Role of dentist in mass disaster forensic odontology

Role of dentist in mass disaster - forensic odontology

1. Role of Dentist in Mass Disaster
Role of Dentist in Mass Disasters
Dentists and dental auxiliaries can play a vital role in disaster response by wide range of skill sets
based on personal experience, training and enthusiasm.
Oral health care personnel can be successfully integrated into the emergency medical response
system in building needed partnerships, identifying and garnering resources, and facilitating training,
policy development, surveillance and evaluation.
1.Supporting other Health Professionals
2. Dental Offices acting as Medical Sites
3.Dental Surveillance
4.Forensic Assistance
5.Triage services
6.Definitive treatment
7.Distribution of medication and immunization
Interpol Protocols/Identification Center protocols
Policies, guidelines and training programmes have been produced in the following
areas:
1.Victim care and family support;
2.Occupational care for DVI teams;
3.Compliance with international standards and forensic quality assurance
controls;
4.Information-sharing and exchange;
5.Operational assistance to countries which lack DVI capacity.
Open and closed disasters
DVI teams are deployed in so-called open and closed disasters.

Open Disasters: Number of casualties is not known.
Eg: natural disasters such as earthquakes, floods, wildfires, but also certain
(large) terrorist attacks.
Closed disasters: Number of casualties will be immediately.
Eg: aircraft accidents (passenger list).
Combination open and closed disasters: These are disasters where a
combination of the above mentioned disasters occurs.
Eg: airplane crashing into a residential area
Phases to identification
Phase 1 – Scene examination: Depending on the incident, and where it happened, it can take days
or even weeks for all the victims and their property to be recovered.
Phase 2 – Post-mortem or PM data: The human remains are examined by specialists to detect as
much biometric data as possible. This can include:
•    Fingerprints;
•    Odontology, or dental examination;
•    DNA profiling;
•    Physical indications – tattoos, scars or surgical implants
Phase 3 – Ante-mortem or AM data:  The next of kin are interviewed about their missing family
member to collect information about the person. Biometric data can also be collected as for a PM
investigation, mainly fingerprints, DNA, odontological and medical data.
Phase 4 – Reconciliation: Once the PM and AM data is collected, a team of specialists compares
and reconciles the two sets of information to identify the victims. Identification is only possible if
there is a 100% match between AM and PM data on DNA and/or odontological data and/or
fingerprints. In addition, other information gathered should not exclude an identification.
Methods of dental identification:
•Dental biometrics
•Genetic fingerprinting
Dental biometrics automatically
analyzes dental radiographs to identify
the deceased individuals for whom other
means of identification (e.g. finger
prints, face, etc) are not available.
There are two stages for dental
biometrics:
Extraction
Matching
During feature extraction, the tooth contours and the dental work
shapes are extracted while at the stage of matching, the
identification is obtained in three steps;
•matching at the tooth level
•matching at contextual level
•matching at subject level
Extraction of tooth contour involves radiographic segmentation
and gum line detection. The methods include;
Pixel classification.
Adaptive thresholding.
Active contour modeling.
Matching has three steps:
First step: the tooth contour and dental work
shapes of the neighboring teeth are matched.
Second step: matching at the contextual level
Final step: matching at subject level
DNA in dental identification:
Dental tissue is resistant to incineration,
immersion, trauma, mutilation and decomposition
so it represents an excellent reservoir of DNA
materials.
Genetic fingerprinting, DNA testing, DNA typing
or DNA profiling is a technique used to distinguish
between individuals of the same species using only
samples of their DNA.
Incident command system
The incident command system (ICS) has become the accepted standard for all disaster response.
The incident command system (ICS) was created to allow different kinds of agencies (fire, police,
emergency medical services) and diverse disaster management teams to work together effectively in
response to a disaster.
Incident command system hierarchy
Incident commander: maintains overall responsibility
Operations: directs disaster resources (local, regional, national, and international) to achieve the
goal of disaster medical care: the greatest good for the greatest number of patients

Planning: develops action plans and collects/evaluates information

Logistics: provides resources and personnel to meet incident needs

Finance/administration: monitors costs
Disaster Management Teams
Disaster management teams involving medical personnel are also called
disaster medical assistance teams (DMATs). These teams are designed and
trained to provide specific functional areas of medical care.
(1) A cadre of medical specialties to care for the team and assist in the
initial extraction and treatment of entrapped victims
(2) Technical specialists knowledgeable in hazardous materials, structural
engineering, heavy equipment operation, and technical search-and-rescue
method- ology (e.g. sensitive listening equipment, remote cameras)
(3) Trained canines and their handler
Triage:
On-site triage (level 1)
Rapid categorization of victims with potentially severe injuries
needing immediate medical care where they are lying or at a triage
site
Medical triage (level 2)
Rapid categorization of victims at a casualty site by the most
experienced medical personnel available to iden- tify the level of
medical care needed
Evacuation triage (level 3)
Level 3 triage assigns priorities to disaster victims for transfer to
medical facilities