general aspects regarding management of dead bodies; tsunami victim identification in thailand dr....
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General Aspects Regarding General Aspects Regarding Management of Dead Bodies;Management of Dead Bodies;
Tsunami Victim Identification Tsunami Victim Identification in Thailandin Thailand
Dr. Pongruk SRIBANDITMONGKOLDr. Pongruk SRIBANDITMONGKOLDepartment of Forensic Medicine,Department of Forensic Medicine,
Faculty of Medicine, Faculty of Medicine, Chiang Mai University, ThailandChiang Mai University, Thailand
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Prepared byPrepared by
• Dr. Pongruk SribanditmongkolDr. Pongruk Sribanditmongkol
• Dr. Porn PongpanitanontDr. Porn Pongpanitanont
• Dr. Nop PorntrakulsereeDr. Nop Porntrakulseree
• Dr. Maythinee PetjuDr. Maythinee Petju
• Dr. Supachai KunaratanaprukDr. Supachai Kunaratanapruk
• Pol.Lt.Col. Pattana Kitkailass, MDPol.Lt.Col. Pattana Kitkailass, MD
• Pol.Col. Pornpraseart GanjanarintrPol.Col. Pornpraseart Ganjanarintr
• Gen Nopadol SomboonsubGen Nopadol Somboonsub
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Country informationTHAILAND USA
Surface Area 514,000 sq km 9,631,418 sq km
Population
Doctor
Forensic Doctor
64,865,523
30,000
70
293,027,571
Population
Distribution
0-14 yrs: 24.1%
15-64 yrs: 68.7%
> 65 yrs: 7.3%
0-14 yrs: 20.8%
15-64 yrs: 66.9%
> 65 yrs: 12.4%
GDP (US$) $7,400 $37,800
Labour force
agriculture 49%
industry 14%
services 37%
agriculture 1%
industry 39%
services 60%
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Scope of presentation
• Tsunami victim identification in Thailand– What have been done?– What did not work?
• What do we learn?
• What should be done?
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• December 26, 2004, a 9.0 Richter scale earthquake occurred north of Sumatra Island.
http://en.wikipedia.org/wiki/Image:2004_Indonesia_Tsunami_Complete.gif
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• Caused a huge tsunami
• struck countries on the coast of the Indian Ocean, including Thailand
from Manfred Leier, World Atlas of the Oceans, 2000, Firefly Books, Buffalo NY, USA.
www.http//saranitet.police.go.th/0008/fv92.htm
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Tsunami hit Thailand10:05 hoursMax. height 4-10.6 m (12-32 feet)
http://www.aviation.go.th/rbm/tsunami_files/tsunami.htm#4
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Causes destructions• to the beaches
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Cause destructions
• to the land
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Mass fatalities
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Summary of the human toll caused by the tsunami as of 23 March 2005
Countries Dead Missing Displaced HomelessIndonesia* 220,153 - 400,062 n/aSri Lanka 31,147 4,115 519063 480000
India 16,389 - 647599 20000Maldives 82 26 21663 NaThailand 5,395 2932 Na NaMyanmar 90 10 Na 3200Malaysia 68 12 Na 4296
East Africa 312 158 2320 NaTotal 273,636* 7,253 >1,590,707 >507,496
* 265,000 – 3140,000
From MOPH, Thailand
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The number of deaths in Thailand
Province No. of Deaths
Ranong 160
Phang Nga 4,224
Phuket 279
Krabi 721
Trang 5
Satun 6
Total 5,395reported by the Thai authorities Official figures as at 24 March
Photo from http://en.wikipedia.org/wiki/Image:Souththailand.GIF
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Forensic Aspect• Under the Thai law, a forensic
investigation is required for these types of deaths.
• In general, the purpose is – to identify the victim – to determine the time and place of death– to determine the cause and manner of
death.
main purpose for tsunami victims
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Management of Dead Bodies in Thailand
Responsible Institution
Inter-institution Teams
Search and Recovery
Final Arrangement
Identification
Assistance for Family members
Supported by
Coordinated by
Storage and preservation
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Responsible Institution• At the beginning- not clear, no command center
related to management of dead bodies• During the early period; under
– Department of Disaster Prevention and Mitigation, Ministry of Interior
– The Royal Thai Police– The Ministry of Public Health
• Jan 13, 2005; Set up The Tsunami Victim Identification Executive Committee, chaired by the Minister of Interior
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Inter-institution Team
• academic institutes
• local government
• military
• police
• Public Health
• NGO
• volunteers
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Body search and recovery• Conducted by
– Local Government / Ministry of Interior– Military – Charity Foundations Team (volunteer
rescue teams)
Different from the WHO recommendation
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Body search and recovery
• Performed after rescued survivors
• Transferred bodies to temporary morgues
• No central coordinator, not in a good order
• Did not map the location where the bodies found
• Did not label the corpses
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Examination of bodies
Morgue sites• Established in the
affected area by forensic teams and local government
• Using temples or public areas
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Setting in the temporary morgues
• Holding area– On the floor– In the pavilion of
temples
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• Examination Area– On the site – sunny and
temperature up to 39 ˚C
– performed examination on the ground, no facilities
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Body identification
Phase 1. Conducted by local authorities then released at scene.
Phase 2. Conducted by Thai forensic teams from many institutes (1-2 weeks)
Phase 3. Conducted under the TTVI operations (Thai authorities Thai forensic team and international DVI teams)
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Body identification
1. Conducted by local authorities then released at scene.– Families came and identified victims at
scene.
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Body identification2. Examined by Thai forensic teams from
various institutes.– Using institute’s protocol
• Labeling number to the cases• Photographing• Recording external appearance, personal
belongings and specific marks.• Collecting DNA specimens
• No committee nor meeting together before start working.
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Finger printing
• Conducted by crime scene investigation police
• performed about 600 cases
• Reasons not to collect all of the cases– Lack of cooperation between relevant
authorities– Not enough staff– Bodies were decomposed
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Dental examination• Occurred on the fifth day after the disaster
• Organized by the Thai Dentist Council
• Conducted by the Thai dentists from– Various universities - Government hospitals– Private hospitals and clinics
• About 550 dentists, mostly were not forensic dentists
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Identification and released of the bodies
No. of deaths
Identified by local authorities
Examined by Thai Forensic team before TTVI
Released by Thai Forensic team before TTVI
5,395 213 3,698 1,390
Almost identified by external and physical appearance
Summary of identifications, examinations and releases by Thai forensic teams
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Summary of victims identified by Dental record during the early phase
No. of deaths
Dental examination by Thai Dentist t
eam
Identified and released based on de
ntal records
5,395 2070 111
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DNA analysis
• Specimen collection from post mortem– Buccal during the first few days– Hairs during the first few days– Muscle during the first few days– Rib– Tooth– Femur
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DNA Laboratories
• Department of Forensic Medicine, Siriraj hospital
• Forensic unit, Ramathibody hospital
• Institute of Forensic Medicine, and Crime Scene Investigation Police Office, Royal Thai Police
• Forensic Science Institute, Ministry of Justice
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Result of DNA analysis from Thai laboratories
AM PM Possible match
1930 cases 664 cases 310*
*In the process of identification or collecting more specimens to compare
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Storage and preservation of the bodies
During the first week
During the end of first weekAfter the second week
Same and differenceFrom WHO recommendation
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Bury the deceased• After a week, without any proper
preservation method and the bodies were more decomposed.
• About 300 corpses from Phang-Nga then were buried after forensic examination, but later the bodies were exhumed and kept in the refrigerated containers for further identification.
• We should emphasis this point in WHO recommendation (how?)
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Assistance for Family members
• To receive victim’s ante mortem data using– local hospital staff– police– volunteers
• No really set up the AM center nor the Family assistance center to help the family members get over with this tragedy and accept for the losses of their loved ones.
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Problems in victim identification
• Management perspective
• Technical perspective
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Problems in victim identification
Management perspective
• Lack of central coordinator and command center.
• No proper storage method and preserve the bodies
• Shortage of available resources response to the situation
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Problems in victim identification
Technical perspective• No single numbering and labeling system• No standard protocol of body examination.• Redundant body examinations• Lack of experienced and number of staff, eg.
forensic dentists, fingerprint experts• Cannot consolidate information to single
system.
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Problems in victim identification
• Lack of ante mortem information from families especially dental records and fingerprints
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Problems in victim identification
Lack of National Mass Fatality plan
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Consolidation of victim identification• Thai Tsunami Victim Iden
tification (TTVI)• International DVI and Thai
forensic teams cooperation under the control of Thai authorities
• All bodies were treated equally using the Interpol DVI examination protocal.
• All the information are consolidated into a single system
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Temporally morgue in
Phang-Nga under TTVI
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Temporally morgue in Phuket under TTVI
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Number of bodies examined, identified and released under TTVI operation
Body examination (including additional examination)
Identified and released (cases)
Bodies unidentified (cases)
3,684 1,468 2,230
Source: TTVI on April 30, 2005
Approximately 41 % of total
deaths in Thailand
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Reconciled bodies by primary evidence
0
200
400
600
800
1000
1200
1400
Dental Fingerprint DNA Physical
83.86 %
14.37 %
0.48% 1.29%
Source: TTVI on April 30, 2005
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At present
• All the unidentified bodies had dental, fingerprints and DNA specimens collected.
• All post mortem data are placed in the TTVI database (PLASS data)
• 2301 ante mortem records are in the system, only 444 from Thai
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Reconciled Thai victims by primary evidence under TTVI (after Feb 3, 05)
0
10
20
30
40
50
60
70
Dental Fingerprint DNA Physical
49 %46 %
2 % 3 %
Source: TTVI on April 30, 2005
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What do we learn?• Identification and return bodies back to
their families is an important health issue related to mass disaster.
• This tsunami devastation is over the expectation and the available resources.
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What do we learn?
• The command center of victim identification is necessary and should be set up as soon as possible and responsible for the whole processes of identification.
• The labeling and numbering should be one system to avoid confounding bodies and data.
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What do we learn?• Preparation of morgue sites as well as
storage system is important at the beginning in order to have a proper work place and avoid any hazard to personnel as well as the environment.
• Data should be consolidated to one system so that it is easy to access by victim’s families.
The local and international ? The language and term used in different countries?
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What do we learn?
• Identification of the victims should based on the external evidences, dental records, fingerprints, and DNA.
–Should not rely only on DNA-
Do we need to confirmed by
other evidence
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What should be done?• National Mass Fatality Plan• System of National Mass Victims
Identification– Recruitment of personnel.– Post mortem storage and examination.– Ante mortem information from families.– Long term storage of unidentified corpses.– Data management– Family assistance
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What should be done?
Since the severity of any disaster may not be predicted exactly, preparation of the relevant resources may not enough.
International cooperation and assistance are necessary and play an important role in an international disaster.
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Legal Health
Interpol-DVI D.M.O.R.T WHO
SEARO VEPRO PAHO
Red Cross
Member countries
U.S.A.
National mass fatality plan
National mass fatality plan
Regional plan
National mass fatality plan
National mass fatality plan
Regional plan National mass fatality plan
National mass fatality plan
Regional plan
ADOP
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The best way to pay The best way to pay respect to the Tsunami respect to the Tsunami
victims is to use the victims is to use the lessons learned to create lessons learned to create
a safer future.a safer future.
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