Recent world events have shown that there is an increasing frequency of deadly incidents wherein multiple victims have needed dental identification. Tragic incidents can include car bombings involving a few victims, airplane crashes where hundreds die, and the World Trade Center disaster in 2001 where thousands of people perished (Figures 17‑20). Similarly, natural disasters can lead to a massive loss of life, such as occurred during Hurricane Katrina in 2005 (Figures 21‑25). Thus, the need for a structured system designed to manage multiple victim identification becomes readily apparent.
Disaster victim identification (DVI), also known as mass disaster victim identification and multiple fatality incidents (MFI), involves the identification of multiple victims usually from a single incident. Many of these types of incidents involve violent death. The victims’ remains can be fragmented and intermingled, adding a significant layer of complexity to the identification process. The method of identification is similar to the routine dental identification process describe previously, with one significant difference. Each and every fragmented PM remains that is recovered becomes a separate case for identification purposes. Therefore, it is entirely possible to have a single AM dental chart used to identify a number of PM dental remains. This complication requires a significantly more complex system for managing the identifications. Typically, disasters of fifty or fewer victims are managed using the AM and PM paper dental charts and radiographs, as is done with the routine single dental identification. However, with more than 50 victims, past history has shown that DVI management is better suited to computer assisted programs such as WinID. A discussion of this management program follows.
The open source dental program WinID, was created for multiple fatality incidents and was one of several computer databased programs used at the World Trade Center disaster. It is important to emphasize that a computer program like WinID is used for managing data for both AM and PM dental records only. The program contains a search algorithm where possible matches are shown. A dental identification team member will then obtain the actual records and radiographs, and then proceed with the comparison (Figures 26‑28). WinID points to possible matches; it does not do comparisons. Only qualified experts do that. The WinID software is free to the public domain and can be downloaded from the website. Once installed on a Windows or Macintosh platform, its contents include pages for AM, and PM data entry, printable comparison forms, and portals to import digital dental radiographs and photos. Included in the software is a pre-loaded “practice disaster,” a useful training exercise.
Once a disaster has occurred and site security has been achieved, response teams begin their assigned tasks. The initial response team activity focuses on search, recovery and providing emergency medical treatment for the injured. At the same time, the recovery teams and morgue facility will begin preparations to receive deceased victims as they are recovered and transported. The dental team is just one of several teams that work together within the Disaster Command Structure (Figure 29a). The Dental ID Team contains its own structure of command as seen in Figure 29b.
The methodology used in disaster victim identifications involves working in teams of two in order to facilitate the collection of AM and PM data and creation of the associated charts. By working in teams of two as a source of dual confirmation to do the chartings, the risk for creating errors is significantly diminished as each team of two is providing a redundant layer of review to make sure there are no charting errors. This protocol applies to the AM dental team, which is responsible for the collection of the AM dental record, deciphering the records, cataloging the radiographs for uploading to WinID, and assembling the AM dental chart that will be used for the comparisons.
Simultaneously there will usually be two separate PM dental teams deployed. One will be working at the central disaster location (usually a temporary morgue), to take x-rays of and record all PM dental data within the recovered remains. A separate PM dental team will go to the disaster site to work with the other recovery teams in locating and collecting PM dental remains.
As the process of adding AM and PM dental records continues, a separate comparison team will begin the identification of the victims. In a smaller disaster (less than fifty victims) this process will involve spreading out all AM dental charts on large tables to which any unidentified victim's PM records are compared. If a presumptive identification is found, the AM and PM radiographs will then be compared. Should the results of these comparisons support the identification, the presumptive identification is then reviewed and confirmed by the comparison team and the dental commander. If the dental identification is confirmed, a definitive identification will be recorded and the coroner, medical examiner or incident commander notified. The dual identification process again provides an additional redundant layer of oversight; thus minimizing errors and misidentifications.
Once a victim's remains have been positively identified, surviving loved ones are notified by either a public relations officer or the incident commander. Thereafter the remains will be transported to a designated mortuary of the surviving family's choice. The dental team has no direct contact with anyone outside the disaster incident command structure, especially media personnel. As more of the victims are identified and case load decreases, the number of dental team responders decreases as well until the identification process concludes.