging can assist particularly when forensic anthropologists are involved in the identification process. There are several advantages to imaging the body bags before they are opened and one of the most important is safety. Thus, this paper examines the viability of using a baggage scanner as a practical resource for X-ray imaging, as many regions worldwide may not be able to access conventional imaging equipment. Baggage scanners are readily available and found in airports and various government buildings. The baggage scanner is particularly suited to this task and produces images that can be used by forensic anthropologists to distinguish between human and non-human remains, identify items of evidence and personal effects, and even perform a preliminary or partial biological profile. When considering their response plans, emergency responders should consider including baggage scanners as a contingency for screening body bags if no other imaging system is available.

Dental identification using 3D printed teeth following a mass fatality incident

• Forensic odontology remains at the forefront of the disaster victim identification (DVI) process following mass fatality incidents. • Post-mortem CT scanning has become established as part of the DVI process, and the scan data can be used in a variety of ways including 3D printing. • A case is presented where a 3D printed model of the dentition of a deceased individual enabled successful identification without resorting to disfiguring facial incisions in a charred body. Following a mass fatality event there is a requirement to establish the identities of the deceased individuals as quickly as possible, but with sufficient certainty. Comparison of post-mortem dentition with ante-mortem records remains one of the most cost-effective methods of achieving this reliably and in a timely manner. The relatively recent introduction of post-mortem CT scanning into the Disaster Victim Identification (DVI) environment has brought with it an abundance of additional detailed information that can be used in a variety of novel ways. Here we present a case where 3D printing was used to produce a model of a victim's dentition, enabling confident odontological identification without resorting to disfiguring incisions in a charred body. On-site access to a 3D printer of sufficient quality meant that there was no significant delay in the identification process, and the cost of consumables used to manufacture the model totalled less than £1.

Planning for the Use of Imaging in Mass Casualty Incidents

Introduction:A mass casualty incident presents a challenging situation in any health care setting. The value of preparation and planning for mass casualty incidents has been widely reported in the literature. The benefit of imaging, in particular, forensic radiography, in these situations is also reported. Despite this, the inclusion of detailed planning on the use of forensic radiography is an observed gap in disaster preparedness documentation.Aim:To identify the role of forensic radiography in mass casualty incidents and to explore the degree of inclusion of forensic radiography in publicly available disaster planning documents.Methods:An extended literature review was undertaken to identify examples of forensic radiography in mass casualty incidents, and to determine the degree of inclusion of forensic radiography in publicly available disaster planning documents. Where included, the activity undertaken by forensic radiography was reviewed in relation to the detail of the planning information.Results:Limited results were identified of disaster planning documents containing detail of the role or planned activity for forensic radiography.Discussion:While published accounts of situation debriefing and lessons learned from past mass casualty incidents provide evidence for integration into future planning activities, limited reports were identified with the inclusion of forensic radiography. This presentation provides an overview of the roles of forensic radiography in mass casualty incidents. The specific inclusion of planning for the use of imaging in mass fatality incidents is recommended.

Az Interpol DVI-protokoll-adaptációjával a hazai áldozatazonosítás fejlesztésének útján

This paper deals with the establishment of disaster victim identification (DVI) work after mass fatality incidents in Hungary. DVI is one of the standing committees of Interpol, and also the name of the international protocol and methodology on disaster victim identification. In order to adapt the DVI protocol in Hungary, European and other international examples are presented, and also the efforts to establish the Hungarian DVI Unit between the autumn of 2017 and the summer of 2018 is accounted.

Dental Post-mortem Computed Tomography for Disaster Victim Identification: A literature review

Abstract Over the last decade, post-mortem computed tomography (PMCT) has been increasingly adopted within the forensic setting. The three-dimensional (3D) capability and non-destructive approach of PMCT allows it to have several advantages over conventional x-rays, and as such it may be of potential use within forensic odontology for disaster victim identification (DVI). However, the implementation of dental PMCT can only have a real forensic benefit if its accuracy is comparable to that of conventional post-mortem (PM) dental radiographs; which is currently standard practice. Therefore, the purpose of this review was to evaluate if dental PMCT is as accurate as PM dental radiographs. A review of the current literature has shown the accuracy of dental PMCT to be comparable or similar to that of PM dental radiographs. As a result, there is a potential for dental PMCT to replace conventional PM dental radiographs in the DVI process of Mass Fatality Incidents (MFIs). However, further research is required to establish an international standard protocol for dental PMCT before it can be recognised as a new standard practice within the forensic setting.

Trends in United States Mass Fatality Incidents and Recommendations for Medical Examiners and Coroners.

It is imperative that medicolegal jurisdictions prepare for the occurrence of a mass fatality incident. Despite the trend to plan for catastrophic and complicated incidents, this analysis of recent mass fatality events seeks to better inform authorities regarding the scale and types of incidents that could potentially impact their jurisdiction. The guidance provided by this study serves as a tool to guide the development of plans, acquisition of appropriate resources, and training of staff. To perform this analysis, data were collected from mass fatality incidents occurring in the United States from January 1, 2000 to December 31, 2016 that resulted in ten or more fatalities. Specific data points were collected for each incident including the date, location, number of fatalities, incident type (e.g., man-made or natural), incident subtype, and description (e.g., mass shooting, hurricane, aviation). A total of 137 incidents fit the criteria for inclusion in the analysis, resulting in a total of 8462 fatalities. The average number of incidents was eight per year during the study period. The analysis demonstrates that most mass fatality incidents (88.8%) result in between ten and 50 fatalities and are variable based on incident type and geographic location. This study includes several large-scale incidents, which as outliers have influenced fatality management operations and preparedness efforts on a national level. In particular, the World Trade Center attack of September 11, 2001 and subsequent remains recovery and identification operations have served to inform the New York City Office of Chief Medical Examiner of the capabilities required to manage a complex, protracted victim identification process involving extensive body fragmentation and commingling. While the World Trade Center attack has been shown to be outside the normal trends of mass fatality incidents, it has nonetheless offered the medicolegal community several invaluable lessons.

Mortuary operations following mass fatality natural disasters: a review.

This is a critical review to discuss the best practice approaches to mortuary operations in preparation for and the response to natural, mass fatality, disaster events, as identified by a review of published articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) Statement guided the identification of potential articles to use in this critical review. Subsequent searches were also conducted to identify articles relating to heat wave, and flood mortality. All identified peer-reviewed studies published in English which discussed the preparation and response of mortuaries to mass fatality natural disasters occurring in developed countries were included. Using the PRISMA-P method of identifying articles, 18 articles were selected for inclusion in this review. Although there are numerous articles which describe the mortuary response to mass fatality incidents, few articles analyzed the response, or discussed the roles which supported and enabled the organization to undertake the task of identifying disaster victims. It is thus difficult to determine objectively if the actions and activities outlined in the articles represent best-practice.

Self-reported Preparedness to Respond to Mass Fatality Incidents in 38 State Health Departments.

Public health departments play an important role in the preparation and response to mass fatality incidents (MFIs). To describe MFI response capabilities of US state health departments. The data are part of a multisector cross-sectional study aimed at 5 sectors that comprise the US mass fatality infrastructure. Data were collected over a 6-week period via a self-administered, anonymous Web-based survey. In 2014, a link to the survey was distributed via e-mail to health departments in 50 states and the District of Columbia. State health department representatives responsible for their state's MFI plans. Preparedness was assessed using 3 newly developed metrics: organizational capabilities (n = 19 items); operational capabilities (n = 19 items); and resource-sharing capabilities (n = 13 items). Response rate was 75% (n = 38). Among 38 responses, 37 rated their workplace moderately or well prepared; 45% reported MFI training, but only 30% reported training on MFI with hazardous contaminants; 58% estimated high levels of staff willingness to respond, but that dropped to 40% if MFIs involved hazardous contaminants; and 84% reported a need for more training. On average, 76% of operational capabilities were present. Resource sharing was most prevalent with state Office of Emergency Management but less evident with faith-based organizations and agencies within the medical examiner sector. Overall response capability was adequate, with gaps found in capabilities where public health shares responsibility with other sectors. Collaborative training with other sectors is critical to ensure optimal response to future MFIs, but recent funding cuts in public health preparedness may adversely impact this critical preparedness element. In order for the sector to effectively meet its public health MFI responsibilities as delineated in the National Response Framework, resources to support training and other elements of preparedness must be maintained.

A new morphological trait in forensic identification - middle phalangeal hair (MPH).

Middle phalangeal hairs (MPH) are present on the dorsal aspect of the middle phalange of the fingers except for the thumb. The MPH have been of interest to anthropologists, human biologists, clinicians, geneticists and anatomists in the past as a morphological trait of the human body. The anthropological value of MPH is well established in studying population variations, with implications for age, ancestry and sex differences. We are of the opinion that MPH may be used significantly for forensic identification purposes along with other morphological characteristics of the human body. MPH can be one of the individualistic features in comparing the ante-mortem and post-mortem records in mass fatality incidents and in establishing identity in forensic casework pertaining to CCTV images of the hand.

The Forensic Anthropologist in the Mass Fatality Context.

Mass fatality incidents require a multi-agency, multidisciplinary response to effectively and efficiently manage the recovery and identification of human remains. The forensic anthropologist is uniquely suited for a significant role in the disaster response, demonstrated in the recovery and triage of human remains, interpretation of skeletal trauma, and identification of victims. However, the majority of published literature discusses these response operations in the context of large-scale incidents with significant numbers of highly fragmented and commingled human remains, which does not reflect the operational reality of mass fatality incidents in the United States. This article provides a realistic definition of the term "mass fatality incident" for medicolegal jurisdictions and provides the contributions of the forensic anthropologist for all types of incidents.