General Aspects Regarding General Aspects Regarding Management of Dead Bodies;Management of Dead Bodies;

Tsunami Victim Identification Tsunami Victim Identification in Thailandin Thailand

Dr. Pongruk SRIBANDITMONGKOLDr. Pongruk SRIBANDITMONGKOLDepartment of Forensic Medicine,Department of Forensic Medicine,

Faculty of Medicine, Faculty of Medicine, Chiang Mai University, ThailandChiang Mai University, Thailand

Prepared byPrepared 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 informationTHAILAND USA

Surface Area 514,000 sq km 9,631,418 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 Thailand10:05 hoursMax. 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

Mass fatalities

Summary of the human toll caused by the tsunami as of 23 March 2005

Countries Dead Missing Displaced HomelessIndonesia* 220,153 - 400,062 n/aSri Lanka 31,147 4,115 519063 480000

India 16,389 - 647599 20000Maldives 82 26 21663 NaThailand 5,395 2932 Na NaMyanmar 90 10 Na 3200Malaysia 68 12 Na 4296

East Africa 312 158 2320 NaTotal 273,636* 7,253 >1,590,707 >507,496

* 265,000 – 3140,000

From MOPH, Thailand

The number of deaths in Thailand

Province No. of Deaths

Ranong 160

Phang Nga 4,224

Phuket 279

Krabi 721

Trang 5

Satun 6

Total 5,395reported 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

Supported by

Coordinated 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 identification2. 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

5,395 213 3,698 1,390

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 t

eam

Identified and released based on de

ntal records

5,395 2070 111

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

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

AM PM Possible match

1930 cases 664 cases 310*

*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 weekAfter the second week

Same and differenceFrom 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 Iden

tification (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)

3,684 1,468 2,230

Source: TTVI on April 30, 2005

Approximately 41 % of total

deaths in Thailand

Reconciled bodies by primary evidence

0

200

400

600

800

1000

1200

1400

Dental Fingerprint DNA Physical

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)

0

10

20

30

40

50

60

70

Dental Fingerprint DNA Physical

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-DVI D.M.O.R.T WHO

SEARO VEPRO 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 The best way to pay respect to the Tsunami respect to the Tsunami

victims is to use the victims is to use the lessons learned to create lessons learned to create

a safer future.a safer future.