Mass disaster forensic medicine mbbs.pptx

Mass Disaster - Definition, classification, Objectives, Management, NMDA, TNSDMA

1. MASS DISASTER

2. MASS DISASTER The WHO has defined disaster as an occurrence that causes Damage Ecological Disruption Loss Of Human Life Deterioration Of Health And Health Services on a scale sufficient to warrant an extraordinary response from outside the affected community.

3. MASS DISASTER A "Mass Disaster" is considered to have occurred when the number of casualties occurring in a single event exceeds twelve. It is the number of deaths that exceeds the capacity of local death investigation system to handle it.

4. Mass Disaster - Classification

5. Natural Non-biological

6. Natural Non-biological EARTHQUAKE CYCLONE LANDSLIDE FLOOD

7. Natural Non-biological Earth Quake Cyclone Flood Drought Heat Wave Volcanic Eruption Landslide VOLCANIC ERUPTIONS DRAUGHT

8. Natural Biological

9. Natural Biological DISEASE EPIDEMIC MASS POISONING (FOOD/LIQUOR)

10. Natural Biological Disease epidemic Mass poisoning (food/liquor)

11. Man Made Disasters Accidental Industrial Civil disturbances Warfare

12. Accidental transportation (road, rail, sea, river, and air), building collapse, mining accidents, dam-bursts, food poisoning, fires. Transportation Building Collapse

13. Mining accidents Fire accidents

14. Industrial fires, explosions, leakage of toxic substances/gases.

15. Civil disturbances riots and demonstrations.

16. Warfare Conventional (bombardment, exchange of fire, shelling) Non-conventional (nuclear, biological and chemical warfare, terrorism).

17. Management It is primarily a teamwork of the civil administration and its agencies on one hand and a multi-disciplinary medical task force usually comprising of clinicians, nurses, paramedical staff, odontologists, radiologists, forensic scientists, mortuary assistant, and funeral officials, etc., on the other hand Resources of the Armed Forces may be called-in to reinforce efforts. Over the past couple of decades, many countries have established protocols for the management of disasters, often with the setting up of Disaster Victim Identification (DVI) teams. ’

18. Management Indian Government also constituted the National Disaster Management Authority This authority aims at bringing about a change in orientation from a relief-centric approach to a holistic multi-disciplinary and multi-sectoral approach. Protocols need be ‘simple and flexible’

19. Objectives in a Mass Diaster Retrieval, reconstruction, examination and early disposal of the bodies Establishing identity. Conducting autopsy, wherein practicable, and to establish the cause of death. Seeking evidence in the form of some foreign material/ fragment (of bomb or detonator) that may be embedded in the bodies

20. Objectives in a Mass Diaster First stage - at the accident site Second stage- in the mortuary Third stage-comparison of records:

21. First Stage - At The Accident Site Isolation, Demarcation and Protection Identification and Investigation Management of Survivors

22. 1. Isolation, Demarcation And Protection Isolation, demarcation and protection of the site by the security cordon and entry of the team through some predetermined route. Involvement of by-standers and other officials need be checked.

23. 2. Identification and Investigation In accidental cases, identification of the individual may contribute towards cause of the accident in case the deceased had the history/record of having some pre-existing disease or some toxicological problem. Visual recognition may not be helpful because of severe disfigurement (due to trauma, burning or decomposition, etc.). Belongings can be helpful and may include clothing, jewellery , and personal documentation.

24. 2. Identification and Investigation Clothing found on a body can be of great value in establishing identity but must not be accepted as a positive proof in isolation. The corpse needs be searched and undressed very carefully Jewellery being relatively fire-resistant can be very helpful, especially when some unusual and strongly identifiable fragment is available. However, it being secondary evidence must not always be assumed that the item belongs to the deceased or will be recognized by relatives.

25. 2. Identification and Investigation Personal documents carry potential value but again, being secondary evidence, should not in their own be used to assume the identity of the deceased. The compact and protective way of carrying documents can often afford a great protection from fire and water, and every tiny fragment can be useful and therefore be handled with care. Medical and X-ray evidence may contribute or confirm identification. Clearly, the more unusual the medical or postsurgical condition is, the more positive will be the identification of the body.

26. 2. Identification and Investigation Odontology has proven to be very helpful, especially when fire or putrefaction has destroyed the soft tissues. Obviously, the method needs obtainable dental records. Fingerprinting is another method of personal identification with well-established criteria for reliability. Obviously, fingers or fingerprints may be destroyed in the event of fire or severe mutilation. It is for this reason that some recommend retaining of heel print records too , the heel being relatively better protected from fire or decomposition by shoes or boots.

27. 2. Identification and Investigation DNA-profiling has been shown to be of great value in identifying a wide range of human fluids and tissues It is chiefly because DNA molecules remain highly stable in stains, are present in virtually all human cells and are extremely polymorphic.

28. 3. Management of Survivors Establishing a System Of Triage to determine priority for evacuation is the need of the hour. Colour -coded tokens may be hung around the neck of the injured.

29. 3. Management of Survivors The colours recommended are the following: Category Black - survival not likely Category Red - requiring resuscitation and emergency lifesaving surgery, Category Yellow - requiring possible resuscitation and early surgery, Category Green -less serious injury not endangered by delay

30. Objectives in a Mass Diaster First stage - at the accident site Second stage- in the mortuary Third stage-comparison of records:

31. Second stage- in the mortuary External Internal

32. Second stage- in the mortuary Note state of body-entire, mutilated or fragmentary remains. For each unknown remains, as well as for multiple remains, prepare photographs, diagrams and tables for comparison between the unknown and known features. Note presence or absence of P.M. changes. Note injuries-size, site, number, nature, age, and special features, if any.

33. Examine for comparison with medical records eyeglasses, including frames and lenses Review reports of missing persons, statements of witnesses and relatives in mass disaster situations and content of passenger manifests provided by representatives of airlines, bus, train, etc. following aircraft accidents. Examine, describe, record, and photograph the clothing and other physical evidence. Describe the size, colour , condition, and type of each garment. Record descriptions of laundry marks, labels, and name tags.

34. Examine personal effects, such as rings, watches, belt buckles, and bracelets for engraved markings Determine if keys found on the remains provide access to the home or vehicle of the missing person. Obtain fingerprints for comparison. Remove and examine dentures if present. Examine teeth for comparison with antemortem dental records and X-rays. Age can be determined by examination of ground sections of teeth. Examine denture for name and identification number.

35. Examine skeletal remains to determine race, sex, age, evidence of prior disease or injury, etc. Occupation marks, moles, tattoos, operation scars, congenital defects, pre-existing disease, old injuries and fractures. Radiological examination of entire body for foreign bodies, which is particularly useful in mutilated bodies. Compare hair with known hair. Confirm gross pathological findings by microscopic examination. Determine the age of antemortem injuries. Establish and maintain a chain of custody for physical evidence.

36. Second stage- in the mortuary Internal: Stage of putrefaction of internal organs. Surgical removal of any organ carried out in life. Evidence of preexisting disease. Nails, plates, etc. due to surgery. Nature, extent and degree of organ injury. Evidence of organic disease causing sudden death such as coronary occlusion, cerebro -vascular accident, etc. Evidence of poisoning. Presence of foreign bodies.

37. Specimens to be collected and preserved. The exact specimen required to be collected would depend on the nature of the disaster. They could be: Clothes if charred or blood stained. Foreign bodies. Viscera, blood and urine for chemical analysis. Obtain blood for grouping, Rh typing, sex chromatin, karyotyping and DNA tingerprinting , alcohol, drugs, CO, etc. Retained products in stomach. Internal organs for histopathological examination.

38. Third Stage-Comparison Of Records Compare all evidence collected with information made available by relatives and establish the identity of the deceased. It is essential that record of all medical and dental examination including X-ray films be filed for future reference.

39. National Disaster Management Authority (NDMA)

40. National Disaster Management Authority (NDMA) The National Disaster Management Authority (NDMA), headed by the Prime Minister of India, is the apex body for Disaster Management in India. Setting up of NDMA and the creation of an enabling environment for institutional mechanisms at the State and District levels is mandated by the Disaster Management Act, 2005. NDMA is mandated to lay down the policies, plans and guidelines for Disaster Management. India envisions the development of an ethos of Prevention, Mitigation, Preparedness and Response.

41. National Disaster Management Authority (NDMA) NDMA Vision "To build a safer and disaster resilient India by a holistic, pro-active, technology driven and sustainable development strategy that involves all stakeholders and fosters a culture of prevention, preparedness and mitigation."

42. Functions and Responsibilities NDMA, as the apex body, is mandated to lay down the policies, plans and guidelines for Disaster Management to ensure timely and effective response to disasters. Towards this, it has the following responsibilities:- Lay down policies on disaster management. Approve the National Plan. Approve plans prepared by the Ministries or Departments of the Government of India in accordance with the National Plan. Lay down guidelines to be followed by the State Authorities in drawing up the State Plan.

43. Functions and Responsibilities Lay down guidelines to be followed by the different Ministries or Departments of the Government of India for the Purpose of integrating the measures for prevention of disaster or the mitigation of its effects in their development plans and projects. Coordinate the enforcement and implementation of the policy and plans for disaster management. Recommend provision of funds for the purpose of mitigation.

44. Functions and Responsibilities Provide such support to other countries affected by major disasters as may be determined by the Central Government. Take such other measures for the prevention of disaster, or the mitigation, or preparedness and capacity building for dealing with threatening disaster situations or disasters as it may consider necessary. Lay down broad policies and guidelines for the functioning of the National Institute of Disaster Management.

45. TamilNadu State Disaster Management Authority (NDMA)

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