61 Lost: Mass Casualty Identification of Human Remains
Kevin Whaley MD
2011 Annual Meeting – Las Vegas, NV
AMERICAN SOCIETY FOR CLINICAL PATHOLOGY 33 W. Monroe, Ste. 1600
Chicago, IL 60603
61 Lost: Mass Casualty Identification of Human Remains This session will explore the unique topic of the various methods of human identification, with case studies from mass casualty.
• Familiarize yourself with the advantages and disadvantages of common modalities of postmortem identification.
• Gain the ability to identify whether a modality of postmortem identification is of primary, secondary, or tertiary significance.
• Understand the layout and work flow of postmortem identification with regards to mass disasters. FACULTY: Kevin Whaley MD Entire Pathology Team Autopsy, Forensic, Neuropathology, Grossing Autopsy, Forensic, Neuropath, Grossing 1.0 CME/CMLE Credit Accreditation Statement: The American Society for Clinical Pathology (ASCP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). Credit Designation: The ASCP designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. ASCP continuing education activities are accepted by California, Florida, and many other states for relicensure of clinical laboratory personnel. ASCP designates these activities for the indicated number of Continuing Medical Laboratory Education (CMLE) credit hours. ASCP CMLE credit hours are acceptable to meet the continuing education requirements for the ASCP Board of Registry Certification Maintenance Program. All ASCP CMLE programs are conducted at intermediate to advanced levels of learning. Continuing medical education (CME) activities offered by ASCP are acceptable for the American Board of Pathology’s Maintenance of Certification Program.
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Mass Casualty Identification
Kevin D. Whaley, M.D.Assistant Chief Medical Examiner
Richmond, VirginiaAssistant Chief Medical Examiner, Central District
Pathology Section Chief, DMORT
2011 ASCP Annual MeetingFaculty Disclosure Statement
• Kevin D. Whaley, MD has no financial interests with the manufacturer(s) of commercial product(s) that may be referred to in this presentation or with one or more of the corporate organizations offering financial support or educational grants for this continuing medical education program.
Overview
• Levels of Identification• Open vs. Closed Populations• Eli Whitney Principle• Modalities of Identification
– Personal effects– Radiology– Autopsy findings– Anthropological assessment– Odontology– DNA comparison
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Levels of Identification• Primary
• DNA• Fingerprints• Odontology• Unique medical features
• SecondarySecondary• Physical features
• Anthropometrics• Anthropology• Body modifications• Non-unique medical features
• Tertiary• Clothing• Location of remains• Personal effects
Two Types of Population
• Open population
• Closed population
Eli Whitney Principle
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Optimal Flow of Modalities
Admitting
Photography Fingerprinting
DNA
Photography
Pathology Anthropology
Fingerprinting
X‐Ray Odontology
Admitting• Documentation
• Maintaining integrity of remains
• Ramifications of 95%Ramifications of 95% certainty of identification
Photography
• Remains pouch with number
• Clothed remains
• “Cleaned”Cleaned personal effects
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Personal EffectsClothing
Dry cleaning tagsSizesAssociated with
significant event
Personal EffectsClothingJewelry
Family heirloomsClass ringsWedding bandsRetirement watches
Personal EffectsClothingJewelryWallet / Purse contents
Driver’s licenseSocial Security cardCredit cardsTelephone numbersFamily photographs
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Personal EffectsClothingJewelryWallet / Purse contentsFirearmsFirearms
Radiological Assessment
• Primary – Surgical hardware
• Sternal wires• Geometry of surgical clips
/ screws/ screws• Pacemaker• Hip replacement
Radiological Assessment
• Primary – Surgical hardware– Unique osseous
morphology• Frontal sinus pattern• Osteodegenerative
changes• Healed/healing fracture
morphology
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Radiological Assessment
• Primary • Secondary
– Calcaneal spurs– Single clips/nailsg p– Myositis ossificans– Healed/healing fracture
morphology
Physical FeaturesCaveats• Hair color
– Photodegradation– Thermal exposure
• Eye colorl l di– Corneal clouding
– Contact lenses• Skin color
– Mixed race– Decompositional
changes
Thompson & Black, Forensic Human Identification
AnthropometricsSexHeightWeightBody habitusBody habitus
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Caveat to Photographs and Visual Identification
•Kubler-Ross stages of grief:
•Denial•Anger•BargainingBargaining•Depression•Acceptance
Scientific Visual Identification1st Stage
Major discrepancies
Scientific Visual Identification
1st Stage2nd Stage
Facial Landmarks
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1st Stage2nd Stage
Photogrammetric facial landmark alignment
Scientific Visual Identification
Thompson & Black, Forensic Human Identification
Anthropological Basic Assessment
• Sex– Pelvis– Skull– Ribs– Long bones
Anthropological Basic Assessment• Sex• Age
– Adults• Pubic symphysis• Cranial suture closure• Cranial suture closure• Sternal rib ends, 4th
– Juveniles• Union of primary
ossification centers• Dental eruption• Long bone length• Epiphyseal closure
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Anthropological Basic Assessment
• Sex• Age • Stature
– Long bonesLong bones
Anthropological Basic Assessment
• Sex• Age • Stature• Geographic• Geographic
ancestry– Caucasoid
Anthropological Basic Assessment
• Sex• Age • Stature• Geographic• Geographic
ancestry– Caucasoid– African-American
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Anthropological Basic Assessment
• Sex• Age • Stature• Geographic• Geographic
ancestry– Caucasoid– African-American– Asian
Pathological Assessment
External Examination• Body Modification
– Piercings
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External Examination• Body Modification
– Piercings– Branding
External Examination• Body Modification
– Piercings– Branding– Tattoos
External Examination
• Decomposition
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External Examination• Decomposition
– Adipocere
External Examination• Obscured tattoos
External Examination
• Acquisition of new antemortem data
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External Examination• Decomposition
– Adipocere– Mummification
External Examination
• Insect activity– Forensic value
External Examination• Ocular prostheses
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External Examination• Ocular prostheses• Intraocular lens implants
External Examination• Ocular prostheses• Intraocular lens implants• Scars
External Examination
• Ocular prostheses• Intraocular lens implants• Scars• Suitability for fingerprinting
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External Examination
• Ocular prostheses• Intraocular lens
implants• Scars• Suitability for
fingerprinting• Occupational
stigmata
External Examination• Ocular prostheses• Intraocular lens
implants• Scars• Suitability for
fingerprintingg p g• Occupational
stigmata• Surgical scars
– Autopsy prognostication
Internal ExaminationFibrotic disease processes
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Internal ExaminationFibrotic disease processesSurgical procedures
AppendectomyVasectomy / tubal ligationGastric bypass
Odontology
Challenges to Dental Identification
• Obtaining records• Adequate charting
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Challenges in Dental Identification
• Obtaining records
• Adequate charting
• Uniformity in charting
Challenges to Dental Identification
• Obtaining records
• Adequate charting
• Uniformity in charting
• Adequate radiography– DEXIS
Dental CharacteristicsTeeth present. Erupted. Unerupted/impacted. Missing teeth.
Congenitally missing.Lost antemortem.Lost perimortem/postmortem.
• Tooth Type Permanent. Mixed dentition. Retained primary teeth. Supernumerary teeth.
• Malpositionsfacial/linguoversionrotationssupra/infra positionsdiastemas.
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Dental CharacteristicsDental Restorations Metallic restorations: amalgams, gold or nonprecious metal crowns/inlaysPosts, pins, fixed prostheses, implants. Nonmetallic restorationsNonmetallic restorationsPartial and full removal prostheses.
Root Morphology
Periapical Pathology
Periodontium
Periodontal ligament
Lack of Antemortem Dental Records
• Photographic comparison
ABFO Categories of Identification
Positive Identification:The antemortem and postmortem data match in sufficient detail to establish that they are from the same individual. In addition, there are no irreconcilable discrepancies.
Possible Identification:The antemortem and postmortem data have consistent features but due toThe antemortem and postmortem data have consistent features, but, due to the quality of either the postmortem remains or the antemortem evidence, it is not possible to positively establish dental identification.
Insufficient Evidence:The available information is insufficient to form the basis for a conclusion.
Exclusion:The antemortem and postmortem data are clearly inconsistent. However, it should be understood that identification by exclusion is a valid technique in certain circumstances.
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Fingerprinting
Postmortem FingerprintsMethods of obtaining
Postmortem FingerprintsComplicating factors
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Postmortem Fingerprints
• Characteristics
• Method of comparison
• Utility in yidentification
DNA Acquisition
DNA Identification
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DNA Reference Samples
• Personal Effects– Toothbrush– Hairbrush– Razor– Unwashed
undergarments– Soiled personal hygiene
products
DNA Reference Samples• Personal Effects
– Toothbrush– Hairbrush– Razor– Unwashed undergarments– Soiled persona hygiene products
• Biological specimens– Neonatal blood cards– Surgical specimens
• Blood stored for elective surgery
• Pap smears• Surgical pathology slides &
specimens• Deciduous teeth / extracted
adult dentition
Thank You… Questions?