Mass DisastersCristina Cattneo, Danilo De Angelis,and Marco Grandi

FromForensic Anthropology and Medicine:

Complementary Sciences From Recovery to Cause of Death

Edited by: A. Schmitt, E. Cunha, and J. Pinheiro © Humana Press Inc., Totowa, NJ

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Chapter 18

Mass Disasters

Cristina Cattneo, Danilo De Angelis, and Marco Grandi

Summary

A mass disaster is commonly construed as an event (air, naval, railway, or motorway accident, flooding, earthquake, and so on), resulting in a large number of victims that need to be identified and subject to medicolegal investigation. Furthermore, depending on which continent one comes from, innumerous protocols and procedures are avail- able, the Interpol Disaster Victim Identification form being the most frequently used one in Europe. Whatever the case may be, the procedure is the same, and it consists of a meticulous collection of both antemortem and postmortem data. Consequently, the identification modalities to be applied will vary according to the quality of the ante- mortem data available and preservation conditions of the victims. This chapter gives general guidelines, common to most protocols, for the management—strictly from a medicolegal point of view—of victims of a mass disaster. As mentioned, intervention protocols may differ greatly depending on the country in which the disaster occurs;

furthermore, medicolegal intervention in a mass disaster is dependant on local authori- ties, such as the magistrate’s court, the police, local health authorities, and so forth.

These authorities decide, in many countries, what should be done and when. For this reason, it is always wise for medicolegal services and departments to create (ahead of time) contacts and connections with local authorities in order to avoid a confused con- duction of the emergency. At the scene of the accident or disaster, when conditions allow it, medicolegal staff should contribute to the recording of victims’ position and condition just as at any “normal” scene of crime situation, although time constraints must be respected. Once the remains have been removed from the disaster site, the bodies should be brought to a morgue for medicolegal activity. While the above-men- tioned preliminary procedures are carried out, a place at which to interview relatives of the victims must be established. On every cadaver or human remains, a full autopsy

according to European standards should be performed, along with appropriate analysis and sampling from an odontological, genetic, anthropological, and a fingerprinting point of view according to the methods described in previous chapters. Adequate toxicologi- cal and histological sampling (if necessary) should also be performed for establishing (when necessary) manner and cause of death. Antemortem and postmortem data are then crossmatched in order to obtain best matches among the victims with every person that has been reported missing or who was on the passenger list. The modality of iden- tification will depend on, in the end, the state of conservation and condition of the corpses and on the available antemortem documentation. It should always be kept in mind that visual identification on well-preserved cadavers in such cases should always be double-checked with another biological method.

Key Words: Mass disasters; identification; manner and cause of death; autopsy;

Europe.

1. I

Extensive literature exists concerning the medicolegal investigation of air traffic accidents and other mass disasters. Thus, various events, ranging from the scene of crime to the actual autopsy and identification of the vic- tims, have been reported (1–7). Furthermore, depending on which continent one comes from, innumerous protocols and procedures are available, the most frequently used one in Europe being the Interpol Disaster Victim Identifica- tion (DVI) form. Nonetheless, in the authors’ point of view, what patholo- gists, odontologists, and other experts involved in mass disasters should realize is that the main factor in these cases is a profound knowledge of reliable and proper identification procedures in order to, according to the variables that one may encounter, be able to appropriately deal with the situation. From a medicolegal perspective, there are three main objectives with regard to the study of human remains: a good scene of crime investigation, with proper retrieval and registration of human remains, application of proper identifica- tion procedures; adequate autopsy techniques along with tissue sampling (e.g., toxicology) for eventually reconstructing cause; and manner of death. It may be very difficult, depending on the country and authorities involved, to place these activities in a set protocol. For example, in countries in which DVI teams are well organized and Interpol protocols known to all specialists involved, appli- cation of preset logistics and methodologies is fairly easy and automatic. In many other countries these modi operandi may not exist. For this reason, the authors, in this chapter, have focused on explaining what should be done, and how, rather than entering the detail of preordained protocols, which may not be applicable to all countries.

A mass disaster is commonly construed as an event (air, naval, railway, or motorway accident, flooding, earthquake) resulting in a large number of fatalities (some authors consider an event to be a mass disaster when the num- ber of victims is greater than 12), the remains of which, being often badly traumatized, burned or dismembered, have to be identified and subjected to medicolegal investigation (Fig. 1).

Mass disasters can be considered as a “closed” or “open” system. The first is a system in which a specific number of known individuals are involved, for example, an air disaster with a passenger’s list. In this case, the work consists of mainly matching antemortem (AM) data of individuals on the pas- senger list with postmortem (PM) data from the victims. An open system, on the other hand, is much more difficult to manage. It is the case, for instance, of a sunken ship with illegal immigrants on board (and therefore without a formal passenger list) or the case of an explosion in a railway station or in the underground. In these cases, it is necessary to wait for information concern- ing missing persons that should have been in that place on that specific day.

Many times, bodies remain unidentified for a large length of time.

Whichever the case may be, the procedure is the same, and it consists of a meticulous collection of both AM and PM data. Thus, the identification modalities to be applied will vary according to the quality of the AM data available and preservation conditions of the victims (for details on identifica- tion procedures, see Chapter 8). For example, in the case where the victims Fig. 1. Examples of types of remains (referring to the head and face) that can be encountered in mass disasters: on the left, burned remains; in the center, severely traumatized remains; on the right, badly putrefied.

come from Western industrialized countries (for example, the Linate aircraft accident of October 8, 2001, which involved mainly northern European and Italian victims), it is often possible to apply odontological and genetic meth- ods, considering that the recovery of suitable medical clinical data from den- tists is feasible as is the acquisition of DNA swabs from suitable relatives. In the cases of victims from poorer countries from which it is very difficult to attain useful medical data or relatives, it is sometimes necessary (as in the case of the Albanian refugees traveling on the Kater Rades, which sunk on the coast of Brindisi, Italy in 1997) to identify individuals by other methods (age, morphological dental features, and so on). Sometimes in these cases, as in cases of victims of war crimes, a definite identity cannot be achieved.

First, it should be said that scene-of-the-crime investigations, from a medicolegal point of view, may be crucial for many reasons in cases of mass disasters. The first consists of the complete recovery of all remains. In the case, for example, of remains of an aircraft that has exploded in the air, remains may be scattered over a very large area. Only thorough searches performed with field-walking techniques, cadaver dogs, and expert personnel will lead to a complete recovery. Furthermore, a precise topographic positioning of all remains should be sought. This may be crucial in reconstructing the dynamics of the accident. Again, take as an example an aircraft explosion. If it is known where specific passengers were sitting, the manner of dispersal of their remains, once identified, may be important for reconstructing the point of origin of the explosion. This may be done with the help of a total station, which uses a laser beam to register topographic coordinates. Finally, pathologists, anthro- pologists, and odontologists should be present on-site during recovery. Only expert personnel will be able to accurately search for burned bones or teeth, for example. Furthermore, for the pathologist, it may be crucial to record the immediate environment around and position of the victims, if the pathologist later has to help reconstruct the modalities of death.

It is also crucial for expert personnel to be on-site before removal of the victims in order to protect fragile parts that are fundamental for identifica- tion, for example, in cases of badly charred victims.

2. G

What follows are general guidelines common to most protocols for the management, strictly from a medicolegal point of view, of victims of a mass disaster. As has already been mentioned, intervention protocols may differ greatly depending on the country in which the disaster occurs. Furthermore, medicolegal intervention in a mass disaster is dependant on local authorities,

such as the magistrate’s court, the police, local health authorities, and so on.

These authorities decide, in many countries, what should be done and when.

For this reason, it is always wise for medicolegal services and departments to create (ahead of time) contacts and connections with local authorities in order to avoid a confused conduction of the emergency.

2.1. Medicolegal Steps for the Mass Disaster

1. At the scene of the accident, when conditions allow it, medicolegal staff should contribute to the recording of victims’ position, condition, and so forth, just like at any normal scene-of-the-crime examination, although time constraints must be respected. This should obviously take place after the intervention of emer- gency personnel (fire department, first aid, and rescue units). Once all has been registered, every victim should be assigned a number, photographed, and deli- cate areas should be protected. An example may be teeth in the case of burned remains. The dentition should be protected with fixative sprays or, preferably, a mask, in order to guarantee that further damage will not be inflicted during body removal and transportation to the morgue. All such activities should be carried out together with the police and other intervening bodies. Accurate search for all other remains should be performed.

2. Once the remains have been removed from the disaster site, the bodies should be brought to a morgue for medicolegal activity. If the accident is near a morgue, then already available structures can be used; otherwise, prefabricated, tempo- rary, “mobile” morgues can be rented. One should always keep in mind that for very badly maimed or degraded bodies, it is also useful to have radiological equip- ment for identification purposes.

3. While the above-mentioned preliminary procedures are carried out, a place where to interview relatives of the victims must be established. Such information must be given to the media and to crisis centers in order to be able to inform relatives and to keep them constantly posted on how operations are proceeding. A list must also be prepared and published so that relatives can bring all necessary AM data. In the preordained area destined to the reception of relatives, the collection of all AM data useful for identification will be performed. A AM team (or several AM teams, depending on the number of victims), preferably constituted by a forensic pathologist, an odontologist, a geneticist, and a psychologist, for pos- sible assistance to mourning relatives must be set up. This team is appointed to collect clinical and nonclinical data related to the victims, and to register the information on appropriate forms. Such AM data includes information on per- sonal effects; clothing; jewelry worn; descriptors such as age, sex, height, race, hair and eye color, tattoos, scars, moles, malformations, prosthetic devices, osseous and dental pathologies; and any clinical, in particular radiological, and dental data (along with a contact name or number of physicians and dentists of the victim), pictures of the victim alive, possibly when smiling and displaying

the front teeth (in order to be able to carry out an identification via the dental profile). A list of useful items to be sent to the identification team later on and to a prearranged place must be given to the relatives. These are clinical medical and odontological records, radiographs, personal effects, such as combs, razors and toothbrushes used by the victims (useful for DNA analysis), and photographs.

Medical data consisting of case histories and radiographs of any body district must be collected. For the odontological data, the victim’s dentist is generally contacted in order to obtain dental charts, casts, endoral radiographs, ortho- pantomographs, dental-arch X-rays, or clinical photographs.

4. Collaterally, the programming of body examinations and autopsy (or anthropologi- cal examination, depending on the manner of conservation of the remains) is car- ried out. Thus, PM teams are organized for the autopsy and the collection of all data useful for identification of the human remains. This team is formed, prefer- ably, by a pathologist, an odontologist, an anthropologist, a geneticist, a toxicolo- gist, a morgue technician, and a secretary. The pathologist will perform the autopsy according to standard procedures for badly preserved human remains (8). From the point of view of identification, the pathologist, on external examination, should clean the skin looking for scars, tattoos, and the like, and, once the autopsy has begun, should look for signs of surgery and important pathologies useful for iden- tification. Appropriate sampling for toxicological and other laboratory analyses should also be performed. Registration of identification features and sampling will be carried out according to the identification protocols already described and estab- lished by Interpol forms. The odontologist will perform a dental examination as described in Chapter 15 (Heading 4), with photographs, UV light testing, and so forth, the odontologist will make dental casts, perform X-rays, and excise the man- dible and maxillae if necessary. Minimal anthropological sampling should also be performed: this includes samples for aging (dental and osteological)—pubic sym- physes and fourth rib and one monoradicular tooth should always be taken. Aging may greatly aid in an initial matching of antemortem and PM data. X-ray analysis, if soft tissue is still present, will be useful in distinguishing the adult and subadult individuals. For this latter group, X-rays of the dental arches and of the hand and wrist will allow for quick age determination. Of course, if cadavers are skeleton- ized, the role of the anthropologists becomes more relevant as sexing, determina- tion of ancestry, and stature may be crucial, as well as full skeletal analyses. Finally, the geneticist will assist in collecting adequate samples of tissue for DNA extrac- tion. Of course, not all experts may be available, so various identification groups should always ask for sampling protocols if specific experts are not present. For each corpse, a form will be completed, complementary to the antemortem form, and the data are then transferred to a suitable computer program.

In this manner, appropriate analysis and sampling of the remains will guaran- tee optimal conditions for identification and study of the cause of death. One final comment that should be made is that often fingerprinting of the victim may

be useful. Thus, fingerprints are taken, according to the state of preservation as described in Chapter 15, Heading 2.

In conclusion, on every cadaver or human remains, a full autopsy according to European standards (8) should be performed, along with appropriate analysis and sampling from an odontological, genetic, anthropological, and a fingerprinting point of view according to the methods described in Chapter 15. Adequate toxi- cological and histological sampling (if necessary) should also be performed for establishing (when necessary) manner and cause of death.

5. All collected data are then recorded on Interpol forms (as previously mentioned, many forms exists; however, because in Europe the Interpol form is the one most commonly used, it should always be used in cases where victims of different nations are involved). All data can then be put into a database. Interpol does have appropriate software for crossmatching data and selecting best matches; how- ever, it is very expensive for nonpolice organizations, such as universities. For this reason, a simpler database for initial comparison can be used, such as Microsoft Excel or Access, on which one can then search for common descrip- tors. It should be kept in mind that frequent updates concerning which proce- dures are being used and what is being done should be released to the press in order to avoid extra pressure from relatives who may think they are being kept in the dark.

6. The AM and PM data are then crossmatched in order to obtain best matches among the victims with every person that has been reported missing or who was on the passenger list. The modality of identification will depend ultimately on the state of conservation and condition of the corpses and on the available AM docu- mentation. It should always be kept in mind that visual identification on well- preserved cadavers in such cases should always be double-checked with another biological method.

7. Finally, according to each country’s requirements, documents necessary for the burial and transportation of the body must be prepared. A direct channel with consulates and embassies in cases of foreign victims should always be kept. Most countries in Europe require a declaration of identity, cause of death, and magis- trates’ and civil statuses’ permission to bury the body. Problems involving differ- ent legislations in different countries have been exemplified by Lunetta et al. (9).

3. A

E

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L

A

D

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O

8, 2001

The logistics of the Linate mass disaster is possibly a good example of the organization of a non-DVI identification group, which, however, follows the above-mentioned guidelines.

On October 8, 2001, at 8:06 AM, a Scandinavian Airlines (SAS) MD 87 on its scheduled flight SK 686 from Milan-Linate Airport in Italy, to

Copenhagen, Denmark, collided on the ground with a Cessna Citation II busi- ness jet on takeoff. The small jet fragmented into two main portions and caught fire. The MD 87, after sliding for several hundreds of meters, crashed into an airport baggage hangar. Here, a posterior portion of the fuselage separated from the main body of the aircraft and caught fire within the hangar, whereas the more anterior portion, although severely warped, remained untouched by the flames.

The Milan Prefecture was responsible for the general emergency. The prefecture is an organization attached to the Ministry of Internal Affairs (Ministero dell’Interno), which deals with the logistics of all catastrophes and coordinates many police activities. The judicial authority in charge of the entire investigation of the mass disaster was a magistrate (Procuratore della Repubblica) from the Milan Magistrate’s Court, whose territorial jurisdiction covers the airport area. The immediate emergency was dealt with by the fire department (Vigili del Fuoco) that arrived at the site of the MD 87 impact, assisted by police personnel from the airport (Polaria) and from the Milan Police Department (Squadra Mobile, Polizia Scientifica). Then, other law enforcement officers and rescue service personnel belonging to agencies gen- erally involved in the management of mass disasters within the city and re- gion (Carabinieri, Guardia di Finanza, Polizia Municipale, ASL, Croce Rossa, and so on) arrived at the scene.

The victim recovery procedures were handled mainly by the fire depart- ment, assisted by 10 specialists from the scene of crime personnel of the Milan Police Department (Polizia Scientifica della Questura) for photographic and video recording. Unfortunately, in this case, medicolegal personnel were not involved. Bodies were placed in numbered body bags supplied by the airport administration.

The entire recovery of victims from the wreckages took about 28 h.

Although medicolegal personnel could not participate directly in the recov- ery operation, personnel of the identification team and forensic pathologists, all from the Institute of Legal Medicine, University of Milan, screened and performed preliminary examination of the bodies at a working station located within the airport in order to direct the badly burned or maimed bodies to the Institute of Legal Medicine (directly connected with the main morgue in Milan, which can hold more than 100 bodies) for further investigation, and the better preserved bodies to another smaller Milan cemetery morgue (Lambrate). This was possible because Linate Airport is only a few kilometers from the city of Milano.

The passenger list was provided to the Italian authorities by SAS on October 8th at 9:00 AM and included 104 passengers, plus six pilots and flight

attendants. The Cessna jet had two pilots and two passengers on board; four other victims were airport employees working on the ground in the hangar at the time of the SAS MD 87 impact. Foreign embassies in Rome and the Con- sulates in Milan were informed by the Italian authorities that foreign citizens might be among the victims.

Scandinavian disaster teams arrived, almost unannounced, at the Insti- tute expecting to find their equivalents of the Italian DVI team. This was not so because such a team in practice does not exist and because the Magistrate in charge of all operations had already appointed the Institute of Legal Medi- cine performing autopsies and identification of the victims. Italy, as many other European countries, has no official protocol for mass disasters. In Rome, forensic pathologists are affiliated with the Polizia Scientifica as Interpol DVI representatives, but there is actually no operative DVI team, and magistrates generally turn to experts at the nearest university department or institute of legal medicine.

Foreign experts, however, helped in the collection of AM data of the victims from their respective countries.

This leads to considerations on a present problem in identification, which recently emerged with the 2004 tsunami events in South East Asia. As previ- ously mentioned, in cases of mass disasters, usually “political” forces are activated. These have, in most European countries, on a national logistic level, absolutely no contact with universities. It is well known that within the Scientifiche (i.e., forensic science services) of the police or Carabinieri, there are valid fingerprint and DNA experts, but no pathologists, odontologists, or anthropologists. Nor can such professional figures, present in several Italian universities, be recruited by police or Carabinieri—for beaurocratical and administrative reasons—within the logistics of the ministries of Internal Affairs or of Defense. In other words, expert and qualified personnel necessary for a thorough approach to identification procedures in mass disasters, paradoxi- cally, will not be involved. This problem, which is present in most southern European countries, must be dealt with in the future, in order to avoid subse- quent mishaps and inadequate modi operandi in mass disasters.

In the case of the Linate mass disaster, the prosecutor’s main interest was identification of the victims; however, examination of the bodies and sampling was necessary in order to acquire data on manner of death, which may have been subsequently useful—particularly in the case of the Cessna victims—with regard to the issue of time of survival and delays of the rescue teams. After the accident, the magistrate ordered full medicolegal autopsies and laboratory investigations for the Cessna pilots and passengers and for all members of the SAS crew and attendants of the MD 87. Moreover, she ordered

external (and internal) examination of all other victims to collect data and samples necessary for identification and determination of cause of death.

The Milan-Linate aircraft disaster counted, in total, 118 victims: 104 SAS passengers (of which 58 were Italian, 17 Swedish, 16 Danish, 6 Finnish, 3 Norwegian, 1 Romanian, 1 British, and 1 South African), 6 members of the SAS crew (3 Swedish, 2 Danish, and 1 Finnish), 2 pilots (Italian) and 2 pas- sengers (German) of the Cessna aircraft, and 4 Italian employees working on the ground in the hangar. Of the victims, 54 (46%)—those situated mainly in the rear section of the aircraft)—were badly burned, whereas others were maimed but still possessed recognizable facial features (Fig. 2).

Autopsies and external examinations were performed from October 10–19, 2001, according to the guidelines listed above. The proper collection, han- dling, storage, and processing of data allowed positive identification of the victims within 14 d. The identification team was composed of an AM and PM groups, working on-site and at the Institute of Legal Medicine, University of Milano. The AM group was composed of five specialists in legal medicine, five trainees in legal medicine, and two odontologists collecting data on Interpol AM forms and medical and dental history of the victims; one techni- cian entering AM data into an Excel database file; and two geneticists col- lecting buccal swabs from relatives and personal effects of the victims that Fig. 2. Distribution of the victims within the MD 87 aircraft and mode of conservation of the body (Linate mass disaster). In black, bodies with severe blunt trauma; in gray, badly burned bodies.

could be useful for genetic identification. The PM team was composed of 12 specialists in legal medicine working on rosters for autopsies/external exami- nations, two dentists collecting information on the Interpol DVI form, one anthropologist collecting samples useful for age determination (e.g., pubic symphysis, 4th ribs, and diaphyseal shafts for microscopy), two geneticists collecting muscle and soft tissue samples, and one laboratory and three morgue technicians. Dental examinations were performed with UV light and X-ray facilities, and entire jaws were excised from badly burned victims. Patholo- gists and technicians were also engaged in entering PM data into the Excel database for subsequent comparison with AM data.

The collection of AM data from foreign victims was completed in 7 d and transmitted by fax or internet to Milano for comparison with PM data.

Fig. 3. Manner of identification of the bodies and distribution within the large aircraft (Linate disaster). As can be seen, in the rear portion of the aircraft where bodies were burned, DNA and odontology were the prevailing identifi- cation methods. Visual identification for bodies with a preserved physionomy was always assessed by biological means (e.g., descriptors). Unique descrip- tors were unusual tattoos and bone prosthetic devices.

All victims were identified in the following manner: facial recognition (confirmed by anthropological and odontological analyses) (42%), odontol- ogy only (22%), DNA only (16%), combination of odontology and DNA methods (when one or the other was not sufficient for technical reasons [18%]), and tattoos and scars (2%) (Fig. 3).

The magistrate gave permission for the release and transfer of corpses on a daily case-by-case basis after identification. The transfer of foreign vic- tims was then done according to the Berlin Convention that Italy signed and ratified in 1937.

4. C

In conclusion, mass disasters, regardless of the affiliation of the medi- colegal experts involved, should be dealt with by qualified professionals from the scene of the accident to the subsequent autopsy and identification. Logis- tics and protocols for countries who do not have organized DVI teams may be more complex; however, if a general consensus and agreement on who does and needs what is reached among intervening authorities, proper identifica- tion and examination of the victims should not be impeded. Finally, patholo- gists must always keep in touch with the media (and therefore, relatives), explain what is being done, and justify the time needed for proper identifica- tion and autopsy to be performed in everyone’s best interest.

R

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