Presentation on theme: "General Aspects Regarding Management of Dead Bodies; Tsunami Victim Identification in Thailand Dr. Pongruk SRIBANDITMONGKOL Department of Forensic Medicine,"— Presentation transcript:
General Aspects Regarding Management of Dead Bodies; Tsunami Victim Identification in Thailand Dr. Pongruk SRIBANDITMONGKOL Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Thailand
Prepared 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
Country information THAILANDUSA Surface Area514,000 sq km9,631,418 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%
Scope of presentation Tsunami victim identification in Thailand –What have been done? –What did not work? What do we learn? What should be done?
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
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
Tsunami hit Thailand 10:05 hours Max. height 4-10.6 m (12-32 feet) http://www.aviation.go.th/rbm/tsunami_files/tsunami.htm#4
Causes destructions to the beaches
Cause destructions to the land
Summary of the human toll caused by the tsunami as of 23 March 2005 CountriesDeadMissingDisplacedHomeless Indonesia*220,153-400,062n/a Sri Lanka31,1474,115519063480000 India16,389-64759920000 Maldives822621663Na Thailand5,3952932Na Myanmar9010Na3200 Malaysia6812Na4296 East Africa3121582320Na Total273,636*7,253>1,590,707>507,496 * 265,000 – 3140,000 From MOPH, Thailand
The number of deaths in Thailand Province No. of Deaths Ranong160 Phang Nga4,224 Phuket279 Krabi721 Trang5 Satun6 Total5,395 reported by the Thai authorities Official figures as at 24 March Photo from http://en.wikipedia.org/wiki/Image:Souththailand.GIF
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
Management of Dead Bodies in Thailand Responsible Institution Inter-institution Teams Search and Recovery Final Arrangement Identification Assistance for Family members Supporte d by Coordinate d by Storage and preservation
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
Inter-institution Team academic institutes local government military police Public Health NGO volunteers
Body search and recovery Conducted by –Local Government / Ministry of Interior –Military –Charity Foundations Team (volunteer rescue teams) Different from the WHO recommendation
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
Examination of bodies Morgue sites Established in the affected area by forensic teams and local government Using temples or public areas
Setting in the temporary morgues Holding area –On the floor –In the pavilion of temples
Examination Area –On the site –sunny and temperature up to 39 ˚C –performed examination on the ground, no facilities
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)
Body identification 1. Conducted by local authorities then released at scene. –Families came and identified victims at scene.
Body identification 2. 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.
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
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
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 5,3952133,6981,390 Almost identified by external and physical appearance Summary of identifications, examinations and releases by Thai forensic teams
Summary of victims identified by Dental record during the early phase No. of deaths Dental examination by Thai Dentist team Identified and released based on dental records 5,3952070111
DNA analysis Specimen collection from post mortem –Buccal during the first few days –Hairs during the first few days –Muscleduring the first few days –Rib –Tooth –Femur
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
Result of DNA analysis from Thai laboratories AMPMPossible match 1930 cases664 cases310* *In the process of identification or collecting more specimens to compare
Storage and preservation of the bodies During the first week During the end of first week After the second week Same and difference From WHO recommendation
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?)
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.
Problems in victim identification Management perspective Technical perspective
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
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.
Problems in victim identification Lack of ante mortem information from families especially dental records and fingerprints
Problems in victim identification Lack of National Mass Fatality plan
Consolidation of victim identification Thai Tsunami Victim Identification (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
Temporally morgue in Phang-Nga under TTVI
Temporally morgue in Phuket under TTVI
Number of bodies examined, identified and released under TTVI operation Body examination (including additional examination) Identified and released (cases) Bodies unidentified (cases) 3,6841,4682,230 Source: TTVI on April 30, 2005 Approximatel y 41 % of total deaths in Thailand
Reconciled bodies by primary evidence 83.86 % 14.37 % 0.48% 1.29% Source: TTVI on April 30, 2005
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
Reconciled Thai victims by primary evidence under TTVI (after Feb 3, 05) 49 % 46 % 2 % 3 % Source: TTVI on April 30, 2005
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.
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.
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?
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
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
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.
Legal Health Interpol-DVID.M.O.R.T WHO SEAROVEPRO 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
The best way to pay respect to the Tsunami victims is to use the lessons learned to create a safer future.