Mass Disaster Management

Presented by:

Madhur Sejwal(41)

Definition:Disaster is an event of serious magnitude, causing severe damage to life and property. Casualties numbering more than 10 (or 12) individuals at a certain time and place is considered as mass disaster.• The WHO has defined disaster as an

occurrence that causes damage, ecological disruption, loss of human life and deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community.

Such disasters are broadly classified into:(1) NATURAL

Non biological Earthquake Cyclone Flood Drought Heat wave Volcanic eruption

Biological Disease epidemics Disease pandemic Mass poisoning (eg.

Food)

Mass disaster management is a team work which consists of police, army, civil authorities and medical experts, like forensic pathologist/odonthologist, finger print/ballistic experts. They are responsible for investigations including the following:

• Identification of the site & preparation of sketch diagram showing the geographical location

• Reaching the site, well equipped• Immediate isolation, demarcation and protection of the site

• Identification of bodies if possible.

MANAGEMENT

Investigative process comprises of following actions:

Management

First Stage-At the Disaster Site

Second Stage-In The Mortuary

Third Stage-Comparison Of

Records

1) Reaching the disaster site as soon as possible

2) Isolation, demarcation and protection of the site by a security cordon

3) Photography of the site from all angles

4) Identification of the precise site of occurrence and preparation of a detailed sketch

FIRST STAGE – AT THE DISASTER SITE

Rescue workers from the Civil Aviation Authority and troops helped recover bodies and sift wreckage for clues to the cause of the crash.

Rescue workers in Air Crash

1) APPEARANCE: Complexion, length and color of hair

Description of deformities, birthmarks, scars and tattoo marks

2) AGE DETERMINATION: using data provided by teeth, bones, height, weight, build, changing occurring at puberty and in old age, and personal documents if available

Advanced techniques available: superimposition photography, and facial reconstruction using models

3) SEX AND RACE DETERMINATION: by careful examination of physical characteristics and dimensions.

Identification of the bodies; carried out by noting the following points:

4) STATURE- could be determined if a single long bone is available

Clothing may provide a vital clue wherein the label, size and laundry mark is noted

Accessories such as wallet, and documents like drivers license maybe of use.

However, accessories and circumstantial evidence are not accepted as absolute proof of identity

In case of survivors, establishing a system of Triage to determine priority of evacuation. Color coded tokens maybe hung around neck of the injured.

Information on composition of gathering maybe used to establish identity by exclusion

Establishment of temporary mortuaries at a suitable site

Proper scientific documentation including numbering and tagging of bodies or aiding identification by next of kin

Arranging transportation of bodies to a mortuary

1) Identification of body (repeat in case of identified bodies also)

2) Take photographs, finger prints, foot prints of the body

3) Arrange radiological examination of the entire body- to identify foreign bodies. This is particularly useful in mutilated bodies

SECOND STAGE – IN THE MORTUARY

Examination At The Mortuary

Autopsy Examination

External Examination

InternalExamination

1) STATE OF THE BODY Entire Mutilated Fragmentary remains Height and weight

2) PRESENCE OR ABSENCE OF POSTMORTEM CHANGES especially in unidentified bodies

3) DENTAL DATA 4) GROSS EXAMINTAION OF INJURIES: size,

site, nature, number and special features

EXTERNAL EXAMINATION

FOLLOWING POINTS NEED SPECIAL ATTENTION:

1.Stage of putrefaction of internal organs Surgical removal of an organ carried out in life 2.Evidence of pre-existing disease 3.Nature, extent and degree of organ injury 4.Evidence of organic disease causing sudden

death: coronary occlusion, cerebro-vascular accident etc.

5.Evidence of poisoning 6.Presence of foreign bodies

INTERNAL EXAMNINATION

Specimens to be collected and preserved-exact specimen would depend on nature of disaster. They could be: 1.Clothes, if charred or blood stained 2.Foreign bodies 3.Viscera, blood and urine for chemical

analysis 4.Internal organs for histopathological

examination

SPECIMENS COLLECTION

It should be given to cover 2 aspects:1. The exact cause of death after analyzing all

information collected during post-mortem examination and detailed study of viscera and organs

2. The nature of force, fire, foreign body or chemical agent which has produced injuries that have resulted in death. This is particularly true in care of air disasters.

OPINION

1) Compare all evidence collected with the information made available by relatives and establish identification of deceased

2) A minimum of 7 to 8 points of comparison must tally to confirm identity

3) It is essential that record of all medical and dental examination including X-ray films be filed for future reference.

THIRD STAGE-COMPARISION OF RECORDS

Parikh CK. Identification in Mass Disaster, Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 6th Edition 1999.

Bibliography