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By Jules Kieser, BSc, BDS, PhD, DSc, FLS, FDS RCSEd
The Asian Tsunami of Boxing Day, 2004, was the result of 1000 kilometres of a tectonic fault that ruptured beneath the sea west of Sumatra, creating an earthquake that measured 9 on the Richter scale. It claimed over 250,000 lives, including more than 5,500 in southern Thailand (Stone, 2005). In response to this disaster, the Thai government issued an urgent request for assistance from the international community. Within a day an initial dental disaster victim identification (DVI) team consisting of two Australian forensic odontologists arrived in Phuket; they were joined 48 hours later by two New Zealand colleagues. Over the next few months these numbers swelled enormously as individual volunteers and national teams arrived from Thailand and over 30 other countries.
Initial mortuary sites were established at three Buddhist temples or Wats: Site 1 at Wat Yan Yao, Site 2 at Mai Khao, and Site 3 at Krabi. Given the overwhelming casualty rates, the large numbers of tourists who had been killed, and the high temperature and humidity, the top three priorities were security, disease containment, and cooling the bodes with dry ice, followed by tagging, bagging, and storing bodies in refrigerated containers. A temporary mortuary was set up at Site 1, and work began under Interpol DVI standard operating procedures. Although the design of the morgue was primitive and consisted of locally available materials, the identification process started with the flow of bodies through four sequential phases: fingerprinting, photographing and having pathologists examine bodies, performing full dental post-mortems and collecting DNA specimens, and maintaining quality control, which was directed by a forensic odontologist.
Standard Operating Procedures
While operating under an overall Interpol protocol, dental standard operating procedures were established on day 3 after consultation between the Australian and Dutch teams (James, 2005). First, it was decided to work in two-dentist teams within each mortuary line, with a ‘super dentist’ to oversee quality assurance. The latter proved to be highly successful, especially once the multinational teams arrived and the pace of work became frenetic. It was crucial having a ‘super dentist’ in overall charge of quality control when large numbers of different national teams were working together and also when inevitably, fatigue set in.
Second, the teams resolved to avoid full mouth radiographs and limit radiography to a pair of posterior bitewing radiographs and X-rays on any other feature of interest. In retrospect, this may have been a poor decision. Forensic dentists conducting post mortems were confronted with the problems posed by tooth-colored restorations. These were difficult to detect at autopsy, especially given the limited lighting available in the makeshift morgue at Wat Yan Yao. This, together with the fact that they are often radiolucent or vaguely radio-opaque, suggests that additional radiographic views would have been ideal.
Third, a set of Polaroid photographs of the anterior dentition in edge-to-edge view, as well as the occlusal tables of the left and right posterior teeth were taken. This proved to be a useful decision, as the photographs were an essential aide to interpreting unclear dental chartings and/or radiographs. They were also useful in the identification of tooth-colored fillings, especially when these were radiolucent or vaguely radio-opaque (Sholl & Moody, 2001).
Finally, a pair of unrestored posterior teeth was extracted for DNA profiling. This protocol was later changed to anterior teeth, then to the collection of a bone sample from the iliac crest, and finally to the removal of a piece of rib.
Lessons from the Post-mortem Procedures
In addition to discovering that having a ‘super dentist’ and taking photographs were crucial to the identification process, there were three other major lessons to be learned from this experience:
• There needs to be an overall dental DVI commander in charge of a site and under whose direction regular debriefs are held to address problems and issues as they arise.
• All operators, and especially commanders, need to be fully aware of the negative effects that can result from inexperience and burnout, as over-confidence in inexperienced operators as well as the effects of burnout can easily lead to false positive or false negative (exclusion) identifications (Dailey, 1997).
• As there are a host of standards used to dentally age children in different parts of the world, each with its own unique set of determinants, a single method needs to be adopted on evidence-based principles, and this method needs to be made available to all operators.
Ante-mortem Data Collection
Both ante-mortem data entry and subsequent reconciliation were performed at the Thai Tsunami Victim Identification Information Centre in Phuket. As usual this phase proved to be highly challenging, with ante-mortem record collection dependent upon respective countries of origin, coordinated by Interpol. As Sakoda et al. (2000) noted, the three main factors involved in successful dental identification are the availability of recent dental records, the accuracy of the ante-mortem dental data, and the alteration of dental status after the last clinical examination. Unfortunately, half of all ante-mortem records received had to be returned for additional information (Kieser, Laing, & Herbison, 2005). One of the clearest messages to come from this exercise is that dental ante-mortem data needs to be collated in the country of origin by forensically trained dentists. An example of this was the leadership role taken by the Bureau of Legal Dentistry (BOLD) in Canada, which received and processed all dental records of missing Canadians. High quality digital data with adequate radiographic records and forensic dental chartings proved to be invaluable.
The value of dental data in reconciliation is absolutely beyond doubt. Six months after the Thai Tsunami, 1,474 bodies had been identified, 90% of them based on dental data (James, 2005).
Conclusion
After 9/11 it seems as though there has been an acceleration of terror attacks, airplane crashes, and natural disasters worldwide. Each of these underscores the value of having dedicated, trained teams of forensic odontologists who can be applied wherever they are needed. Each disaster also underscores the importance of having adequate standard operating procedures that are well-known by the forensic odontologist and the importance of coordinated ante-mortem data collation.
Acknowledgement
This article acknowledges the huge effort of the large number of volunteers in Phuket, Thailand, and is dedicated to all those who lost their lives as a result of the Boxing Day Tsunami.
References
Dailey, C. J. (1997). Charting errors in mass disaster dental records: Incidence, issues, and implications. In C. M. Bowers & G. L. Bell (Eds.), Manual of forensic odontology (pp. 250-257). Saratoga Springs, NY: ASFO.
James, H. (2005). Thai Tsunami victim identification—overview to date. Journal of Forensic Odonto-Stomatology, 23, 1-18.
Kieser, J. A., Laing, W., & Herbison, P. (in press). Lessons learnt from large-scale comparative dental analysis following the South Asian Tsunami of 2004. Forensic Science International.
Sakoda, S., Zhu, B. L., Ishida, K., Oritani, S., Fujita, M., & Maeda, H. (2000). Dental identification in routine forensic casework: Clinical post-mortem investigations. Legal Medicine, 2, 7-17.
Sholl, S. A., & Moody, G. H. (2001). Evaluation of radiographic identification: An experimental study. Forensic Science International, 115, 165-169.
Stone, R. (2005). A race to beat the clock. Science, 307, 502-504.
About the Author
Jules Kieser, BSc, BDS, PhD, DSc, FLS, FDS RCSEd, is a professor and the head of the Department of Oral Sciences at the Faculty of Dentistry, University of Otago, New Zealand. He was drafted as part of the Royal New Zealand Police response to the Asian Tsunami of December 26, 2004, and spent a month in Phuket, Thailand, performing dental disaster victim identification (DVI) with odontologists from more than 30 countries. Dr. Kieser has published widely and continues to conduct forensic research, particularly in the fields of the evidentiary reliability of bite mark analysis, dental anthropology, and more recently, craniofacial blood spatter analysis.
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The American College of Forensic Examiners International began in 1992; it is still here. Most membership associations rise and fall in less than a decade, but the passion of ACFEI’s founder, Dr. Robert O’Block, and the thousands of reputable people his associations help each year, has fueled continued growth since ACFEI’s inception nearly two decades ago.
As we continually improve our continuing education coursework, Web presence, and printed publications, that growth is bound to continue. The fields in which our members work, study, and fight are not going anywhere anytime soon, and are dynamic and ever evolving. When you join the American Board for Certification in Homeland Security, the American Association for Integrative Medicine, the American Psychotherapy Association, or the tried-and-true American College of Forensic Examiners Institute, you will see that we rise above the competition in offering continuing education excellence. Dr. Robert O’Block has created a unique opportunity for you to meet like-minded professionals to network, learn, and teach one another and the world at large.
To learn more, please visit www.acfei.com.
What is it that draws so many—nurses, physicians, soldiers, investigators, government employees, psychologists, psychiatrists, social workers, forensic examiners, and a sheer multitude of other honorable professions—into the American College of Forensic Examiners Institute fold? Let me share with you just a few of the numerous reasons so you can better decide for yourself, as thousands wisely did before you:
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By Leann Long, BS
A Tragedy Unfolds
On the morning of February 2, 2002, the parents of Danielle van Dam were forced to face their worst nightmare when they discovered the empty bed of their 7-year-old daughter. Danielle was last seen the night before when Damon van Dam put his beautiful blue-eyed daughter to bed. The distraught parents immediately reported Danielle as missing, and an extensive search involving hundreds of volunteers began. Authorities assumed that the innocent young child was abducted from her bed while she slept on the night of February 1, 2002.
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