Presentation on theme: "Dr. Pongruk SRIBANDITMONGKOL Department of Forensic Medicine,"— Presentation transcript:
1 General Aspects Regarding Management of Dead Bodies; Tsunami Victim Identification in Thailand Dr. Pongruk SRIBANDITMONGKOLDepartment of Forensic Medicine,Faculty of Medicine,Chiang Mai University, Thailand
3 Country information THAILAND USA Surface Area 514,000 sq km PopulationDoctorForensic Doctor64,865,52330,00070293,027,571Distribution0-14 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$37,800Labour forceagriculture 49%industry 14%services 37%agriculture 1%industry 39%services 60%
4 Scope of presentation Tsunami victim identification in Thailand What have been done?What did not work?What do we learn?What should be done?
5 December 26, 2004, a 9.0 Richter scale earthquake occurred north of Sumatra Island.
6 struck countries on the coast of the Indian Ocean, including Thailand Caused a huge tsunamistruck countries on the coast of the Indian Ocean, including Thailandfrom Manfred Leier, World Atlas of the Oceans, 2000, Firefly Books, Buffalo NY, USA.
7 Tsunami hit Thailand 10:05 hours Max. height 4-10.6 m (12-32 feet)
11 Summary of the human toll caused by the tsunami as of 23 March 2005 CountriesDeadMissingDisplacedHomelessIndonesia*220,153-400,062n/aSri Lanka31,1474,115519063480000India16,38964759920000Maldives822621663NaThailand5,3952932Myanmar90103200Malaysia68124296East Africa3121582320Total273,636*7,253>1,590,707>507,496From MOPH, Thailand* 265,000 – 3140,000
12 The number of deaths in Thailand ProvinceNo. of DeathsRanong160Phang Nga4,224Phuket279Krabi721Trang5Satun6Total5,395reported by the Thai authorities Official figures as at 24 MarchPhoto from
13 Forensic AspectUnder the Thai law, a forensic investigation is required for these types of deaths.In general, the purpose isto identify the victimto determine the time and place of deathto determine the cause and manner of death.main purpose fortsunami victims
14 Management of Dead Bodies in Thailand Coordinated byResponsible InstitutionSupported byInter-institution TeamsSearch and RecoveryIdentificationStorage and preservationFinal ArrangementAssistance for Family members
15 Responsible Institution At the beginning- not clear, no command center related to management of dead bodiesDuring the early period; underDepartment of Disaster Prevention and Mitigation, Ministry of InteriorThe Royal Thai PoliceThe Ministry of Public HealthJan 13, 2005; Set up The Tsunami Victim Identification Executive Committee, chaired by the Minister of Interior
16 Inter-institution Team academic instituteslocal governmentmilitarypolicePublic HealthNGOvolunteers
17 Body search and recovery Conducted byLocal Government / Ministry of InteriorMilitaryCharity Foundations Team (volunteer rescue teams)Different from the WHO recommendation
18 Body search and recovery Performed after rescued survivorsTransferred bodies to temporary morguesNo central coordinator, not in a good orderDid not map the location where the bodies foundDid not label the corpses
19 Examination of bodies Morgue sites Established in the affected area by forensic teams and local governmentUsing temples or public areas
20 Setting in the temporary morgues Holding areaOn the floorIn the pavilion of temples
21 Examination Area On the site sunny and temperature up to 39 ˚C performed examination on the ground, no facilities
22 Body identificationPhase 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)
23 Body identification1. Conducted by local authorities then released at scene.Families came and identified victims at scene.
24 Body identification2. Examined by Thai forensic teams from various institutes.Using institute’s protocolLabeling number to the casesPhotographingRecording external appearance, personal belongings and specific marks.Collecting DNA specimensNo committee nor meeting together before start working.
25 Finger printing Conducted by crime scene investigation police performed about 600 casesReasons not to collect all of the casesLack of cooperation between relevant authoritiesNot enough staffBodies were decomposed
26 Dental examination Occurred on the fifth day after the disaster Organized by the Thai Dentist CouncilConducted by the Thai dentists fromVarious universities - Government hospitalsPrivate hospitals and clinicsAbout 550 dentists, mostly were not forensic dentists
27 Identification and released of the bodies Summary of identifications, examinations and releases by Thai forensic teamsNo. of deathsIdentified by local authoritiesExamined by Thai Forensic team before TTVIReleased by Thai Forensic team before TTVI5,3952133,6981,390Almost identified by external and physical appearance
28 Summary of victims identified by Dental record during the early phase No. of deathsDental examination by Thai Dentist teamIdentified and released based on dental records5,3952070111
29 DNA analysis Specimen collection from post mortem Buccal during the first few daysHairs during the first few daysMuscle during the first few daysRibToothFemur
30 DNA Laboratories Department of Forensic Medicine, Siriraj hospital Forensic unit, Ramathibody hospitalInstitute of Forensic Medicine, and Crime Scene Investigation Police Office, Royal Thai PoliceForensic Science Institute, Ministry of Justice
31 Result of DNA analysis from Thai laboratories AMPMPossible match1930 cases664 cases310**In the process of identification or collecting more specimens to compare
32 Storage and preservation of the bodies During the first weekAfter the second weekDuring the end of first weekSame and differenceFrom WHO recommendation
33 Bury the deceasedAfter 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?)
34 Assistance for Family members To receive victim’s ante mortem data usinglocal hospital staffpolicevolunteersNo 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.
35 Problems in victim identification Management perspectiveTechnical perspective
36 Problems in victim identification Management perspectiveLack of central coordinator and command center.No proper storage method and preserve the bodiesShortage of available resources response to the situation
37 Problems in victim identification Technical perspectiveNo single numbering and labeling systemNo standard protocol of body examination.Redundant body examinationsLack of experienced and number of staff, eg. forensic dentists, fingerprint expertsCannot consolidate information to single system.
38 Problems in victim identification Lack of ante mortem information from families especially dental records and fingerprints
39 Problems in victim identification Lack of National Mass Fatality plan
40 Consolidation of victim identification Thai Tsunami Victim Identification (TTVI)International DVI and Thai forensic teams cooperation under the control of Thai authoritiesAll bodies were treated equally using the Interpol DVI examination protocal.All the information are consolidated into a single system
43 Approximately 41 % of total deaths in Thailand Number of bodies examined, identified and released under TTVI operationBody examination (including additional examination)Identified and released (cases)Bodies unidentified (cases)3,6841,4682,230Approximately 41 % of total deaths in ThailandSource: TTVI on April 30, 2005
44 Reconciled bodies by primary evidence 83.86 %14.37 %0.48%1.29%Source: TTVI on April 30, 2005
45 At presentAll 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
46 Reconciled Thai victims by primary evidence under TTVI (after Feb 3, 05) 49 %46 %2 %3 %Source: TTVI on April 30, 2005
47 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.
48 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.
49 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?
50 Do we need to confirmed by other evidence What do we learn?Do we need to confirmed by other evidenceIdentification of the victims should based on the external evidences, dental records, fingerprints, and DNA.Should not rely only on DNA-
51 What should be done? National Mass Fatality Plan System of National Mass Victims IdentificationRecruitment of personnel.Post mortem storage and examination.Ante mortem information from families.Long term storage of unidentified corpses.Data managementFamily assistance
52 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.
53 Legal Health Interpol-DVI D.M.O.R.T SEARO VEPRO PAHO Member countries ADOPLegalHealthInterpol-DVID.M.O.R.TWHORed CrossU.S.A.SEAROVEPROPAHOMember countriesNational massfatality planRegional planNational massfatality planRegional planNational massfatality planRegional plan
54 The best way to pay respect to the Tsunami victims is to use the lessons learned to create a safer future.