Mass Fatality Research Articles

Marked decline of sudden mass fatality events in New Zealand 1900 to 2015: the basic epidemiology

Objective:To describe the basic epidemiology of sudden mass fatality events for the 1900 to 2015 period in New Zealand (NZ). Methods:Official lists and internet searches were used to identify the events. Events were categorised, rates calculated and time trends analysed. Results:A total of 56 sudden mass fatality events with 10 or more fatalities between 1900 and 2015 in NZ were identified. There were 1,896 deaths in total, with the worst event being the Hawke’s Bay earthquake (258 deaths). Events were classified as transportation‐related (64%), natural causes (11%), industrial (9%), war (9%) and infrastructure (5%). There were marked declines in the rate of events per person‐years of exposure and the associated mortality rate (both p<0.0001). Knowledge gaps were identified around: i) the basic epidemiology, e.g. non‐fatal injuries and numbers of survivors; ii) the role of subsequent official inquiries in guiding preventive measures; and iii) the likely cost‐effectiveness of measures to prevent harm from such events. Conclusions:The occurrence and health burden of sudden mass fatality events have markedly declined in NZ over time. Implications for public health:There remains large scope for addressing the knowledge gaps in the basic epidemiology and societal responses to these events to guide primary prevention and appropriate disaster response.

Jurisdiction, Privacy, and Ownership: DNA Technology and Field Dynamics in Conflict-Related Mass Fatalities

This article explores the dynamics and challenges of undertaking human identifications in states experiencing armed conflict or emerging therefrom. It emphasises the integral role of the State in human identifications and the need for the legal acts of the State in identifying an individual and confirming their death to be integrated into any humanitarian response to repatriating the dead. Conflict-related mass fatalities occur in uncontrolled circumstances, making DNA-based human identifications necessary. In states lacking the necessary forensic infrastructure, the promise of expedited human identifications through outsourcing DNA work can lead to the State abdicating the necessary jurisdiction and scientific transparency over DNA samples and their analysis. This raises important issues of consent, privacy and human rights. Furthermore, attempts to minimise initial delays in human identifications at the expense of building local knowledge, skills and necessary legal frameworks risks undermining the legitimacy of the human identification effort. Through analysis of the cases of Guatemala, the former Yugoslavia, and Libya, the authors conclude that human identification efforts cannot be separated from the need for a long-term integrated solution within a transitional justice context in which accountability and the right to the truth are addressed as part of a political solution.

Mass Fatality Management in the US

Mass Fatality Management in the US

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.

Amelogenin Gene - The Pioneer in Gender Determination from Forensic Dental Samples.

In the event of any mass fatality incident, DNA analysis plays a vital role in disaster victim identification. Teeth are one of the most resistant structures in the human body that resist decomposition hence making them prime choice for extracting DNA for identification of individuals. Polymerase Chain Reaction (PCR) analysis that target regions of Amelogenin gene have become the method of choice for sex determination of biological samples. Determining the sex of a given DNA sample from either dental pulp or dentin of tooth and help in identification of missing persons and disaster victims. In our study 50 teeth samples were studied and they were subjected to various environmental conditions along with freshly extracted teeth taken as control for duration of one month and three months. Pulpal tissue was retrieved from the teeth specimens by access opening of root canals and for incinerated samples, the specimens were crushed. From the DNA that was extracted from the dental pulp sample Amelogenin gene locus was used for sex determination by amplifying a segment of X-Y homologous gene locus through PCR analysis. ANOVA test and t-test proved to be statistically significant and 100% retrieval rate was observed in samples. Pulpal tissue along with degenerating odontoblastic processes yield sufficient amount of DNA for gender determination when subjected to various forensic conditions with maximum accuracy.

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.

Review of: DNA Analysis for Missing Person Identification in Mass Fatalities

Journal of Forensic SciencesVolume 61, Issue 6 p. 1697-1697 Book Review Review of: DNA Analysis for Missing Person Identification in Mass Fatalities Mechthild Prinz Ph.D., Mechthild Prinz Ph.D. Department of Sciences, John Jay College of Criminal Justice, New York, NYSearch for more papers by this author Mechthild Prinz Ph.D., Mechthild Prinz Ph.D. Department of Sciences, John Jay College of Criminal Justice, New York, NYSearch for more papers by this author First published: 10 November 2016 https://doi.org/10.1111/1556-4029.13192Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume61, Issue6November 2016Pages 1697-1697 RelatedInformation

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.

Revised practical guidance for first responders managing the dead after disasters

AbstractThe proper and dignified management of the dead is one of the three pillars of the humanitarian response to disasters, along with the rescue and care of survivors and the provision of essential services. First launched in 2006, the widely used publication Management of Dead Bodies after Disasters: A Field Manual for First Responders offers practical and easy-to-follow guidelines. It has become the go-to guide not only for non-experts confronted with dead bodies in the aftermath of a catastrophe, but also for those responsible for disaster planning and preparedness in countries with well-developed forensic services. Ten years after the publication of the 2006 Manual, a revised edition has been released. The inclusion of a decade of experience in its field implementation, as well as the incorporation of recent scientific developments in mass fatality management, makes the revised Manual an invaluable resource for first responders confronted with the realities of dead body management following a disaster.

Assessment of Mass Fatality Preparedness and Response Content in Dental Hygiene Education

When mass fatality incidents (MFIs) occur, they can quickly overwhelm local, state, and government agencies, resources, and personnel. It is important to have a rapid and effective response with skilled, multidisciplinary victim identification teams since specific skill sets are necessary to participate in mass fatality preparedness and response. The aims of this study were to determine the extent of formal education related to mass fatality preparedness and response training in U.S. dental hygiene programs and to assess program directors' perceptions of the need for such training. A 23-item cross-sectional survey was emailed to 319 U.S. dental hygiene programs in 2015. Survey questions addressed if the program offered mass fatality preparedness and response training to its students and how much training was given, as well as collecting respondents' demographics and opinions regarding education and training. An overall response rate of 36% was obtained, with 111 program chairs completing the survey. The results showed that only a small percentage of responding programs incorporated coursework related to mass fatality and preparedness in their curricula. Of the responding programs, 84% had no formal instruction on the role of a dental hygienist in MFIs; however, 53 of 69 program directors agreed or strongly agreed that the role of dental hygienists in MFIs should be covered in dental hygiene curricula. The top three barriers to incorporating such training reported by respondents were time requirements, lack of faculty expertise, and lack of equipment. Future research is needed to establish standardized competencies for mass fatality preparedness and response in dental hygiene education.

Population Health: Assessing Gains and Addressing Challenges Ahead

In 2015 we published the volume Disaster Response: Medical and Health Policies, a compilation of articles from World Medical & Health Policy offering research and insights from medical professionals and policy scholars to help improve interventions and reduce suffering when disasters occur, whether they result from natural or human-made threats (Nicogossian & Stabile, 2015). In this first issue of 2016 we continue that initiative, begun in collaboration with our colleague Dr. David McCann, to whose memory Disaster Response is dedicated, by adding several articles to the existing body of literature. Drs. Lisa Moreno-Walton and Kristi Koenig apply their expertise in emergency medicine to a consideration of the question of how gender impacts disaster resilience and survival within diverse populations through a review of the relevant literature in their article “Disaster Resilience: Addressing Gender Disparities.” They identify five categories of gender-related disparities: biology, responsibility for dependents, development of skills, clothing, and vulnerability to assault and trafficking. Identification of gender disparities is a first step in improving policy to enhance survival across a wide range of disaster scenarios when future events occur. A consideration of the effectiveness of integrated care teams, one approach humanitarian organizations may use to support community resilience following mass fatality disasters, is offered by Professor Lavonne M. Adams of the Harris College of Nursing & Health Sciences at Texas Christian University in “Promoting Disaster Resilience through Use of Interdisciplinary Teams: A Program Evaluation of the Integrated Care Team Approach.” And in “State Mandate Influences on FEMA-Approved Hazard Mitigation Plans Under the Disaster Management Act of 2000” Professor Oluponmile Olonilua of Texas Southern University addresses the question of whether or not such mandates materially impact policy outcomes of interest. Emergency departments are a critical component of the health-care infrastructure, so understanding influences on their capacity could help in crafting policy to enhance preparedness for both disaster scenarios and more routine crises. In the United States, emergency department utilization has increased nationally, leading to overcrowding, which in turn increases wait times, adverse clinical outcomes, and costs. Niyousha Hosseinichimeh, Erika G. Martin, and Stephen Weinberg investigate one potential factor in their article, “Do Changes in Health Insurance Coverage Explain Interstate Variation in Emergency Department Utilization?” More slow moving, but no less impactful crises loom on the public-health horizon in the form of widespread obesity and antibiotic resistance. The policy implications of therapies designed to mitigate or work around the negative impacts of these are considered in articles on bariatric surgery and fecal microbiota therapy, a non-antibiotic treatment alternative for Clostridium (C.) difficile infection (CDI). David B. Muhlestein, Thomas Wickizer, and Abigail Shoben examine effects of regulations regarding bariatric surgery procedures in the United States in “The Spillover Effect of a Change in Medicare Reimbursements on Provider Behavior in the Non-Medicare Population for Bariatric Surgery.” Shahad Salman, George Vardatsikos, Denise Avard, Nicole Palmour, Ken Dewar, and Ma'n H. Zawati examine implications of emerging Canadian policy in “FMT Happens: Regulating Fecal Microbiota Therapy in Canada; What You Need to Know.” All adverse health outcomes represent potential disasters to those who suffer them. This point is raised in Kristi Heather Kenyon's review of The AIDS Generation: Stories of Survival and Resilience, in which the book's author Perry N. Halkitis refers to the AIDS pandemic as “our natural disaster.” Health-care providers and policymakers must continuously confer and collaborate to devise health-improving and life-saving solutions. Health Behavior Change in Populations, a textbook edited by Scott Kahan, Andrea C. Gielen, Peter J. Fagan, and Lawrence W. Green, and reviewed in this issue by Michael Plouffe and Liang-Kim Ong of University College, London, offers some tools for improving population health outcomes. Our journal remains dedicated to this ongoing pursuit. We encourage physicians and all health-care professionals to actively engage in all aspects of policy formulation to ensure that community health and rights are protected and included in the debates leading to responsible and effective legislation.

Promoting Disaster Resilience Through Use of Interdisciplinary Teams: A Program Evaluation of the Integrated Care Team Approach

One approach humanitarian organizations may use to support community resilience following mass fatality disasters is by integrating services through formation and deployment of interdisciplinary teams. One such model is the Integrated Care Team (ICT) used by the American Red Cross. This paper describes a program evaluation conducted on the ICT, in which 120 ICT participants completed a survey. Although fewer than half of the respondents agreed that ICT members had sufficient ICT‐specific training, the majority of respondents understood their role and that of others in ICT. The majority agreed that the ICT effectively provided health services, mental health services, and spiritual care. The majority agreed that ICT effectively used community resources and provided financial support. Recommendations stemming from the evaluation include implementation of more consistent ICT‐specific training within the context of interdisciplinary collaboration, establishment of clear protocols for use of financial and other resources, and future research into effectiveness of the ICT approach.

Bird collisions at an offshore platform in the North Sea

Capsule Collisions with offshore structures in the North Sea could account for the mortality of hundreds of thousands of nocturnally migrating birds.Aims To assess, for the first time, the circumstances of mass fatalities at an offshore structure, including the species involved, their numbers, ages, body conditions and injuries.Methods At an unmanned tall offshore research platform in the southeastern North Sea, bird corpses were collected on 160 visiting days from October 2003 to December 2007. Corpses were identified to species and kinds of injury, ages, and fat and muscle scores were determined. Nocturnal bird calls were recorded, identified to species and quantified. Local and large-scale weather parameters were also considered.Results A total of 767 birds of 34 species, mainly thrushes, European Starlings and other passerines, were found at 45 visits. Most carcasses were in good body condition and young birds were not more affected than adults. Three quarters of 563 examined individuals had collision induced injuries. Birds in poor body condition were less likely to be collision victims than those in good condition. Mass collision events at the illuminated offshore structure coincided with increasingly adverse weather conditions and an increasing call intensity of nocturnal birds.Conclusions Assuming an average of 150 dead birds per year at this single offshore structure and additionally assuming that a considerable proportion of the corpses were not found, we estimate that mortality at the 1000 + human structures in the North Sea could reach hundreds of thousands of birds. Since offshore industrialization will progress and collision numbers at offshore turbines will consequently increase considerably, we recommend reinforced measures to reduce bird strikes at offshore structures, especially in the light of substantial declines in some migrant species.

Beyond DVI: Future Identification, Research and Archiving

In the context of mass fatality incident, it is of utmost importance to identify the victims rapidly and accurately, both for judicial reasons and to provide closure for family members. DVI teams work in an interdisciplinary manner, engaging the services of experts in various disciplines, comprising of pathologists, anthropologists, odontologists, radiologists, fingerprint and DNA experts to work collaboratively towards the identification of victims. The DVI process is accomplished with four phases namely, scene, post-mortem, antemortem and reconciliation, adopting the fundamental principle where the highest possible quality standards should be applied and victims are to be treated with dignity and respect, in accordance to the internationally recognized INTERPOL DVI guide. This DVI guide has extensively adopted and used by many countries in numerous disasters with successful identification for victims. Nevertheless, the problem to positively identify victims lies with the case of insufficient or missing of the antemortem data. This paper focuses on the dynamic and continuous evolution, particularly the application of the DVI process in setting up a procedure for temporary controlled burial for all the unidentified remains in the two cases of Malaysia mass fatality incidents. It highlights the importance of temporary controlled burial for all the unidentified remains as means of forensic humanitarian reason as well as for criminal investigation where the extended version of the DVI protocol to include temporary controlled burial as a measure to treat victims with respect and dignity. The two cases convey the importance of expanding the DVI process to include procedures for future identification and archiving. DVI procedures are dynamic and have evolved as well as developed particularly in its application going beyond merely identification, to recording and documenting for future referencing by the victim's family to researchers.

Are We Ready for Mass Fatality Incidents? Preparedness of the US Mass Fatality Infrastructure

To assess the preparedness of the US mass fatality infrastructure, we developed and tested metrics for 3 components of preparedness: organizational, operational, and resource sharing networks. In 2014, data were collected from 5 response sectors: medical examiners and coroners, the death care industry, health departments, faith-based organizations, and offices of emergency management. Scores were calculated within and across sectors and a weighted score was developed for the infrastructure. A total of 879 respondents reported highly variable organizational capabilities: 15% had responded to a mass fatality incident (MFI); 42% reported staff trained for an MFI, but only 27% for an MFI involving hazardous contaminants. Respondents estimated that 75% of their staff would be willing and able to respond, but only 53% if contaminants were involved. Most perceived their organization as somewhat prepared, but 13% indicated "not at all." Operational capability scores ranged from 33% (death care industry) to 77% (offices of emergency management). Network capability analysis found that only 42% of possible reciprocal relationships between resource-sharing partners were present. The cross-sector composite score was 51%; that is, half the key capabilities for preparedness were in place. The sectors in the US mass fatality infrastructure report suboptimal capability to respond. National leadership is needed to ensure sector-specific and infrastructure-wide preparedness for a large-scale MFI.

A comparative study between muscle, cartilage and swab from inside the urinary bladder samples for DNA typing of severely burnt bodies in disaster victim identification (DVI)

In mass fatality incidents, the kind and quality of samples collected for DNA typing play an important role in the identification of the victims. Depending on the kind of event and on the conditions of the bodies, it is very important to consider all kinds of possible samples available for DNA typing. In this study, we compared DNA yields and STRs profiles obtained from samples of deep red muscle and cartilage from hip joint (head of femur) and swab from inside the urinary bladder collected from three severely burnt bodies due to a car crash in Brazil. The amount of DNA recovered from each sample and the quality of the STRs profiles obtained demonstrated that deep red muscle, cartilage and swab from inside the urinary bladder are excellent sources of samples for DNA typing of severely burnt bodies in disaster victim identification (DVI).

A new computer-tomography-based method of sex estimation: Development of Turkish population-specific standards

The identification of victims involved in mass fatality incidents has become an increasingly important issue nowadays, and identification of unknown individuals is an important aspect in criminal cases and Disaster Victim Identification scenarios. Therefore, the sex estimation is one of the most important biological attributes towards establishing personal identity. In addition, several studies have demonstrated that metric sex determination methods of the skeleton are population-specific due to variation in size and patterns of sexual dimorphism. Unfortunately, the modern Turkish population still lacks wide and representative population standards for identification. Previous research has shown that modern technologies, such as CT scanning appear to offer promising means for the establishment of new standards for contemporary populations. The main aim of this project is to examine the application of measurements taken from the femur in order to assess sex, as well as to contribute to the establishment of discriminant function equations for the Turkish population for forensic applications.The sample population was composed of CT images taken from 200 adult hospital patients. The images of the femora were segmented from the surrounding bones to ensure correct usage of landmarks as accurately as possible. The 3D reconstructions were then created using the volume-rendering function in OsiriX (v.5.6.). Thirteen measurements were acquired using a 3D viewer and were located and marked on each of the CT reconstructed femora.Thirteen anthropometric parameters were measured and analysed by basic descriptive statistics and discriminant analysis methods using the SPSS 21.0 software package. The intra-observer variation was assessed by obtaining the inter-cross correlation coefficient in order to evaluate the accuracy of the linear measurements taken. The accuracy of sex prediction ranged from 63.5 to 88% with single variables. In stepwise analysis, Epicondylar Breadth, Femur Vertical Diameter of Neck and Medial Lateral Subtrochanteric Diameter were found to be the most discriminating variables providing an accuracy of 91%.Ultimately, it is envisaged that this research study will produce data and interpretations that will inform on and improve standards of sex estimation from postcranial osteometric landmarks. Additionally, this research will consider how this data provides value for a developing discipline of forensic anthropology and how it integrates within the existing systems of criminal investigation and Disaster Victim Identification practices in Turkey.

Postmortem computed tomography (PMCT) and disaster victim identification.

Radiography has been used for identification since 1927, and established a role in mass fatality investigations in 1949. More recently, postmortem computed tomography (PMCT) has been used for disaster victim identification (DVI). PMCT offers several advantages compared with fluoroscopy, plain film and dental X-rays, including: speed, reducing the number of on-site personnel and imaging modalities required, making it potentially more efficient. However, there are limitations that inhibit the international adoption of PMCT into routine practice. One particular problem is that due to the fact that forensic radiology is a relatively new sub-speciality, there are no internationally established standards for image acquisition, image interpretation and archiving. This is reflected by the current INTERPOL DVI form, which does not contain a PMCT section. The DVI working group of the International Society of Forensic Radiology and Imaging supports the use of imaging in mass fatality response and has published positional statements in this area. This review will discuss forensic radiology, PMCT, and its role in disaster victim identification.

The basics of disaster victim identification

Abstract Mass fatality incidents can occur due to an environmental, medical, vehicle, industrial or terrorist event. They can be major, mass or catastrophic in size and generally involve large numbers of victims. Identification of these victims is of upmost importance in these situations for legal and compassionate reasons. Whilst radiography has been used for this purpose since 1949, it has since been suggested that post-mortem computed tomography (PMCT) could provide a more rapid and logistically beneficial modality-reducing the number of on-site personnel and minimizing the number of different imaging modalities required. The International Society of Forensic Radiology and Imaging (ISFRI), who include disaster victim identification (DVI) as one of their six key areas of development, support this idea. The DVI sub-group of the ISFRI supports the use of radiology including PMCT in mass fatality responses through the DVI group’s published positional statements. This review will discuss the basics of disaster victim identification and the role that radiology has in it, both in the past and in the future.