Forensic Medicine and Disaster: Victim identification - EUSEM 2012

Identification issues in mass casualty
Nagi Souaiby, MD, MPH, MHM
Emergency, Forensic and Disaster Medicine specialist
Saint Joseph University (USJ) – Beirut – Lebanon
WHO Expert
National School or Emergency Care - Director
Lebanese Resuscitation Council - President
Lebanese Society of Emergency Medicine – Former president
Oct. 4-6, 2012 – EuSEM

Mediterranean Journal of Emergency Medicine
www.newhealthconcept.net
No potential conflict of interest for this lecture

Feb 14 2005

2005 – 2008: 2 wars
and more than 14 criminal explosions

A disaster is an unexpected event
causing the death of
many people….
….but also the admission to the ED/ICU
of unconscious injured patients
Thus DVI operations may be required

Outline
Global approach of disaster management
Disaster Victim Identification
Specific Legal issues (forensic)

Disaster Victim Identification
Humanitarian issue to families & relative
It’s a duty of the society / international
community.

Key message of this lecture
The most important
requirement for victim
identification work is the
application of international
standards, which are the
common basis for the work in
multinational DVI operations

DVI: International standards
(Interpol)
Require strict methodology on scene &
in Forensic institute
Specific religious, cultural needs and
national laws and directives of the
concerned country must be taken into
consideration.

Disaster Plan
Emergency Contingency Plan
Chief Commandant
Director of Rescue Operations
…..
Disaster Victim Identification Teams
…..
Director of Public Relations

Issued from the Interpol Guide

Body Recovery

Mortuary Branch

Identification
Center

DVI teams work in an
interdisciplinary manner and
engage the services of experts in
various different fields, as needed.
Issued from the Interpol Guide

DVI Guidelines
Positive identification of victims
Highest possible quality standards
Victims are to be treated with dignity and respect,
Interpol forms should be used to document
victim identification
AM (ante mortem)
PM (post mortem) data

Disaster typology / classification
Open disaster: major catastrophic event
resulting in the deaths of a number of
unknown individuals for whom no prior
records or descriptive data are available.
Closed disaster: major catastrophic event
resulting in the deaths of number of
individuals belonging to a fixed, identifiable
group.

Concorde Crash July 2000
Tsunami
Before
After

Disaster Victim Identification
Accurate mapping of the disaster area:
GRID
If wide disaster area, aerial photography

Aircraft Crash scene

methods of identification
Primary
Secondary
Certitude elements of
evidence
Probable elements of
evidence

Primary methods of identification:
Fingerprint
analysis
Forensic dental
analysis
DNA analysis

Secondary methods of identification:
Personal descriptions /
medical findings
Evidence / clothing

Identification of the fire victim
Fire may be very destructive,
No or little material available for
identification,
Metal prosthesis,
Teeth
Some soft tissues / tongue
Skeletal radiology

Dental examination
Dental Record : AM / PM ++++
Survives incineration very well,
Accurate, reliable and legally acceptable
identification
Results of AM data can be computerized:
digital radiographs can be easily stored in
a central archive, retrieved and
transmitted, via modem, to mass casualty
sites (Gruber j, Kameyama MM 2001).

X-ray
Estimation of age is required,
Discover fractures or other unique
identification information
Locating and identifying evidential material
(prosthesis, bullets or bomb fragments)
X-ray equipment, preferably portable,
should always be made available in the
mortuary

Metal prosthesis
Plate in a long bone

Comparative dental
identification by radiology

Genetic identification
An individual's genetic data is the same in all his or
her cells and remains constant even after death
Complement other methods especially if body
severely mutilated / burned
Biological sample analysis can result in:
The genetic linking of a victim to members of his
natural family
The conclusion that victims were not related
The matching of body parts
It must be remembered, however, that attempts to link a victim with his
father or children involve the risk of proving non-paternity

Collection of post mortem samples Interpol recommendations
Condition of body Recommended sample
Complete, non-decomposed corpse Blood (on FTA paper or swab)) and buccal (oral)
smears
Mutilated, non-decomposed corpse If available: blood and deep-seated red muscle
tissue (~1.0g)
Complete, decomposed corpse or
mutilated remains
Sample from long, compact bones ( 4-6 cm
sections, window section, without shaft
separation)
Or.
Healthy teeth (preferably molars)
Or.
Any other available bone (~10g, if possible;
preferably cortical bones with dense tissue)
Severely burnt corpses All samples listed above and impacted teeth or
tooth roots if present
or
smears from the gold bladder

Conclusion
Social cultural, religious & economic
problem
No place for improvisation
Must be as quick as possible
Must be held by senior experts

Examples

Lockerby (21/12/1988): 259 victims,
2 Km2, 28 days for identification,

Scandinavian Star: 7/4/1990: 158
burned victims, 17 days,

Noronic (Toronto)
1949: 4 months to
identify 115 /118
victims (524
passengers)

Thank you
Byblos the oldest city in the world