All Hazards Emergency Preparedness

1
All Hazards Emergency Preparedness

• Forensic Dental Team
• By
• Richard Meckstroth, DDS, Chairman, Dental
  Practice and Rural Health, School of Dentistry,
  WVU
• John M. Carson, DDS, DABMDI, Chief Dental
  Examiner
• WV office of the Chief Medical Examiner
• Dental Section Chief, DMORT Region III
  DHS/FEMA/NDMS

2
Objectives

• Establish the role of the dental profession in
  disaster preparation
• Explain the functions of the forensic dentist
  (forensic odontoglogist) during a disaster
  response

3
Key Player in EmergencyPreparedness

• Forensic dentistry plays a vital role in
  identifying the human remains of victims, not
  only those of natural and mass disasters but also
  victims of mutilation, incineration, burning, and
  decomposition.

4
Disaster Preparedness Considerations for the
Dental Profession

• Participate with local emergency resources LEPC
  (Local Emergency Planning Committee)
• Participate with CERT (Community Emergency
  Response Training)
• Participate in disaster drills and training
• Develop an emergency plan for family, office, and
  staff

5
Disaster Preparedness (contd)

• Become involved with state dental disaster
  response teams
• Become involved with dental sections of federal
  response teams (DMORT)
• Obtain forensic dental training (AFIP, ADA, AAFS)

6
Disaster Drills

• Mass disasters represent a significant challenge
  for dental personnel called upon to provide
  identification. Groups must prepare with an
  emphasis on team integration, organization and
  the psychological and emotional effects of such
  work.

7
Working with other Teams

• The forensic dental team generally works with
  other mass disaster response teams whose members
  include first responders, security personnel,
  recovery team members, forensic photographers,
  DNA analysts, fingerprint specialists, state and
  federal agency representatives, and coroners.

8
Key Player in Disaster Recovery

• Recent occurrences have re-emphasized the
  important role forensic odontologists play in the
  dental identification of victims from aircraft
  accidents, industrial mishaps, natural disasters,
  and terrorist attacks.

9
Factors Affecting a Disaster Response

• Effectiveness of NIMS / ICS Implementation
• Degree of Cooperation of Local Officials
• Presence or Absence of Hazmats (Hazardous
  Materials)
• Proficiency of Responders

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Factors Affecting a Disaster Response (Contd)

• Size of the Debris Field
• Condition of Remains Intact V. Fragmented
• Condition of Remains Decomposed, Burned,
  Mutilated, Intact
• Open v. Closed Populations

11
Clinical Implications

• Accurately confirming a victims identity is
  important for legal and humanitarian reasons.
• The accurate identification of a mass disaster or
  homicide victim also allows surviving family
  members to grieve and observe religious beliefs
  properly.

12
Dental Functions During Disaster

• Provide a continuum of dental care to the
  community
• Participate in recovery of remains with response
  teams
• Recovery dental records and obtain antemortem
  dental information through the family assistance
  center
• Perform dental identification functions during
  Morgue Operations

13
Indications for Forensic Dental Identification

• When remains are
• Incinerated
• Decomposed
• Mutilated
• Fragmented
• Otherwise Unidentifiable

14
Morgue Ops Dental Sections

• Antemortem Team
• Postmortem Team
• Comparison Team

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Antemortem Team

• The antemortem team is responsible for
  transcribing dental records received from dental
  practitioners on to standardized forms.

16
Antemortem Team

• Collect records from the family assistance center
• Enter antemortem records into the database
• Utilize the Win Id V. 3.0 computer program for
  database entries

17
Postmortem Team

• The postmortem team is responsible for the dental
  examination and charting of the found remains.

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Postmortem Team

• Works in the morgue
• Performs both clinical and x-ray examination of
  remains
• May require removal of upper and/or lower jaw(s)
  Dental Autopsy
• Requires Full-Mouth x-rays- Preferably using the
  Dexis Digital x-ray system
• Postmortem findings and x-ray graphics are
  entered into the Win Id V. 3.0 database

19
Comparison Team

• The comparison team uses laptop computers to
  analyze the information entered by the antemortem
  and postmortem teams.
• Possible matches are established and then the
  team compares actual records to produce final
  conclusions.

20
Comparison Team

• Win Id v. 3.0 antemortem and Postmortem Databases
  are compared
• Looking for points of concordance
• Findings are presented to the director of morgue
  ops and medical examiner or coroner with
  jurisdictional authority
• Data is reconciled and archived

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Summary

• The forensic odontologist plays a vital role in
  the identification process involving victims of
  mass disasters.
• The unique characteristics of the dentition allow
  the forensic dentist to compare antemortem and
  postmortem dental records and make a conclusion
  about the victims identification.