A mass disaster is a catastrophic event where there is almost, always a substantial loss of life as well as damage of property and loss of crops and livestock. It invariably overwhelms the resources of the community directly affected and their capacity to cope or respond to the tragedy. Unfortunately, such tragedies are becoming more common with the increase in terrorism, the expansion of travel facilities, larger size of means of passenger transport, bizarre climatic condition etc.
Experience from recent tragedies like airplane crash, transportation accident, building collapse (fire, explosion etc), industrial accidents, epidemics, environmental conditions (earthquake, cyclone, flood etc), civil riots etc have shown the need of a multidisciplinary approach for the management team. In the recent year, frequent tragic disaster and its management thereof have drawn the attention and scrutiny of the public and have been discussed endlessly in various platforms and flora leading to formulation of Mass Disaster Plan in many places, covering many aspects such as search and rescue service, health care, rehabilitation, reconstruction, preventive measures etc.
However, inspite of drawing many grandiose plans, the management of mass disaster has always been akin to something like ‘locking the stable only when the horse has bolted’. In comparison to the western countries, the scenario in India is pathetic. The management was never been up to the expectation of the public. Analysis of the cause, reviewing of the plan and prevention of recurrence has never been able to come up from the back seat. This is not due to lack of capabilities. Our abilities are not inferior to that of western countries. The vital difference is that we are not been able to recognize and utilize the expertise of our professionals for the job they are trained for. This shortsightedness has led to many serious but preventable socio-economic problems in the recent past. In short, we have been defeated and this has been shown by the repeated recurrence in more sinister forms.
Instead of tackling the problem eye to eye leaving behind any inter-professional differences and making the best use of various professions that may be helpful in the management of mass disaster for the overall benefit of the public, these plans often tends to overlook many crucial disciplines. In fact, in our country, in many of these ‘standard’ Mass Disaster Plans, the role of Forensic Pathologist is often ignored or even if it is mentioned, provision of logistic support is never a priority for the policy makers with obviously no thought as to how crisis could be managed with the hands tied. It is not just making tall claims, but indeed, in western forensic pathologist plays a pivotal role and indispensable in the mass disaster management.
Many are unaware of the importance of preservation and examination of the dead, and still continue to have the age-old casual attitude, obvious of the tremendous development and advancement in this field of science. The consequences of this grave omission will not only cause untold anxiety and misery to the bereaved families but also seriously jeopardize the investigation. Sometimes, even the plan may become useless, as in case of tragedies where there are several hundred corpses, a plan without any provision for the dead will obviously be found lacking, leaving a massive and unprepared crisis in relation to the dead.
Apathy towards this critical important aspect may be due to lack of insight, logistic constraints, ignorance etc. Whatever is the reason, one should not forget that, the manner in which a society deals with its dead reflects its attitude to the sanctity of life and the rights of the individuals, and, our honor to the dead is a reflection of our respect for the society in which we live. Needless to say, the examination of the dead is for the benefit of the living. There are many social, legal and health reasons as to why it is necessary to preserve and examine the dead.
The role of Forensic Pathologist is the management of Mass Disaster may be highlighted here for the benefit of Planners and the society.
1. Establishment of identity of the victim: Identification is not just tightening a mere bureaucratic ‘loose ends’ but gives cognizance of the fundamental human right to have an identity both in life and in death. In a more pragmatic context, the identification of the dead is essential for life of others to proceed and return to normalcy. In almost every disaster, there is an urgent and pressing need to identify the victims. Most people will find little difficulty to establish the identity from the morphological manifestation of an intact body. This seemingly simple process becomes much more complex and difficult to recapture the living appearance of an individual from mutilated, charred or skeletal remains that may be partial or intermingled, which are usually encountered in mass disasters. In such case, forensic pathologist can help in establishing the identity of the
victims from the morphology, anatomy, individual peculiarity, fingerprinting, DNA profiling etc.
The importance and necessity of establishment of identity are as follows:
Humanitarian reason: It is not uncommon, despite having learned about the involvement of loved ones in the tragedies, emotionally traumatized bereaved family often fails to identify their loved ones, which may be due to disfigurement and mutilation of the body, putrefactive changes after death etc. One can imagine how much anxiety and suffering the next of kin would face in such situations. For instance, there is a strong desire on the part of the vast majority of people that their loved ones be identified and fulfill the rightful funeral rituals as per religious and cultural practice rather than to be interred in a mass grave as is necessary if identification cannot be effected.
Sometimes the relief following identification can be short-lived if another bereaved family also claims the same body. Involvement of Forensic Pathologist in the mass disaster management can help ascertain the identity and thus prevent occurrence of these painful states.
The settlement of the following mundane but pressingly practical issues such as: inherence of property, access to bank accounts, pensions, insurance, etc depends on the formal identification of the deceased, recorded in a form of a certificate of death.
Civil court action and litigation relating to issues of liability, eg. on the part of an airline contributing to a disaster needs the identity of the deceased to be formally corroborated. } Similarly, if the incident happened at the workplace, litigation relating to health and safety concerns in the work-place can be initiated with the formal identification of the deceased.
In case of any suspicion of breach of guidelines, regulations or laws by the person at the wheel or the controls at the time of the mishap e.g. any suspicions as to whether such persons were in intoxicated state can be ruled out only after formal establishment of their identities.
Formal identification will enable the authorization for legal disposal of the remains. This allows grieving and funeral rituals to take place - the first steps to be taken to cope with their tragic loss. For initiation of criminal investigation, it is an essential prerequisite to identify the victim.
2. Reconstruction of the mutilated remains for a decent presentation.
3. Proper preservation and handling of the remains by skilled personnel will prevent loss of crucial evidences, check introduction of artifacts and prevent further putrefaction and also reduces health hazards.
4. To determine the cause of the disaster by collecting evidence such as:
Bomb or detonator fragments that may be embedded in the bodies. Toxicological evidence for any evidence of intoxication of the key victims. Pathological evidence to see any disease conditions in the key victims that could have contributed to the disaster.
In case of impending epidemic as well as in tragedies resulting from biological or chemical sabotage, the Forensic Pathologist can help in the detection and diagnosis of the causative agent, which in turn enable the concerned authorities to take necessary preventive measures. Trace evidence to find any physical evidence that could help solve the investigation of the tragedy.
5. To assist in reconstructing the cause of the disaster. This can be achieved by:
Establishing the cause of death particularly the key victims such as pilots, drivers, human bombs etc. Studying the nature and pattern of injuries sustained by the victims to see whether the injuries take the pattern that conforms to other similar incidence. Studying the position of the remains in relation to the wreckage at the site of the tragedy.
6. Establishment of the period of survival of the victims, which is deducible by studying the time since death is required in case of presumption of survivorship. Also it can be helpful to determine whether there was any lapse in the search and rescue operation, and accordingly from the findings necessary corrective measures can be incorporated in the plan.
7. Preventive medicine: Evaluation and analysis of the data during the course of medico-legal investigation can be utilized as a tool for development and improvement of safety measures including workplace e.g. seat belts, airbags, head rests, helmet, leg guards, laminated windshield etc are all developed and improved over the years by studying such data and many of these safety measures has been made mandatory in many countries.
Conclusion:
It is difficult to get most people to consider the unthinkable, yet unimaginable disasters will always occur. This inevitability of disaster should not give rise to fatalistic attitude, for that removes the need to plan and prepare. Today, mass disaster management itself is considered as a discipline. It requires the cooperation and coordination of various professions such as administration, police, medical, forensic experts, fire service, civil defense, public work services (including water and power supply, transport and telecommunication etc), seismologists, hydrologists, geologists, NGOs etc. all these disciplines and professions are essential at different levels in the course of management. In the western countries, Forensic Pathologist plays an integral role in the management of mass disaster. He is a key member in both Disaster Victim Identification as well as Disaster Investigation teams.
Counter disaster plans should be simple, comprehensive and up to date and should be understood by all. A disaster plan should not be something ‘done a few years ago’, gathering dust on the shelf. There is a need for constantly revising the plans to see how good they have been when implemented. This process of review, rehearsal and training should be continuous, so that the oral tradition is every bit as strong as the written manual.
In the words of the famous maxim in QANTAS Airline’s department of safety and environment: ‘If you think safety is expensive, try having an accident’. Such costs are not mere financial consideration. It challenges us all to mitigate accidents and loss of life by the use of good design, workplace practice and counter disaster planning. —
Experience from recent tragedies like airplane crash, transportation accident, building collapse (fire, explosion etc), industrial accidents, epidemics, environmental conditions (earthquake, cyclone, flood etc), civil riots etc have shown the need of a multidisciplinary approach for the management team. In the recent year, frequent tragic disaster and its management thereof have drawn the attention and scrutiny of the public and have been discussed endlessly in various platforms and flora leading to formulation of Mass Disaster Plan in many places, covering many aspects such as search and rescue service, health care, rehabilitation, reconstruction, preventive measures etc.
However, inspite of drawing many grandiose plans, the management of mass disaster has always been akin to something like ‘locking the stable only when the horse has bolted’. In comparison to the western countries, the scenario in India is pathetic. The management was never been up to the expectation of the public. Analysis of the cause, reviewing of the plan and prevention of recurrence has never been able to come up from the back seat. This is not due to lack of capabilities. Our abilities are not inferior to that of western countries. The vital difference is that we are not been able to recognize and utilize the expertise of our professionals for the job they are trained for. This shortsightedness has led to many serious but preventable socio-economic problems in the recent past. In short, we have been defeated and this has been shown by the repeated recurrence in more sinister forms.
Instead of tackling the problem eye to eye leaving behind any inter-professional differences and making the best use of various professions that may be helpful in the management of mass disaster for the overall benefit of the public, these plans often tends to overlook many crucial disciplines. In fact, in our country, in many of these ‘standard’ Mass Disaster Plans, the role of Forensic Pathologist is often ignored or even if it is mentioned, provision of logistic support is never a priority for the policy makers with obviously no thought as to how crisis could be managed with the hands tied. It is not just making tall claims, but indeed, in western forensic pathologist plays a pivotal role and indispensable in the mass disaster management.
Many are unaware of the importance of preservation and examination of the dead, and still continue to have the age-old casual attitude, obvious of the tremendous development and advancement in this field of science. The consequences of this grave omission will not only cause untold anxiety and misery to the bereaved families but also seriously jeopardize the investigation. Sometimes, even the plan may become useless, as in case of tragedies where there are several hundred corpses, a plan without any provision for the dead will obviously be found lacking, leaving a massive and unprepared crisis in relation to the dead.
Apathy towards this critical important aspect may be due to lack of insight, logistic constraints, ignorance etc. Whatever is the reason, one should not forget that, the manner in which a society deals with its dead reflects its attitude to the sanctity of life and the rights of the individuals, and, our honor to the dead is a reflection of our respect for the society in which we live. Needless to say, the examination of the dead is for the benefit of the living. There are many social, legal and health reasons as to why it is necessary to preserve and examine the dead.
The role of Forensic Pathologist is the management of Mass Disaster may be highlighted here for the benefit of Planners and the society.
1. Establishment of identity of the victim: Identification is not just tightening a mere bureaucratic ‘loose ends’ but gives cognizance of the fundamental human right to have an identity both in life and in death. In a more pragmatic context, the identification of the dead is essential for life of others to proceed and return to normalcy. In almost every disaster, there is an urgent and pressing need to identify the victims. Most people will find little difficulty to establish the identity from the morphological manifestation of an intact body. This seemingly simple process becomes much more complex and difficult to recapture the living appearance of an individual from mutilated, charred or skeletal remains that may be partial or intermingled, which are usually encountered in mass disasters. In such case, forensic pathologist can help in establishing the identity of the
victims from the morphology, anatomy, individual peculiarity, fingerprinting, DNA profiling etc.
The importance and necessity of establishment of identity are as follows:
Humanitarian reason: It is not uncommon, despite having learned about the involvement of loved ones in the tragedies, emotionally traumatized bereaved family often fails to identify their loved ones, which may be due to disfigurement and mutilation of the body, putrefactive changes after death etc. One can imagine how much anxiety and suffering the next of kin would face in such situations. For instance, there is a strong desire on the part of the vast majority of people that their loved ones be identified and fulfill the rightful funeral rituals as per religious and cultural practice rather than to be interred in a mass grave as is necessary if identification cannot be effected.
Sometimes the relief following identification can be short-lived if another bereaved family also claims the same body. Involvement of Forensic Pathologist in the mass disaster management can help ascertain the identity and thus prevent occurrence of these painful states.
The settlement of the following mundane but pressingly practical issues such as: inherence of property, access to bank accounts, pensions, insurance, etc depends on the formal identification of the deceased, recorded in a form of a certificate of death.
Civil court action and litigation relating to issues of liability, eg. on the part of an airline contributing to a disaster needs the identity of the deceased to be formally corroborated. } Similarly, if the incident happened at the workplace, litigation relating to health and safety concerns in the work-place can be initiated with the formal identification of the deceased.
In case of any suspicion of breach of guidelines, regulations or laws by the person at the wheel or the controls at the time of the mishap e.g. any suspicions as to whether such persons were in intoxicated state can be ruled out only after formal establishment of their identities.
Formal identification will enable the authorization for legal disposal of the remains. This allows grieving and funeral rituals to take place - the first steps to be taken to cope with their tragic loss. For initiation of criminal investigation, it is an essential prerequisite to identify the victim.
2. Reconstruction of the mutilated remains for a decent presentation.
3. Proper preservation and handling of the remains by skilled personnel will prevent loss of crucial evidences, check introduction of artifacts and prevent further putrefaction and also reduces health hazards.
4. To determine the cause of the disaster by collecting evidence such as:
Bomb or detonator fragments that may be embedded in the bodies. Toxicological evidence for any evidence of intoxication of the key victims. Pathological evidence to see any disease conditions in the key victims that could have contributed to the disaster.
In case of impending epidemic as well as in tragedies resulting from biological or chemical sabotage, the Forensic Pathologist can help in the detection and diagnosis of the causative agent, which in turn enable the concerned authorities to take necessary preventive measures. Trace evidence to find any physical evidence that could help solve the investigation of the tragedy.
5. To assist in reconstructing the cause of the disaster. This can be achieved by:
Establishing the cause of death particularly the key victims such as pilots, drivers, human bombs etc. Studying the nature and pattern of injuries sustained by the victims to see whether the injuries take the pattern that conforms to other similar incidence. Studying the position of the remains in relation to the wreckage at the site of the tragedy.
6. Establishment of the period of survival of the victims, which is deducible by studying the time since death is required in case of presumption of survivorship. Also it can be helpful to determine whether there was any lapse in the search and rescue operation, and accordingly from the findings necessary corrective measures can be incorporated in the plan.
7. Preventive medicine: Evaluation and analysis of the data during the course of medico-legal investigation can be utilized as a tool for development and improvement of safety measures including workplace e.g. seat belts, airbags, head rests, helmet, leg guards, laminated windshield etc are all developed and improved over the years by studying such data and many of these safety measures has been made mandatory in many countries.
Conclusion:
It is difficult to get most people to consider the unthinkable, yet unimaginable disasters will always occur. This inevitability of disaster should not give rise to fatalistic attitude, for that removes the need to plan and prepare. Today, mass disaster management itself is considered as a discipline. It requires the cooperation and coordination of various professions such as administration, police, medical, forensic experts, fire service, civil defense, public work services (including water and power supply, transport and telecommunication etc), seismologists, hydrologists, geologists, NGOs etc. all these disciplines and professions are essential at different levels in the course of management. In the western countries, Forensic Pathologist plays an integral role in the management of mass disaster. He is a key member in both Disaster Victim Identification as well as Disaster Investigation teams.
Counter disaster plans should be simple, comprehensive and up to date and should be understood by all. A disaster plan should not be something ‘done a few years ago’, gathering dust on the shelf. There is a need for constantly revising the plans to see how good they have been when implemented. This process of review, rehearsal and training should be continuous, so that the oral tradition is every bit as strong as the written manual.
In the words of the famous maxim in QANTAS Airline’s department of safety and environment: ‘If you think safety is expensive, try having an accident’. Such costs are not mere financial consideration. It challenges us all to mitigate accidents and loss of life by the use of good design, workplace practice and counter disaster planning. —
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