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Dr. Pongruk SRIBANDITMONGKOL Department of Forensic Medicine,

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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 SRIBANDITMONGKOL Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Thailand

2 Prepared by Dr. Pongruk Sribanditmongkol Dr. Porn Pongpanitanont Dr. Nop Porntrakulseree Dr. Maythinee Petju Dr. Supachai Kunaratanapruk Pol.Lt.Col. Pattana Kitkailass, MD Pol.Col. Pornpraseart Ganjanarintr Gen Nopadol Somboonsub

3 Country information THAILAND USA Surface Area 514,000 sq km
Population Doctor Forensic Doctor 64,865,523 30,000 70 293,027,571 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%

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 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.

7 Tsunami hit Thailand 10:05 hours Max. height 4-10.6 m (12-32 feet)

8 Causes destructions to the beaches

9 Cause destructions to the land

10 Mass fatalities

11 Summary of the human toll caused by the tsunami as of 23 March 2005
Countries Dead Missing Displaced Homeless Indonesia* 220,153 - 400,062 n/a Sri Lanka 31,147 4,115 519063 480000 India 16,389 647599 20000 Maldives 82 26 21663 Na Thailand 5,395 2932 Myanmar 90 10 3200 Malaysia 68 12 4296 East Africa 312 158 2320 Total 273,636* 7,253 >1,590,707 >507,496 From MOPH, Thailand * 265,000 – 3140,000

12 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 5,395 reported by the Thai authorities Official figures as at 24 March Photo from

13 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

14 Management of Dead Bodies in Thailand
Coordinated by Responsible Institution Supported by Inter-institution Teams Search and Recovery Identification Storage and preservation Final Arrangement Assistance for Family members

15 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

16 Inter-institution Team
academic institutes local government military police Public Health NGO volunteers

17 Body search and recovery
Conducted by Local Government / Ministry of Interior Military Charity Foundations Team (volunteer rescue teams) Different from the WHO recommendation

18 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

19 Examination of bodies Morgue sites
Established in the affected area by forensic teams and local government Using temples or public areas

20 Setting in the temporary morgues
Holding area On the floor In 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 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)

23 Body identification 1. Conducted by local authorities then released at scene. Families came and identified victims at scene.

24 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.

25 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

26 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

27 Identification and released of the bodies
Summary of identifications, examinations and releases by Thai forensic teams 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

28 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 5,395 2070 111

29 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

30 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

31 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

32 Storage and preservation of the bodies
During the first week After the second week During the end of first week Same and difference From WHO recommendation

33 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?)

34 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.

35 Problems in victim identification
Management perspective Technical perspective

36 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

37 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.

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 authorities All bodies were treated equally using the Interpol DVI examination protocal. All the information are consolidated into a single system

41 Temporally morgue in Phang-Nga under TTVI

42 Temporally morgue in Phuket under TTVI

43 Approximately 41 % of total deaths in Thailand
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 Approximately 41 % of total deaths in Thailand Source: 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 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

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 evidence Identification 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 Identification Recruitment of personnel. Post mortem storage and examination. Ante mortem information from families. Long term storage of unidentified corpses. Data management Family 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
ADOP Legal Health Interpol-DVI D.M.O.R.T WHO Red Cross U.S.A. SEARO VEPRO PAHO Member countries National mass fatality plan Regional plan National mass fatality plan Regional plan National mass fatality plan Regional plan

54 The best way to pay respect to the Tsunami victims is to use the lessons learned to create a safer future.

55 Thanks for your attention

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