The role of orthodontics in children identification: a case report of two victims of mass disaster.

INTRODUCTION: Human Identification based on dental evidence cannot be accomplished if antemortem dental records are unavailable or of poor quality. The involvement of the orthodontist in mass disaster victim identification processes may be crucial in relation to the amount and quality of the records which can be obtained before, during, and following the treatment. AIM: The aim of the study is the description of the contribution of the findings drawn from orthodontic records to the identification of victims of mass disasters who had received an orthodontic treatment, through the presentation of two cases. The first case involves the identification of a child victim of a plane crash and the second case involves the identification of two identical twin girls who died in a fire. In both cases, the identification was based on the findings obtained from the ante-mortem records provided by the orthodontist. CONCLUSIONS: The orthodontists apply customized orthodontic appliances and keep a comprehensive file of images, casts, radiographs, and other records in their practice. As a result, they can make a substantial contribution to the identification of young people or even adult victims of mass disasters in any case in which the authorities make a request.

Corpse identification in mass disasters and other violence: the ethical challenges of a humanitarian approach.

In October 2022, the Centre for Ethics of Yenepoya University hosted a national workshop entitled: "Respect for human dignity of the unidentified dead from mass disasters and other violence: strategies for the ethical management of biological samples and personal data". The aim was to explore and share experience and ethical considerations regarding the management and identification of human remains in the event of disasters, with the purpose to arrive at a general consensus about what constitutes the ethical foundation of the management of unidentified human remains in forensic practice and, in particular, contextualizing this in India. The main ethical consideration that emerged was tracing the missing and identifying the dead are crucial to maintaining or restoring basic human rights and responsible relief activities. Identification is not only an organizational and scientific achievement but, regardless of circumstances, also necessarily and always an activity with significant political, epistemic, and philosophical relevance and consequence. In India, it could be important to consider new legal provisions for the management of human samples so that this would provide a starting point for the treatment of human remains managed for forensic purposes with uniformity in the country. Another important step in which governments should take part regards the involvement and education of the general public to develop their interest in this important goal. In the field of forensic anthropology, artificial intelligence can support, through the use of algorithms, the decision-making process that leads to the identification of the victim or its remains. Furthermore, they can be used to extract new knowledge from huge databases and shorten identification through computer automation of data binding activities. Applying artificial intelligence tools in forensic sciences to collect new information from massive datasets to enhance knowledge, and reduce human subjectivity and errors, provides a greater scientific basis that could improve the strength of the evidence and support the admissibility of expert evidence. In light of the general lack of national/international guidance about ethical oversight for identification and care of human remains, the fact that regulations are frequently not adequate to govern ethical aspects, we hope that an internationally recognized body should develop such guidance in collaboration with relevant organizations.

Mass fatality and disaster response preparedness across medical examiner and coroner offices in the United States.

With the rise of mass fatalities and disasters, access to mass fatality and disaster planning trainings and resources available to medical examiners and coroners (MECs) in the United States should be reviewed. This paper provides a necessary update on the extent of access to these resources by analyzing data from the 2018 Census for Medical Examiner and Coroner Offices (CMEC). Results show that a high percentage of respondents have access to mass fatality and disaster planning trainings/resources; however, the access is disproportionate. Respondents in the Midwest and South-and those with smaller populations-have less access to resources, while agencies with larger budgets and more full-time staff have more access to resources. This paper discusses potential contributing factors for these disparities, but the data only begin to elucidate gaps in access to mass fatality and disaster planning trainings/resources for MECs and where further research should be conducted.

Validation of the InnoXtract™ DNA extraction method for bone, teeth, and rootless hair.

Forensic casework samples often include human hairs, teeth, and bones. Hairs with roots are routinely processed for DNA analysis, while rootless hairs are either not tested or processed using mitochondrial DNA. Bones and teeth are submitted for human remains identifications for missing persons and mass disaster cases. DNA extraction from these low templates and degraded samples is challenging. The new InnoXtract DNA extraction method utilizes magnetic beads that are optimized to bind small DNA fragments, as small as 100 base pairs, to purify high-yield DNA from compromised samples. This validation study evaluates InnoXtract's ability to obtain amplifiable DNA from samples such as rootless hairs and skeletal remains. Studies performed include sensitivity, stability, repeatability, reproducibility, non-probative samples, and comparison to standard organic extractions. Sensitivity studies demonstrate average yield recoveries ranging from 53% to 100% and 73% to 85% for the InnoXtract hair and bone methods, respectively. Studies demonstrate consistent results across a range of sample types, such as insulted and un-insulted bone and teeth, as well as hair shafts from donors of various ages, gender, race, and hair characteristics. The InnoXtract bone method outperformed organic extraction. The method was successfully automated on a MagMAX™ Express-96, with recoveries over 70% relative to the manual version. InnoXtract has the potential as an automated high-throughput, high-yield bone extraction method with 6 h of total extraction time for up to 96 samples. The validation study results demonstrate that the InnoXtract kits produce high-yield and high-quality DNA from compromised bone, teeth, and hair shaft samples.

The urgent need to achieve an optimal strategic stock of human allogeneic skin graft materials in case of a mass disaster in Poland.

A burn is a sudden injury which immediate or long-term consequences may be life-threatening for the patient. A mass disaster event may involve large numbers of severely burned patients. Patients of this type typically have a limited area of healthy, unburned skin from which an autologous split thickness skin graft could be collected. In a clinical situation of this type, it is necessary to use a particular skin substitute. Non-viable allogeneic human skin graft materials might be considered as the most suitable skin substitutes in the treatment of such patients. At present, Poland does not have a sufficient supply of human allogeneic skin graft materials to meet the needs arising from a sudden and unforeseen mass disaster. This study involved an analysis of selected mass disasters. From this an estimate was made from a verified casualty profile of the necessary minimum stock of human allogeneic skin graft materials. An insufficient amount of skin results from an inadequate number of skin donors, which in turn results from the current tissue donation system. Therefore, a proposal has been made for the organizational, legal and systemic changes required to improve the situation in Polish transplantology, with particular emphasis on skin donation. In order to achieve a strategic stock of human skin grafts, a tissue collecting transplantation team should be organized. The rights and obligations of the non-physician transplant team member should be extended. Proposals have been made for awareness campaigns (adverts, posters etc.) and educational schemes (educational video, lectures during transplant coordinator training, etc.). Finally, a proposal has been made for possible methods to deal with the logistic management of the allogeneic skin stock. The required, essential stock of human allogeneic skin in the event of a mass disaster has been estimated at 600,000 cm2.

Management of Mass Death in COVID-19 Pandemic in an Indian Perspective.

Current international experience has shown the vulnerability of health-care systems of developed nations, and of developing nations such as India, to coronavirus disease 2019 (COVID-19). COVID-19 pandemic is a disaster with mass casualties. International experience has revealed that, even in the countries where mass disasters are less frequent and not involved in conflicts, they are overwhelmed with COVID-19 deaths. Although, in the current scenario with fewer deaths, India's health-care system can handle the situation of COVID-19 but should be prepared for the worst in terms of appropriate management, and adequate infection prevention measures including handling the dead without hampering the dignity of the deceased and of the surviving family. Before any crisis overwhelms responders and resources, emergency response plans should be established and activated to ensure the reliable identification and documentation of the dead. The current review was carried out to recommend the proper management of dead bodies in the COVID-19 mass disaster with a particular focus on resource-poor countries, such as India.

Handling The Identification of Burn Victims in A Traffic Accident: A DVI Case Report

@#The role of the forensic pathologist in a mass disaster is to identify the victims. The procedure refers to Interpol’s Disaster Victim Identification (DVI) guidelines. DVI consists of 4 stages namely Scene Examination, Post-Mortem Examination, Ante-Mortem Examination, and Reconciliation. Post-Mortem (PM) and Ante-Mortem (AM) data collected include fingerprints, dental records, DNA as Primary Identifiers, medical records, and property as Secondary Identifiers. At the reconciliation stage, at least there must be a match between one Primary Identifier or two Secondary Identifiers. Theoretically, 4-phase DVI should be performed according to the DVI standard in every disaster case. In fact, the implementation of DVI encountered many obstacles in the field. This article discusses the various obstacles and problems faced when conducting DVI in the case of a car accident with a truck on the Madiun-Ngawi toll road at KM 631 A to the Madiun – Nganjuk toll road. The chronology of this incident began when the elf’s vehicle hit a truck and a concrete barrier and then caught fire. Three victims were found in a burned condition leaving only the skeleton, thigh and psoas muscle. This of course does not allow fingerprints to be checked. The identification process is carried out only by comparing primary and secondary data as an identification guide given the condition of the bodies that are only slightly left. Then DNA examination was not carried out in this identification process. Tests for CO levels showed that the three victims indicated CO poisoning before they died.

Explosion-related deaths: An overview on forensic evaluation and implications.

PURPOSE: Explosion-related deaths are uncommon events which require expertise and confidence so that an appropriate death investigation can be performed. The present study aims to provide a detailed forensic analysis of the issues and implications arising in the event of an explosion. METHODS: A retrospective review of casualty data was conducted on electronic literature databases. Cases concerning deadly explosions registered at the Milan Institute of Legal Medicine were examined and analyzed altogether. RESULTS: Explosions may involve closed or open systems. A security assessment of the site is always necessary. Alterations of the site due to rescue procedures can occur; thus, on-site forensic investigation should be adapted to the environment. Then, a study protocol based on autopsy procedures is presented. Application of the postmortem radiology enforces forensic procedures both for the analysis of blast injuries and skeleton fractures, and for identification purposes. Blast injuries typically cause lacerations of the lungs, intestine and major vessels; moreover, hyoid fractures can be documented. Histopathology may help to define blast injuries effectively. Forensic chemistry, toxicology and ballistics provide useful investigative evidence as well as anthropology and genetics. Different forensic topics regarding explosions are discussed through five possible scenarios that forensic pathologists may come across. Scenarios include self-inflicted explosion deaths, domestic explosions, work-related explosions, terrorist events, and explosions caused by accidents involving heavy vehicles. CONCLUSION: The scenarios presented offer a useful instrument to avoid misinterpretations and evaluation errors. Procedural notes and technical aspects are provided to the readers, with an insight on collaboration with other forensic experts.

Forensic considerations on the two major civilian terrorist events occurred in Milan: A retrospective autopsy-based study.

Explosion-related deaths are a disregarded topic of forensic sciences, despite the pivotal role of the forensic pathologist in such investigations. In fact, very few scientific articles have been published up to now, even if there is a considerable increase of terrorist attacks worldwide due to the use of improvised explosive devices (IEDs). In this paper, the authors show a retrospective autopsy-based study on the two major civilian terrorist events which occurred in Milan (Italy). The first one took place in a closed system, where a gelignite bomb was set inside the National Agriculture Bank in December 1969. 17 people were killed, and all of them underwent forensic autopsies, which were performed at the Milan Institute of Legal Medicine. The second event took place in an open system, where a car bomb exploded in Palestro Street in July 1993. 5 people were killed, forensic autopsies were performed as well. A total of 22 explosion-related deaths were assessed in this study. For each victim, the analysis of clothes, external and internal examinations were reported; furthermore, a statistical analysis using Fisher's exact test was carried out in order to show differences among blast injuries that occurred in a closed system versus an open system. The analysis of the autopsy reports, which included the descriptions of clothes, and the injury patterns allowed a possible reconstruction of the bodily exposure side of the victims in relation to the origin site of the explosive devices.

Detecting volatile organic compounds to locate human remains in a simulated collapsed building.

The occurrence of mass disasters has increased worldwide due to changing environments from global warming and a heightened threat of terrorism acts. When these disasters strike, it is imperative to rapidly locate and recover human victims, both the living and deceased. While search and rescue dogs are used to locate the living, cadaver detection dogs are typically tasked with locating the dead. This can prove challenging because commingling of victims is likely to occur during disasters in populated areas which will impact the decomposition process and the resulting odour produced. To date, there has been no research to investigate the process of human decomposition in a mass disaster scenario or to understand which compounds are detectable by cadaver detection dogs. Hence, the current study investigated the human decomposition process and subsequent volatile organic compound (VOC) production in two simulated building collapse scenarios with six human donors placed in each scenario. The human remains were only recovered after a period of one month, during which time VOC samples were collected and analysed using comprehensive two-dimensional gas chromatography coupled with time-of-flight mass spectrometry. A considerable degree of differential decomposition was observed upon recovery of the human remains, which was carried out as a part of a police disaster victim recovery training exercise. The location of the bodies in the disaster area was found to impact the decomposition process. The VOC profile was found to correlate with the decomposition process. Fifteen days following the simulated disaster, the VOC profile changed showing that a detectable change in the decomposition process had occurred. Overall, the changing VOC profile can inform the training of cadaver detection dogs for these unique scenarios.

Comparison of air dose and operator exposure from portable X-ray units.

This study was aimed at investigating and comparing exposure dose of workers and the surrounding workers. In addition, worker's exposure was also measure about lens and finger. Four intraoral portable X-ray units were evaluated. The stray radiations were measured using Pitman 37D and ionization chamber (Pitman). MyDosemini (ALOKA) was used for measurement of the finger exposure dose. Without the shield became high in anterior 0.5 m. Comparing the air dose for the four models used in this study showed a high tendency for the two NOMAD models. And using the shields, the images could be taken 4.6 times of the baseline at a maximum and 3.6 times on average. The finger radiation exposure dose was low with both of the NOMAD models, with no significant difference found. By setting the baseline value without a shield, finger radiation exposure when using a shield was lower than the detection limit for the D3000, and was reduced by approximately 94-96% for other three models. All models can photograph around 100 bodies, so it is considered that it is not necessary to switch out the operator considering the operation limit. But even if it does not reach the operation limit, the stochastic effects of radiation exposure can be increased as well as the deterministic effects of the operation limit. The operator and the surrounding workers seek to protect themselves. It is important to perform exposure management that takes into account the stochastic effects to the operator and the surrounding workers.

Increasing ventilator surge capacity in COVID 19 pandemic: design, manufacture and in vitro-in vivo testing in anaesthetized healthy pigs of a rapid prototyped mechanical ventilator.

OBJECTIVE: The advent of new technologies has made it possible to explore alternative ventilator manufacturing to meet the worldwide shortfall for mechanical ventilators especially in pandemics. We describe a method using rapid prototyping technologies to create an electro-mechanical ventilator in a cost effective, timely manner and provide results of testing using an in vitro-in vivo testing model. RESULTS: Rapid prototyping technologies (3D printing and 2D cutting) were used to create a modular ventilator. The artificial manual breathing unit (AMBU) bag connected to wall oxygen source using a flow meter was used as air reservoir. Controlled variables include respiratory rate, tidal volume and inspiratory: expiratory (I:E) ratio. In vitro testing and In vivo testing in the pig model demonstrated comparable mechanical efficiency of the test ventilator to that of standard ventilator but showed the material limits of 3D printed gears. Improved gear design resulted in better ventilator durability whilst reducing manufacturing time (< 2-h). The entire cost of manufacture of ventilator was estimated at 300 Australian dollars. A cost-effective novel rapid prototyped ventilator for use in patients with respiratory failure was developed in < 2-h and was effective in anesthetized, healthy pig model.

Social contribution of forensic odontology in Japan.

Half a century has passed since the department for education and research on forensic odontology was established at dentistry-related universities in Japan in 1964. In order to meet the demands of society, the number of universities with a department of forensic odontology increased up until around 2005. In 2007, the Japanese Society of Forensic Dental Science was established, and then a series of reforms such as establishment of the Study Council on Death Cause Investigation in both the National Police Agency and the Cabinet Office of the Japanese government, cabinet decision of enactment and enforcement of new laws on death cause investigation, publication of an article on the Model Core Curriculum of Dental Education, publication of the results of a fact-finding survey on education and research on forensic odontology conducted by the Ministry of Education, Culture, Sports, Science and Technology, inclusion of questions about forensic odontology in the National Board Dental Examination, and compilation of a database on dental findings by the Ministry of Health, Labor and Welfare, proceeded in succession. We introduced the half century of forensic odontology in Japan in chronological order.

The use of FTA cards to acquire DNA profiles from postmortem cases.

Filter papers have been used for many years in different applications of molecular biology and have been proven to be a stable way to store DNA waiting to be analyzed. Sampling of DNA on FTA (Flinders Technology Associates) cards is convenient and cost effective compared to alternative approaches involving DNA extractions and storage of DNA extracts. FTA cards are analyzed at many forensic laboratories, and the way to perform direct genetic profiling on buccal swab cards has developed into an almost industrial process. The possibility to include postmortem (PM) samples into an FTA-based workflow would facilitate and speed up the genetic identification process compared to conventional methods, both on a regular basis and in a mass casualty event. In this study, we investigated if FTA cards may be used to carry tissue DNA from deceased and present a high-quality DNA profile from the individual in order to be useful for the identification process. The study also aimed to investigate if a specific body tissue would be preferable, and if decomposed tissue is suitable at all to put on an FTA card in order to obtain a DNA profile. We have compared the quality of the DNA profiles acquired from postmortem tissue on FTA cards, with the results acquired with conventional methods from reference bone/muscle samples from the same individual. Several types of tissues have been tested from different identification cases and scenarios. We concluded that tissue cells from inner organs are suitable to put on FTA cards, and that the obtained DNA profiles have the potential to serve as PM data for identification purposes. In cases including compromised samples, however, it is recommended to keep the tissue sample as a backup if further DNA has to be extracted.

Developmental dental anomalies and their potential role in establishing identity in post-mortem cases: a review.

Teeth may provide useful forensic evidence owing to features like uniqueness, stability and comparability. Moreover, the human dentition is heterodont, i.e. all the teeth have different morphology - incisors, canines, premolars and molars. There are sometimes deviations from normal morphology, such as the presence of extra teeth, variation in their shape and size eg the presence of an extra cusp, fractured crown/root, Carabelli's cusp, peg laterals, transpositions, fusion, etc. These differences can help forensic personnel identify bodies, especially where other methods of identification like facial features, fingerprints or DNA typing cannot yield satisfactory results as in cases of badly decomposed bodies, burnt remains, mass disasters, etc. Identification from dentition is based on the direct comparison of post-mortem dental profiles with ante-mortem dental records of the deceased. This article aims to review these developmental and morphological dental traits and their role in post-mortem identification.

Forensic answers to the 14th of July 2016 terrorist attack in Nice.

The terrorist attack of July 14, 2016 in Nice (France) was a devastating event. A man voluntarily drove a truck into a crowd gathered for the fireworks display on the seaside "Promenade des Anglais," plowing pedestrians down over more than 2 km before being shot dead. At the time of this report, a total of 86 casualties and more than 1200 formal complaints for physical and psychological injuries have been recorded. The aim of this work is to describe the forensic management of this event and its immediate aftermath. This paper reaffirms the basic tenets of disaster management: a single place of work, teamwork in times of crisis, a single communication channel with families and the media, and the validation of the identifications by a multidisciplinary commission. This paper highlights other essential aspects of the organization of the forensic effort put in place after the Nice attack: the contribution of the police at the crime scene, the cooperation between the disaster victim identification (DVI) team, and the forensic pathologists at the morgue, applying the identification (ID) process to unconscious victims in the intensive care unit, the input of volunteers, and the logistics associated with the management of the aftermath of the event. All of the victims were positively identified within 4 and a half days. For the first time in such a paper, the central role of medical students in the immediate aftermath of the disaster is outlined. The need to address the possible psychological trauma of the non-medical and even the medical staff taking part in the forensic effort is also reaffirmed.

DNA identification of compromised samples with massive parallel sequencing.

Genetic profiling is a standard procedure for human identification, i.e. in criminal cases and mass disasters, and has been proven to be an important part in the process in the repatriation of victims to their relatives. In the event of a catastrophe whether it be a natural disaster, terror attack or accident, fatalities of many nationalities may be a consequence and international collaboration becomes necessary. Current DNA techniques used on a routine basis at forensic laboratories world-wide are very useful, and results reported from different labs are compared, making it possible to be matched in order to declare the identification of a victim. Statistical calculations of possibilities of a random match are achievable since population data from many parts of the world are available. However, decomposition and degradation of the remains are not uncommon in the aftermath of a catastrophe and hence it may be difficult to retrieve detailed DNA profiles from such samples. Massive parallel sequencing (MPS) is a technique capable of producing a vast amount of DNA sequence data in a high-through put manner, and panels of single nucleotide polymorphism (SNP) markers allow the amplification of small DNA fragments, often seen in compromised samples. Here, we report the results from a set of 10 samples from missing person identification cases, analyzed with an MPS based method comprising 131 SNP markers and compared with direct reference material or buccal swab samples collected from relatives of the deceased. We assess the weight of evidence of a match by statistical calculation. Furthermore, we compare results reported on different platforms using different SNP panels, and conclude that more work has to be done if results from missing person identification cases analyzed on MPS with SNP panels at different laboratories are to be fully reliable and thus comparable.

Investigation of Different Ways in Which the CODIS 7.0 May be Used in Mass Disaster Identification.

DNA analysis is a key method for the identification of human remains in mass disasters. Reference samples from relatives may be used to identify missing persons by kinship analysis. Different methods of applying the CODIS in disaster victim identification (DVI) were investigated. Two searches were evaluated: (i) relating family relatives to a pedigree tree (FPT) and (ii) relating unidentified human remains to a pedigree tree (UPT). A joint pedigree likelihood ratio (JPLR) and rank were calculated for each search. Both searches were similar in average JPLR and rank. In exceptional cases, namely the existence of a mutation different from the CODIS model, a nonbiological father, a mistake in STR, or incorrect profile association, the UPT search returned one true rank, whereas the FPT search returned no results. This paper suggests a novel strategy to overcome these limitations and increase efficiency in conducting identification of mass disaster victims.

Challenges in implementing best practice DVI guidelines in low resource settings: lessons learnt from the Meethotamulla garbage dump mass disaster.

The management of mass fatalities following disasters is a complex process which requires the involvement of multiple stakeholders and resources. A garbage dump at Meethotamulla in Sri Lanka suddenly collapsed, resulting in the death of 32 individuals. Efforts to implement best practice guidelines in Disaster Victim Identification (DVI) during this disaster revealed several important aspects that need to be considered by the forensic community. Delays in initiating the legal processes to investigate and manage the incident resulted in public dissatisfaction towards the post-disaster management process. Body recovery by Police and military personnel without the involvement of medical teams had numerous shortcomings including the lack of proper tagging and photography, commingling of body parts, and non-preservation of personal items. Public expectation and demand for early release of the bodies conflicted with the necessity to undergo a stringent DVI process according to best practice guidelines. Many adaptations and alternate strategies were necessary to ensure that DVI could be done scientifically. The use of primary identification markers including odontology and DNA had many limitations including non-availability of antemortem data, resource availability and cost. Identification was established using a combination of secondary identification markers including clothing, jewelry, scars, tattoos, morphological descriptions and circumstantial evidence. In two cases, odontological features further supported positive identification. Samples for DNA were obtained and preserved but were not utilized in establishing the identities. This paper highlights the need for better public awareness and multidisciplinary commitment in managing mass fatalities and also reflects on the challenges of implementing best practice DVI guidelines in low-resource settings with different legal and socio-cultural expectations.

From unknown to known: Identification of the remains at the mausoleum of fosse Ardeatine.

During the Second World War, on 24th March 1944, 335 Italians were massacred near Rome by the occupying forces of Nazi Germany. Four months later forensic examination led to the identification of 323 out of 335 victims. After approximately 60 years, the identification of the remaining unidentified twelve victims began with anthropological and genetic analysis carried out by a team of Italian forensic experts. Anthropological analysis was performed in field in order to confirm the sex of each victim and verify the presence of only one individual in each grave for a correct sampling. Selected bone fragments for each individual were then collected and transferred to the laboratory for genetic analysis. Although the anthropological ante mortem information was limited, morphological and metrical data was collected for a possible future identification of the victims. Subsequently, the typing of autosomal loci, Y-STR and mtDNA D-loop region of all bone and available reference samples was conducted. LR and cumulative LRs obtained from autosomal STR and Y-STR results confirmed the alleged relationship between three victims and their relatives with values over 104 (one sample) and 106 (two samples). Therefore, the genetic analysis offered the families the possibility of replacing the number of the grave with the name of the victim.