The forensic pathologist has always had a central role in the identification of the dead in every day practice, in accidents, and in disasters involving hundreds or thousands of victims.

1. Role of Forensic Pathologists in
Aviation Mass Disasters
Dr. Mohd. Kaleem Khan
Associate Professor,
Department of Forensic Medicine
J. N. Medical College, Aligarh Muslim
University,

2.  The forensic pathologist has always had a central
role in the identification of the dead in every day
practice, in accidents, and in disasters involving
hundreds or thousands of victims.
 Other branches involved in identification are
forensic odontology, genetics and anthropology

3. Interpol DVI Guide
 According to the Interpol DVI Guide, fingerprints,
dental examination and DNA are the primary
identifiers,
 This has given new emphasis to the role of the
forensic pathologist as the leader of a
multidisciplinary team of experts in a disaster
situation, based on his or her qualifications and the
experience
 From a legal point of view, but also for social and
family reasons, it is necessary to establish with
certainty the identity of the victims.

4.  The process of identification consists
of four different phases:
1) The recovery of bodies,
2) The collection of ante mortem data.
3) The examination of bodies and collection of
post mortem data,
4) The comparison of ante mortem and post
mortem data for reconciliation and
identification

5.  The duration of the identification process must be
evaluated.
 The investigators (technical, judicial, forensic,
firemen, emergency rescue teams and the local
medico-legal and odontological experts)
 As well as the DVI team pathologist must be
coordinated so that they are available to advise
and to obtain information (state of the corpses, the
number, etc.).

6. Forensic pathologist
 Forensic pathologist, to evaluate more particularly:
 The extent of the scene,
 The estimated duration of the recovery process,
 The medico-legal institute able to respond: distant or special
(CBRN for instance),
 Transportable, temporary equipment at the scene,
 The methodology that should be used to remove the bodies,
according to environment and biohazard (equipment,
protection, composition and number of teams), and
 The transportation and storage of bodies.
 It is strongly recommended bodies are not moved
until the transport system, receiving area and
refrigeration facilities are completed.

7.  Enough stakes, body bags and tags must be available
 Recovery teams, use a grid method to enable the recording
of the exact location of bodies and fragments as well as other
remains or evidence.
 Remains and belongings are placed in the same bag if they
are found connected.
 Parts of remains, objects or evidence are put in separate
bags.
 Photos and written documents of everything are mandatory.
 The remains in a body bag and the bag itself must be labeled
with the same number.

8.  The concept of triage of the bodies at the scene
has been considered and used in a disaster
context.
 The objectives were to differentiate bodies or body
parts from the environment (fireplace, explosion
with fragmentation) and
 To select bodies according to their state of
degradation.
 Begin the identification process with the less
deteriorated ones.

9. Ante Mortem Collection
 The identification of victims is realized by a process of comparison
between ante mortem data given by the families and post mortem
data coming from the examination of the bodies.
 It is important to distinguish between open and closed forms of
disasters
 A closed disaster is a major catastrophic event resulting in the
deaths of number of individuals belonging to a fixed, identifiable
group (e.g. aircraft crash with a manifest stating the names of the
passengers).
 As a rule, comparative ante mortem data can be obtained more
quickly in closed disasters.
 Combinations of open and closed disasters are also conceivable
(e.g. aircraft crash in a residential area where ground casualties are
likely).

10.  While dental data, DNA, and fingerprints are essential
to identify the bodies (primary methods of identification),
 It is important to take all information into account, such
as medical data and personal belongings (secondary
methods of identification).
 , It is important to bear in mind the phrase: ‘‘at the AM
collection, don’t neglect anything.’’
 A bayesian approach has recently been suggested to
evaluate the weight of different types of data [7].

11. Postmortem Examination,
 According to the recommendations of the Interpol
DVI Guide [5], a protocol of post mortem
examination must include the following phases:
 Radiological examination.
 External examination including fingerprints.
 Autopsy.
 Dental examination.
 Sampling for DNA investigation.

12.  A body examination rate of no more than
eight victims per day is reasonable and
generally accepted.
 In cases involving a large number of
victims,
 The number of teams must be increased
 The teams will have to work for a long period of time.

13. Radiological examination
The objectives of radiological examination are the following:
1. To give information for the cause, manner and mechanism of death.
2. To search for identification items such as evidence of previous dental
treatments (not always in their proper place), jewelleries, after effects of
diseases, abnormalities and prostheses.
3. To evaluate injuries.
4. To estimate age.
5. To compare ante and post mortem X-rays.
6. To look for foreign objects (metallic items, explosive devices, firearms
projectiles, etc.).
7. To search for specific lesions such as the characteristic lesions of flight
crew members (aircraft accidents).
8. Radiologic examination of remains is essential for a complete evaluation of
an aircraft crash fatality and, for instance, to estimate the position of the
pilot at the time of the crash.
9. A total body X-ray/full body CT scan should be performed in such cases.

14. External examination
1. External examination is very important for the assessment of injuries, but also
2. To search for identifying criteria.
3. Photography is very useful. It ensures the chain of evidence and traceability by
documenting injuries, trauma and identification items very precisely.
4. Photos should include bodies with and without clothes, jewellery, tattoos, scars,
and specific features and face views (front and profile). All the pictures must
have a reference body number and a metric scale.
5. Fingerprint information is very relevant and easy to use as a method of
identification.
6. Standard operating procedures have been described to restore dermis and
epidermis.
7. Clothes must be described as well as personal items such as wallets, jewellery,
flight tickets and id cards.
8. The exact location of these items has to be registered. For instance, a wedding
ring on a finger.
9. Type, label, size and color of clothes can be relevant.
10. Also important is information such as age, gender, ethnic group, size, weight,
hair, scars, circumcision and moles.
11. An external description of trauma per anatomical region has to be done.

15. Autopsy
 A full autopsy covering the whole of the body, including
 Opening of the skull, is strongly recommended.
 It is indispensable if the cause of death has not yet been determined, in
particular for the crew of an airplane or a ship.
 The autopsy report should mention a description of any lesions, fractures and
internal hemorrhages.
 The upper airways should be described and the presence or absence of
burns and soot should be especially noted.
 Previous surgical intervention should be described as should any implants
(such as silicone breast implants, pacemakers or orthopedic material),
anatomical peculiarities and pathological features.
 There should be systematic sampling for toxicology and genetic information
(DNA).

16.  In cases of fragmented bodies, samples from all body parts must be secured.
 The number of fragments to be tested will be determined on a case by case basis.
 In cases of a paucity of fragments, the bony parts should be singled out for
genetic examination.
 A second autopsy may, in some cases, be deemed relevant, for example if crucial
AM information only arrives after the autopsy.
 New information may direct the pathologist's attention to areas not previously
investigated, or he may request additional radiological examinations.
 A whole-body CT-scan and liberal sampling for DNA may avert the need for a
second autopsy, which is never attractive to a pathologist.

17. Forensic Anthropologist
 The forensic anthropologist may materially assist
the forensic pathologists by:
 The identification of human remains.
 The distinction between human and non-human remains.
 The reconstruction of the body.
 The determination of the minimum number of individual
bodies.
 An estimate of age, sex, race and height.
 The confirmation of pathology, anomalies or peculiarities
useful for the identification.

18. Dental examination
 This is the responsibility of the forensic pathologist, but it is performed by forensic
deontologists.
 Usually, dental examination is performed at the end of the autopsy, taking
advantage of the exposition of the relevant parts of the anatomy by the forensic
pathologist.
 The resection of the maxillae has been a contentious issue, and should never be
performed if the deceased is to be shown to relatives, and, in most cases, is not
necessary anyway.
 The removal of the mandible is easily done during the autopsy, and it may be
replaced without any detrimental effect to the face.
 Under no circumstances must either bone be separated from the rest of the body
after the autopsy.
 They must be replaced before the body leaves the autopsy room, as separation
could cause confusion.

19. Sampling of Material for DNA
 The use of DNA must be planned on a large scale.
 In cases, with a disaster of great a magnitude and with
extremely disintegrated bodies.
 It is crucial to secure the quality, the chain of custody, the
preservation, the packing and the transport of the samples to
the different laboratories.
 The types of samples also had to be standardized for the
laboratories involved

20. Reconciliation and Identification
Board
 These procedures are most efficiently performed using
the recommendations of the interpol DVI guide.
 The identification of disaster victims is a
multidisciplinary project and the decision to grant an
identity must be made between a number of colleagues
and co-workers.
 These boards are composed of physicians and dentists
from the am teams, the forensic pathologists and
forensic odontologists of the pm teams,
 Along with those responsible forth recovery and the
different police experts involved in am and pm
operations.

21.  As the identification proceeds, but also at the end of each
day, the finalized AM and PM information is compared.
 The DNA, fingerprints, dental data, X-rays, physical
characteristics and prosthetic material with identifying
features are the first choices for making a definitive
identification.
 The identification may be declared positive, probable,
compatible or incompatible, the latter cases requiring a
renewed search in the material available and perhaps
supplementary examinations.

22. Interaction with the Families of the Victims
 Presence of the forensic pathologist at the hand over of the
body to the families is very important.
 They are, at this moment, the best suited to explain to the
relatives the cause of death and the methods for identification
and to be there to answer any question the relatives might
have.
 This is part of the job of a forensic pathologist, they are used
to handle these often very difficult and awkward situations.

23. Teams and status of forensic
pathologists
 The constitution and organization of DVI teams around the
world differs.
 Fortunately, DVI is rarely a full time job.
 Some countries have a permanent team (usually a small
group dealing with the maintenance of equipment and
organizing training) but it is still necessary to maintain a
network of correspondents in different fields of activities.
 A clear status for those specialists must be written before
enrolling them in a DVI team.

24. Psychological aspects
 While psychological support is obviously a necessity forthe survivors
of a disaster and for their relatives, it must also be considered for the
teams coming to their assistance.
 Identification work is difficult from a physical, emotional and
psychological point of view.
 This is due to the workload, the pressure from various sides to
speed up the work, fatigue and the condition of the bodies.
 The risks impact the PM teams (locating the bodies and performing
autopsies)as well as the AM teams, who are in daily contact with the
relatives, and the commanders, who are subjected to pressures
arising from the disaster.
 Psychological support and debriefing, with short, medium and long
term follow up must be provided.

25. Key points
1. Even with the growing advances in forensic
anthropology,odontology and DNA, the role of forensic
pathologists cannot be overlooked.
2. The pathologists involvement in all areas of the DVI
process is essential.
3. The Pathologist will be judged on their ability to
manage work on the disaster site, and not only by the
number of identifications ascribed to their specialty.
4. Well validated methodologies are essential in DVI.
5. Education in DVI management for forensic
pathologists is essential.

26. Thank you