“Disaster” The crisis & roll of

“Forensic Pathologist”.
DR. A N M AL MAMUN(ROMAN)
DEPARTMENT OF FORENSIC MEDICINE
SIR SALIMULLAH MEDICAL COLLEGE
 Scope
Presentation will address the following
 Disaster and its types.
 Phases of Disasters.
 Roll of Different Authorities in Disasters at different level.
 Forensic Pathologist,Mortuary and Disasters.
 Impact of Disasters.
 Some top Divastating Disasters of the World.
 Disaster Vulnerability of Bangladesh.
 Disaster Management Mechanism in Bangladesh.
 Disaster Risk Reduction Strategies of Bangladesh.
 Challenges and Recommendations.
 What is Disaster ? ?

“Catastrophe”– A large scale mega-disaster.

 Definition

Definitions,According to Forensic Science..

 Mass disaster is commonly defined as the death of more than 12
victims in a single event.
According to “WHO”
 Any occurrence that causes damage, ecological disruption, loss
of human life and deterioration of health and health services on
a scale sufficient to warrant an extraordinary response from
outside the affected community.
Cuny (Prehospital and Disaster Medicine)defined Disaster as:
 “A situation resulting from an environmental phenomenon or
armed conflict that produced stress, personal injury, physical
damage, and economic disruption of great magnitude.”
 Types of Disasters:

Natural Disasters
 Wind-related: Storm, cyclone, tornado, hurricane, tidal waves
 Water-related: floods, cloud burst, flash floods, excessive rains, drought,
communicable diseases etc.
 Earth-related: earthquakes, tsunamis, avalanches, landslides, volcanic
eruptions
Man-made Disasters
 Wars, battles, hostile enemy actions
 Arson, sabotage, internal disturbances, riots
 Accidents of vehicles, trains, aircraft, ships, forest and urban fires etc.
 Ethnic conflicts, terrorism etc.
 Biological disasters: epidemics, pest attacks, food poisoning etc.
Difference Between Natural and Man Made
Disaster
 Types of Disasters:
Classification bonnet(1990)
Minor disaster- Limit of 25
persons killed or injured
Moderate disaster – up to 100
persons injured or killed.
Major disaster – exceeds 100
persons.
Mass disasters also 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.
Othe other hand in “Open” case number of indivisuals are not confined.
Contd…
 Types of Disasters:
Internal versus external disaster
Internal disaster Disaster that affects the hospital and/or hospital grounds,
e.g.: Bomb threat• Fire or explosion• Power failure• Employee strike.

• External disaster Disaster that affects the surrounding community but not
the hospital directly, e.g.: Chemical plant explosion• Riots• Tornado through
a residential community.

Contd….
The United States on the morning of Tuesday,
September 11, 2001.??
Top 10 Deadliest Natural Disasters
 Factors Responsible for Severity

Direct impact.
Disruption of pre-exsisting facilities.
Population density.
Climate exposure.
Population displacement.
Lack of food and nutrition.
Delay in evacuation.
Increased vector breeding.
Non-availability or inadequate medical care.
Disasters...need
 Causes of Disaster…

 Poverty.
 Ungoverned Population growth.
 Transition in cultural practices.
 Environmental Degradation.
 Lack of awareness and information.
 War and civil strife.
 D I S A S T E R ??
DISASTER
alphabetically means-
 - Destructions
 - Incidents
 - Sufferings
 - Administrative
 - Sentiments
 - Tragedies
 - Eruption of Communicable Diseases
 - Research programme and its Implementation
What Happened on Saturday 25th April,2015
??
Saturday 25th April,2015.
 Impacts of Disasters…

Physical:
1. Injuries. Weakness and Physical Disability.
2. Reproductive health.
3. Fatigue, Loss of Sleep.
4. Epidemic.
5. Death.

Economical:
1. Unemployment.
2. Loss of Livelihood .
3. Loss of household articles,Property/Land.
4. Loss of Public Infrastructure.
 Impacts of Disasters…

Psychological:
1. Distress.
2. Flash backs.
3. Avoidance and Guilt Feelings.
4. Dependence and Withdrawn.
5. Helplessness and Hopelessness

Social:
1. Change in individual’s role.
2. Isolation.
3. Sexual abuse & domestic violence.
4. Family & social disorganization.
5. Migration.
Signs and Symptoms of Psychological
Emergencies…
 Victims with Special Needs

Elderly/geriatric people
Very young children/infants
Deaf people
Blind people
Non-English speakers
Confused/developmentally disabled people.
Why is it Necessary for Hospitals to Plan
Specifically for Disasters?
Some have argued that disasters are just like daily
emergencies, only larger.
Therefore, they conclude that the best disaster
response is merely an expansion of the routine
emergency response, supplemented by the
mobilization of extra personnel, supplies, bed space,
and equipment.
 EOC

 Emergency Operation Centers will be

setup at National, State and district
levels with requisite facilities.
 EOCs are nerve centers for coordination
and management of disasters.
Disaster Cycle/Disaster Risk Management
Event…
Integrated Disaster Management
Hospital Management of Disaster…
Phases of Hospital Emergency Planning
There are three key phases of activity within disaster
management:
 1. Pre – Disaster: Before a disaster to reduce the
potential for human, material or environmental losses
caused by hazards and to ensure that these losses are
minimized when the disaster actually strikes.
 2. During Disaster: It is to ensure that the needs and
provisions of victims are met to alleviate and minimize
suffering.
 3. Post Disaster: After a disaster to achieve rapid and
durable recovery which does not reproduce the
original vulnerable conditions
 Phases of Disaster Management
 Pre – Disaster Phase
Prevention and Mitigation
Reducing the risk of disasters involves
activities, which either reduce or modify the
scale and intensity of the threat faced or by
improving the conditions of elements at risk.
Mitigation embraces all measures taken to
reduce both the effects of the hazard itself and
the vulnerable conditions to it in order to
reduce the scale of a future disaster.
 Phases of Disaster Management
Preparedness
 The process embraces measures that enables governments,
communities and individuals to respond rapidly to disaster
situations to cope with them effectively.
 Preparedness includes for example, the formulation of viable
emergency plans, the development of warning systems, the
maintenance of inventories, public awareness and education
and the training of personnel.

Early Warning
 This is the process of monitoring the situation in communities
or areas known to be vulnerable to slow onset hazards, and
passing the knowledge of the pending hazard to people in
harm‟s way.
 Phases of Disaster Management
Response
This refers to the first stage response to any
calamity, which include setting up control rooms,
putting the contingency plan in action, issue
warning, action for evacuation, taking people to
safer areas, rendering medical aid to the needy
etc,simultaneously rendering relief to the
homeless, food, drinking water, clothing etc. to
the needy, restoration of communication,
disbursement of assistance in cash or kind.
 Phases of Disaster Management
The Post- disaster Phase
Recovery:
Recovery is used to describe the activities that encompass the
three overlapping phases of emergency
Relief, Rehabilitation and Reconstruction.
Rehabilitation:
Rehabilitation includes the provision of temporary public
utilities and housing as interim measures to assist long-term
recovery.
Reconstruction:
Reconstruction attempts to return communities to improved
pre-disaster functioning.
Role of emergency health services in disasters..
To minimize mortality and morbidity,three levels of
preventive health measures:
Primary prevention: is the ultimate goal of preventive health
care. It aims to prevent the transmission of disease to
generally healthy populations.
Secondary prevention: identifies and treats as early as
possible diseased people to prevent the infection from
progressing to a more serious complication or death.
Tertiary prevention: reduces permanent damage from
disease such as a patient being offered rehabilitative services
to lower the effects of paralysis due to polio or land mine
injuries.
The role of the military in disaster response..
 The military’s command structure allows it to respond to
disasters in a rapid and coordinated manner.
 Military services generally perform vital functions in
disaster response such as resource distribution, security
services, search and rescue, logistics assistance,
transportation to otherwise unreachable communities and
field hospital staffing and management.
 The host country’s ministry of health and the lead health
agency should consider coordinating with the military in
the response to a disaster as well as in the disaster
preparedness plan.
Role of Media in The Disaster…
 Casualty Profile in Disaster
 Immediate death (50-60%) - largely due to brain damage,
injury to the heart and large vessels. Other groups, many of
which can be prevented, airway obstruction and massive
haemorrhage.
 Early death (30-50%) - due to damage to CNS, Thoracic or
Abdominal injury with internal haemorrhage, extensive
skeletal damage or multiple injury with great loss of blood.
Exception of cranial injury, largely treatable.
 Subsequent death (20-30%) - days or weeks later, majority
caused by infection and sepsis and multiple organ failure
with impaired or destroyed respiratory, kidney and liver
functions.
The December 26, 2004 Indian Ocean
Tsunami.
Mass Casualty Management
System
 Subs-Specializations Pre Hospital Post Basic Emergency Care

Ambulance
parking
point
IN

Medical Ambulance
Inner cordon base loading
station point Outer cordon

SITE
OUT

37 13 April 2018
 Categorization/Setting up priorities

Category Color code Condition Emergency Priority

action
1 RED Life @ limb threatening; death if no IMMEDIATE TOP
intervention. Injuries affecting ABC

2 YELLOW Serious but stable injuries; not URGENT SECOND

immediately life threatening. May
deteriorate without Rx
3 GREEN Non serious, minor stable injuries. NON THIRD
Deferrable URGENT

4 BLACK Dead, decapitated, mutilated, severed, DELAYED LOWEST

apneic, pulseless, incinerated; deemed
unsalvageable

Subs-Specializations Pre Hospital Post Basic Emergency Care

38 13 April 2018
06_azlan
That’s the Starting of our Journey in Disaster
fatality..Victim identification
 Victim identification has been the primary role for forensic
pathologist since the19th century. The fire in the Ring-
Theater of Vienna, Austria in 1881.

 subsequently identified marked the beginning of forensic

autopsy use in identification.

 DVI enables the expansion of the forensic medicine

services with the birth of forensic odontology.
Forensic Family During Mass Casuality..
Why Forensic Science in Mass Disaster??
Examination of the bodies of the victims by forensic expert is
necessary for 3 main reasons:
 (i) To identify each dead body and to establish the cause of
death for legal purposes so that a death certificate can be
issued.
 (ii) To discover evidence relating to the investigations of
the disaster itself like obtaining sample for toxicological
analysis where appropriate.
 (iii) To find out the cause of the disaster itself e.g. bomb or
detonator fragments that may be embedded in the bodies
of the victims.
 Phases for Forensic Pathologist in Disaster
Management.
First phase (at the accident site)

 1.Locate bodies.
 2.Label them with a number.
 3.Photographing them in situ.
 4.Preparing a plan of the disasters .
 5.Exact location of body at a disaster site may prove to be
very important, whatever the disaster.
 6.Work of identification of the bodies should be
undertaken.
Phases for Forensic Pathologist in Disaster
Management.
 7.For accident reconstruction from evidence,
bodies are labeled, photographed
andarecordmadeoftheirpreciseposition
 8.Record each body and place it in a suitable
container for transfer to the mortuary.
 9.Media room(A temporary room).
 10.Counselling room.
 Phases for Forensic Pathologist in Disaster
Management.
Second phase (in the mortuary)

 In the mortuary, accommodation and in particular

refrigeration are likely to be problems following any major
disaster.
 Bodies should be dispersed to numerous small mortuaries
but preferably a building of suitable size to be designated a
temporary mortuary, for a coordinated investigation,
where there is sufficient space and light can be used.
 Phases for Forensic Pathologist in Disaster
Management.

 The procedures in the mortuary should be a team work

involving at least –

 A post mortem team is composed of a forensic

pathologist, two forensic odontologists, an autopsy
assistant,occasionally other specialists such as a
radiologist and a number of police technicians.
 Build up a Mortuary
 Each unit of human remains is tagged, numbered, and removed from
the site by authorized personnel.

 Remains are transported to the morgue by a transportation team.

 All personal effects found on a body or in association with human

remains are not removed and stay with the body when it is placed into
the body bag.

 Each human remain is placed into a separate body bag and given a
separate number.

 Depending on the size and nature of the event, the chief medical
examiner (CME) will determine where to establish an event morgue.
The site may be at the OCME or another location closer to the incident.
 Build up a Mortuary…
 The operational areas may include areas for decontamination,
admitting, forensic pathology, forensic photography, personal
effects, fingerprinting, odontology, radiology, anthropology,
DNA, and release of remains.

 The event morgue may be a portable facility purchased and

prepared prior to the incident or it may be one set up in a
preexisting .

Secure perimeter:
 Hot and cold running water.
 Electricity. Drainage. Biohazardous waste disposal capacity.
 Parking. Restrooms. Communications.
 Refrigerated space for storage of remains.
Disaster Mortuary Operational Response
Teams.(DMORT)
DMORT…
DMORT…
Phases for Forensic Pathologist in Disaster
Management.
(I) Primary identification:
 Primary identification is mainly done by :
 a.Visual identification
 b.Photographs
(II) Examination of clothing:
(iii) External examination:
 To determine: (a) sex (b) height (c) weight (d) hair
colour (e) location and abundance of hair (f) colour of
eyes and skin (g) any anatomical, surgical and
traumatic scars (h) tattoos or birth marks (i)
abnormalities such as congenital or acquired.
 Identification in Mass Disasters:
Split into 4 teams and run by Chief Forensic Dentist.

1.Recovery at Disaster Scene.

2.Postmortem Examination at Morgue.
3.Collect Antemortem Dental records.
4.Comparisons with Computer Software.
Special techniques of Identification in mass disaster
from bones…
1. X-rays examination.
2. Ultraviolet rays.
3. Postmortem serology.
4. DNA profilling.
 Identification Steps by Disaster
Victim Identification Teams…
Disaster victim identification(DVI) teams work in a series of steps
in the process of identifying victims.
 The steps consist of four main stages:
 Body tagging and bagging.
 Fingerprinting.
 Forensic pathology.(Each body is examined by a four-member
team,The team consists of a forensic pathologist, a forensic
death investigator, a mortuary technician, and a forensic
photographer. )
 Forensic odontology.
 The bodies are refrigerated,both before and after the
procedure.
 Steps in Identifying Bodies..
 Initial processing Finger prints Forensic Pathology

Radiology Mortuary Processing

Visual effects Body shipping

Photography Forensic odontology

Anthropology

DNA Laboratory
Source and Collection of DNA sample for
Identifications…
 Antemortem Data and AM team…
The AM team may be based in their home area/country with
information relayed electronically to the incident site, or at the
incident site.
The antemortem data should include dental records such as
radiographs and photographs.
Antemortem Data Procedures:
The AM team will perform the following tasks:
Set up a possible victim list.
Establish and procure antemortem records.
Organize for delivery of original medical/dental fi les to disaster
center (e-mail).
4. Develop a composite antemortem form for each potential
victim from evidence supplied.
Phases for Forensic Pathologist in
Disaster Management.
(iv) Injury sustained during the accident related to cause
of death.
(v) In case of blast injuries, trace evidences may be
preserved.
(vi) Radiographic examination:
(a) Ideally, complete set of skeletal X- rays should be
taken for each victim.
(b) In case of suspicion of damage, full skeletal
radiography is required.
Phases for Forensic Pathologist in
Disaster Management.
(vii) Full internal autopsy:
 Evidence relevant to identification will be collected such
as:
 (a) surgical absence of internal organs (b) presence of
postsurgical states like gastroenterostomy (c) evidence of
preexisting disease (d) any internal injury (e) precise cause
of death.
(viii) Histological examination:
 Certain organs and tissue will be collected for routine
histological examination.
 Tissue specimens containing metal fragments for chemical
analysis should be deep frozen.
Postmortem path for opening of Oral
Cavity…
Access to the Oral Cavity
Forensic odontology adds to the identification process by
estimating age and habits and determining sex and race of
the bodies.
Bite marks or pattern injuries as well as rugoscopy,
photography, and radiography may also serve as useful
material.
A method for the approach comprises cutting the soft tissues
through the fat and muscles from the angle of the mandible
to the midline.
The incision continues to the lateral surfaces of the
mandibular base.
Postmortem path for opening of Oral
Cavity…
 The masseter muscles and the vestibular
attachment are incised.
 The next steps involve the removal of the
mandible and maxilla. It is known as a Stryker
autopsy saw.
 In other cases, the removal of the tongue and
larynx is another possible approach.
Postmortem path for opening of Oral
Cavity…
 Other Techniques for Dissections
Additional techniques used for dissections are as follows:
1. Mallet and chisel method:
According to this approach, in which a Le Fort I fracture is
induced, position the chisel below the zygomatic arch, high
on the maxillary sinus walls bilaterally.
2. Pruning shears method:
The blade of the scissors is placed within the nares and
forced back into the maxillary sinus.
The cut is made superiorly to the apices of roots of the
maxillary teeth.
 Additional Incisions…..
 After adequately identifiable photographs are taken, in
order to record the conditions under which the cadaver
was found, the following incisions are made:
1. Superior incision:
incision from one side of tragus to other tragus of the ear,
including the anterior nasal spine.
2. Inferior incision:
from the mental eminence of the jaw, at the base of the
alveolar process sideways to the body of the mandible,
parallel to its inferior edge, crossing the ramus and arriving at
its back edge, sectioning the masseter muscle.
3. Lateral incisions:
two, one on each side, joining the two aforementioned
sections.
 AUTOPSY REPORT
A full autopsy of the body, including opening of the skull, is strongly
recommended.
It is an indispensable exercise when investigating deaths involving the
crew of an airplane or a ship.
The autopsy report should mention a description of any lesions, fractures
and internal haemorrhages.
The upper airways should be described and the presence or absence of
burns and soot with mucus must be documented.
Evidence of previous surgical intervention should be documented as with
any implants, such as silicone breast implants, pacemakers or orthopaedic
material, anatomical peculiarities and pathological features.
There should be systematic sampling for toxicology and genetic
information (DNA).
 AUTOPSY REPORT
 The forensic pathologist must systematically sample
from the body and fragmented body parts to obtain
material for DNA typing, in case it becomes necessary.
 DNA degrades after death, so any delay in sampling
may result in poor result, particularly in a hot and
humid environment.
 The use of DNA must be planned on a large scale.
 The laboratories must be capable of working with
nuclear DNA, mitochondrial DNA, Y chromosome DNA
and the mini-STR.
 AUTOPSY REPORT
 The identification of victims is realized by a process of
comparison between ante mortem data usually given
by the families and post mortem data obtained from
the examination of the bodies.
 The identification of disaster victims is a
multidisciplinary project.
 These are composed of physicians and dentists from
the antemortem teams,the forensic pathologists and
forensic odontologists of the post mortem teams,
along with those responsible for the recovery, and
different police experts involved in ante mortem and
postmortem operations.
 AUTOPSY REPORT
Cause of Death and Manner of Death:
 When indicated and requested by the local medicolegal
authority, the forensic pathologist should
 document information that allows for a determination of
the cause of death.
Toxicology:
 When indicated and requested by the local medicolegal
authority, obtain appropriate specimens (when available)
for toxicology testing.
All specimens should be promptly labeled with the case
number, the date and time, the name of the medical
examiner or coroner and the initials of the individual who
obtained the sample.
Phases for Forensic Pathologist in
Disaster Management.
(ix) Fingerprints:
 They should be taken after the autopsy when all
possible evidence has been collected from
examination of the body.
 Fingerprints are of limited value in identification of
victims of aircraft accidents due to nationality of most
of passengers being in question.
 After powdering, the fingerprints were then
transposed onto paper.
 Finger skin was removed by “degloving”.
Phases for Forensic Pathologist in
Disaster Management.
(X) Dental examination:
 At the end of the autopsy, dentist should make an
examination of the jaws and teeth.
(XI) DNA techniques:
 Because of the rapid decomposition and subsequently
muscular alterations, a sampling of the femoral shaft
(recommended for DNA analysis) was carried out by the
anthropologist.
 Another possibility for DNA sampling was the extraction of
two sound teeth, preferably two premolars or canines,
because of the presence of a lot of pulp material inside
these teeth.
Roll of Forensic Pathologist…
Basic steps of roll of a Forensic Pathologist during mass
disaster…
Referral of Patients-
Patients who show early signs or symptoms of
infectious disease,have suspicious oral or cutaneous
lesions,or are suspected of having such disease may be
referred to a physician for a definitive diagnosis and
appropriate treatment if Necessary.
Roll of Forensic Pathologist…

 Diagnosis and Monitoring-

After an infectious disease that causes mass disasters
has been identified,dentists or forensic odontologists
who are able to identify the sign and symptoms of that
disease may be identifying a infected patients.
Dentists can collect samples such as salivary and nasal
swabs or other specimens when appropriate for
laboratory processing,which may provide valuable
diagnostic information or indicate the progress of the
treatment.
Roll of Forensic Pathologist…

Triage-
In the effective response to any mass disaster events,a
system must be recognized to prioritize treatment
among casualties.
Dentists or forensic odontologists are able to help in
this important function with additional training
 What is Triage???

 In a disaster medical response, triage sorts and

priorities victims for medical attention according to
the degree of injury or illness and expectations for
survival.
 Triage reduces the burden on health facilities.
Triage classification system:
1. Immediate medical care. 2. Delayed care.
3. Non-urgent or minor. 4. Dead or ‘near dead.
 Shades of Triage…
 Red Triage Tag (“Immediate” or Priority 1): Patients whose lives
are in immediate danger and who require immediate treatment

 Yellow Triage Tag (“Delayed” or Priority 2): Patients whose lives

are not in immediate danger and who will require urgent, not
immediate, medical care

 Green Triage Tag (“Minimal” or Priority 3): Patients with minor

injuries who will eventually require treatment

 Black Triage Tag (“Expectant” or No Priority): Patients who are

either dead or who have such extensive injuries that they can
not be saved with the limited resources available.
Roll of Forensic Pathologist…

 Immunization and Medications:

To prevent the spread of infectious agents, whether
from a natural pandemic,a deliberate bioterrorism
attack, or contamination as a result of a local event,
immunization of great numbers of individuals may be
required in a short amount of time.
Forensic odontologists or dentists can participate in
mass immunization programs and prescribe some
medications with a minimum of additional training and
may be a critical factor in the success of urgent
programs.
 Categories of infectious hazards
associated with cadavers after a
natural disaster
Bloodborne
 Hepatitis B
 Hepatitis C
 HIV

Respiratory
 Tuberculosis

Gastrointestinal
 Rotavirus diarrhea
 Campylobacter enteritis
 Salmonellosis
 Enteric fevers (typhoid and paratyphoid)
 Escherichia coli
 Hepatitis A
 Shigellosis
 Cholera
Roll of Forensic Pathologist…

 Infection Control:
They are well versed and well practiced in infection
control and can bring their expertise to mass casualty
situations.
Dentists or forensic odontologists who are familiar with
disaster mortuary activities can be useful in managing
the remains of victims whose death is a result of the
event, particularly infectious events.
Roll of Forensic Pathologist…

 Definitive Treatment
Forensic odontologists have training and experience in
many areas that may be a part of casualty care in mass
casualty events, such as treating oral,facial,cranial
injuries; providing cardiopulmonary resuscitations;
obtaining medical histories; taking samples; assisting
with anesthesia; starting intravenous lines; suturing and
performing appropriate surgery; assisting in stabilizing
patients; and assisting in shock management.
Storage System of Dead Bodies..

 Storage
Not possible to keep bodies for long
without storage
Limited options if numerous bodies
Refrigeration
Ice
Dry ice
Temporary burial
Storage System of Dead Bodies..
Refrigeration
Refrigeration between 2°C and 4°C is the best option.
Refrigerated transport containers should used for
transport of dead bodies with capacity up to 50 bodies.
Dry ice
Dry ice [carbon dioxide (CO2) frozen at -78.5°C] may be
suitable for short-term storage.
Storage System of Dead Bodies..

Burial
Preserve evidence.
Burial should be 1.5m deep.
Leave 0.4m between bodies.
Storage and Body Preservation..
Injuries Commonly Seen in Disasters..

 Injuries Commonly Seen in Disasters are Crush injuries

(internal injuries),Open
wounds,Abrasions,Lacerations, Avulsions,Puncture
wounds,impaled objects,Burns, Spinal cord
injuries,Bleeding, Bruising,Injuries of the head or
spine,Blood or fluid from ears or nose,Bruising behind
ears, around eyes.
3 Killers….and Management…

3 Killers-
 Airway obstruction.
 Excessive bleeding
 Shock.
It is estimated that 40% of deaths could have been saved if
rescuers had performed the following techniques:
Opened airway
Controlled bleeding
Treated for shock
3 Killers….and Management…

Control bleeding with:

Direct pressure Elevation Pressure points (**Direct pressure
with elevation for 5-7 min.
Prevent secondary infection.
Maintain open airway.
Immobilize the injury and joints above and below the injury.
Treating Fractures, Dislocations, Sprains, and Strains.
Treating Burns.
Maintain body temperature.
 Pediatric Disaster Life Support
(PDLS): Pediatric Disaster Medicine

 Pediatric Disaster Life Support (PDLS)Disaster Specific Patterns of Injury –

1. Localized Head Trauma.
2. Isolated Spinal Trauma.
3. Soft Tissue Injuries.
4. Skeletal System Fractures seen exclusively in children: Growth plate
(Salter Harris) fracture,Torus fractures,Bowing fractures,Greenstick
fracture.
5. Musculoskeletal Injuries.
6. Isolated Abdominal Trauma.
7. Burns and Thermal Injuries Smoke and Inhalation Injuries.Hyperthermia
and Hypothermia.
8. Localized Thoracic Trauma.(Penetrating or Blunt)
Management of Pediatric Crisis..

 Treatment Goal:
1.) Prevent secondary brain damage.
2.) Maintain good cerebral perfusion pressure.
Treatment: (Remember:Airway,Breathing and Circulation comes first)
1.) Control external bleeding.
2.) Oxygenate and hyperventilate if necessary.
3.) Fluid resuscitation to maintain adequate perfusion.
4.) Keep head position in midline.
5.) Control seizures if possible.
6.) Immobilization of the cervical spine with a semirigid collar or
sandbags.
Management of Pediatric Crisis..

7.)Assessment of all localised and isolated injuries and

manage accordingly.
8.) Pain Management for Burn Victim.
9.) Care of the Burn Wound.
10.) Smoke & Inhalation Injuries.
11.) Treatment for Hypothermia and Hyperthermia.
12.) Prevent from hazardous materials exposure.
13.)Supplementation of proper antibiotics and adequate
Immunization Program.
Sufia’s Story..
 Aviation Accidents

There were only 3 years to be left without air crashes

• The first year was 1921
• The second year was 1925
• And the third and last was 1932
The commonest cause of injury in aircraft accidents is
the sudden deceleration that ccurs when an aircraft hits
the ground or water.
 Aircrash Disasters..

The five most common reasons for airliner disasters

 1. Pilot error
As aircraft have become more reliable, the proportion
of crashes caused by pilot error has increased and now
stands at around 50%.
 2. Mechanical failure
Equipment failures still account for around 20% of
aircraft losses, despite improvements in design and
manufacturing quality.
 Aircrash Disasters..

 3. Weather
Bad weather accounts for around 10% of aircraft losses.
 4. Sabotage
About 10% of aircraft losses are caused by sabotage.
 5. Other forms of human error
The remaining losses are attributed to other types of
human error, like mistakes made by air traffic
controllers, dispatchers, loaders, fuellers or
maintenance engineers.
Injuries suffered by Survived victims..

There are many types of injuries suffered by innocent victims of

airplane accidents.
 Burns – When an aircraft veers off a runway or crashes, it’s
common for a fire to erupt due to friction caused by the plane
striking something and/or because of the extreme combustibility
of airline fuel.
 Traumatic Brain Injuries – Sadly, many survivors of airplane
accidents are left with traumatic brain injuries.
 Broken bones – It is common for aircraft accident survivors to
suffer from multiple broken and crushed bones.
 Spinal Cord Injuries – Many aviation accident victims suffer
spinal cord injuries which affect mobility and fatality.
Quotes...
 As a Forensic Investigator…

The investigator should classify the injuries broadly as

Minor,Non-Dangerous,Dangerous or Fatal.A general
classification of apparent injuries is given below:
 Minor injuries - Minor contusions,lacerations,abrasions
and sprains;fractures of the fingers,toes or nose.
 Non-Dangerous injuries- Moderate or severe
contusions(bruises),lacerations(cuts),abrasions,severe
sprains;fractures of the feet,legs,hands,arms,jaw,facial
bones; loss of consciousness up to 30 minutes;sprains of
the back and neck.
 As a Forensic Investigator…

 Dangerous injuries- Fractures of the back,neck or skull

with or without paralysis;crushing injuries of arms or
legs,multiple fractures,multiple lacerations with
hemorrhage,loss of consciousness of more than 30
minutes.
 Fatal injuries- Injuries which cause death within 24
hours.Common causes of fatality in survivable accidents
are head injuries,crushing injuries of the chest,fracture of
the neck or back,severe hemorrhages and puncture
injuries of the head or body.
 Post mortem artefacts..

 Post mortem artefacts may be seen, particularly in cases of burning, which

occurs in approximately one third of all powered aircraft accidents.
 Fire causes the characteristic pugilistic attitude in the victim; this may be
accompanied by fractures of the long bones and loss of the digits.
 The high temperatures may produce intracranial steam resulting in “blow
out” fractures of the cranial vault simulating impact injury.
 The heat may also cause extravasation of blood into the extradural space
simulating a haemorrhage.
 The blood in these cases often shows heat coagulation.
 Another commonly encountered artefact results from part of the body
being soaked in aviation fuel after or at the time of death.
 Skin slippage occurs which may be confused with second-degree burns.
 Date 13th March,2018,Spot-
Kathmandu’s Tribhuvan International
Airport (TIA)
 Mar 13, 2018-At least 49 people died on Monday when a plane
carrying 71 passengers and crew crashed on “abnormal” landing
at Kathmandu’s Tribhuvan International Airport (TIA)—the third
deadliest aviation accident involving an international carrier in
Nepal.
 The 78-seater US-Bangla Airlines Bombardier Dash 8 Q400 aircraft
crashed at 2:18pm.
 This is the third deadliest crash since the twin aviation disaster in
1992—Thai Airways International in July 31 and Pakistan
International Airlines in September 28—crashed into a mountain
while attempting to land at TIA, killing all together 280 people
aboard.
 Things to remember

Things to remember…
 Most valuable tool in a disaster: your brain.
 Use common sense.
 Avoid tunnel vision.
 Follow your training and guidelines.
 Communicate with your team members.
 Stay flexible.
 Be creative.
 Things to remember

Your personal protection comes first!

Got Personal Protection Equipment?
Work with a buddy.
Difficulties for Autopsy Surgeon..
Difficulties During Mass Disasters
Medicolegal personnel will likely encounter the following
issues when coping with a mass disaster:
1. Large numbers of humans whose remains are fragmented,
commingled, and burned
2. Difficulty in determining who was involved in the disaster.
3. Difficulties acquiring useful medical and dental records and
radiographs
4. Legal, jurisdictional, organizational, and political issues.
5. Internal and external documentation and communication
problems.
6. Issues in the application of universal human forensic
identification codes.
 BANGLADESH

 B-Bay of Bengal A- Agriculture

 N-NGOs
 G-Garments and GB
 L-Land of Rivers
 A-Adaptability
 D-Disasters, DM, Democracy
 E-Emergency
 S-SAARC
 H-High: Population growth, Vulnerabilities
Our Pride...
Our Pride...
Our Pride...
Climate Change and Bangladesh…

 Bangladesh is a South Asian country with a population of 160

million living in 147,570 sq. km.
 Bangladesh is 6th in the top 10 countries with highest risk of
disasters (Global Climate Risk Index 2015).
 Among top 10 deadliest tropical cyclones in the human history,
Bangladesh had 6 of them
 Bangladesh ranked 2nd in flood risk index (more than 80%
population exposed to flood)
 Right after USA, Bangladesh is the 2nd most vulnerable
country to tornado disaster
 10 million people of the country are affected by one or more
natural disaster annually.
On 26th April 1989, Spot,Manikganj
District,Bangladesh
Quotes....
 Disaster in Bangladesh..

1. Floods
2. Cyclones and Storm Surges
3. Earthquakes
4. River Bank Erosion
5. Tornados
6. Droughts
7. Arsenic Contamination
8. Landslides.
27th June,2012,Spot,Chittagong,Cox’s
bazar and Bandarban.(What
Happened??)
Heavy rains causing multiple landslideskilled at least 110
people in thedistricts of Chittagong, Cox’s Bazaar
andBandarban in Bangladesh.
The main reason for the occurrence of landslides was
continuous rainfall which was then followed by floods and so,
due to soil erosion the disaster took place.
At least 150,000 people have also beenstranded by the floods,
officials said.
The government tried to protect the people of Bangladesh in
many ways but the death toll reached to 110 in number.
Earthquake Zones
Seismometers…
 What To Do In An Earthquake

• Stay calm! If you're indoors, stay inside. If you're outside, stay

outside.
• If you're indoors, stand against a wall near the center of the
building, stand in a doorway, or crawl under heavy furniture (a desk
or table). Stay away from windows and outside doors.
• If you're outdoors, stay in the open away from power lines or
anything that might fall. Stay away from buildings
• Don't use matches, candles, or any flame. Broken gas lines and
fire don't mix.
• If you're in a car, stop the car and stay inside the car until the
earthquake stops.
• Don't use elevators (they'll probably get stuck anyway).
What to Do After an Earthquake

 Check yourself and others for injuries. Provide first aid for anyone who
needs it.
 Check water, gas, and electric lines for damage. If any are damaged, shut off
the valves. Check for the smell of gas. If you smell it, open all the windows
and doors, leave immediately.
 Turn on the radio. Don't use the phone unless it's an emergency.
 Stay out of damaged buildings.
 Be careful of chimneys (they may fall on you).
 Stay away from beaches. Tsunamis and seiches sometimes hit after the
ground has stopped shaking.
 If we were at school or work, follow the emergency plan or the instructions
of the person in charge.
 Expect aftershocks.
 Tornado in Bangladesh…

 The most record-breaking tornado in recorded history was

the Tri-State Tornado, which roared through parts of
Missouri, Illinois, and Indiana on March 18, 1925.
 The deadliest tornado in world history was the Daultipur-
Salturia Tornado in Bangladesh on April 26, 1989, which
killed approximately 1,300 people.
 Bangladesh has had at least 19 tornadoes in its history kill
more than 100 people, almost half of the total in the rest of
the world.
 Hurricane

If winds reach 74 mph, then they are called:

 "hurricane" (the North Atlantic Ocean, the Northeast Pacific
Ocean east of the dateline, or the South Pacific Ocean east of
160E)
 "typhoon" (the Northwest Pacific Ocean west of the dateline)
 "severe tropical cyclone" (the Southwest Pacific Ocean west
of 160E or Southeast Indian Ocean east of 90E)
 "severe cyclonic storm" (the North Indian Ocean)
 "tropical cyclone" (the Southwest Indian Ocean)
Hurricane Statistics http://www.mthurricane.com/Information.htm
Recent Cyclones in Subcontinent..
Cyclone affected area in Bangladesh
Cyclone 12th November,1970...
SIDR....
Cyclone Aila
Flood Prone Areas
Area Prone to each Disaster Type
2004,Flood,Sylhet Railway Station..
 Management of flood
 Preparation to Management of flood
Before flood

 -*Collected Dry food

 -*Saving money
 -*Conscious about current news about flood
At the time of flood

 -*Should be go nearest shelter centre

 -*Drink pure water and orsalain
 -*Eat dry food
After flood

 -*Repair Disrupted house

 *Don't use flooding water
 *Conscious for government and other NGOs help
November 1970 cyclone,Distribution
of Relief..
Major Landslides in Bangladesh..
 April 24, 2013 Place
Savar,Dhaka,Bangladesh.
What??Happened??
The worst collapse in Bangladesh
Rana Plaza, Eight storied unstructured building
8 Story building • Permission up-to 6 floors, 2 additional floors
built • Built on filled-up pond – weak foundation • Generator
& heavy equipment fitted at the top floors • 4,000 people
working inside the building • Ignored factory & fire safety
rules.
 Blood @ Rana Plaza

1,129 workers died! 2,515

injured! Many dead bodies not
identified! DNA tested! Many
still reported missing! A
number of injured have
developed disability!
The Ministry of Disaster Management
and Relief (MoDMR)
বাাংলাদেদের স্বাধীনতার পরবর্তি সমদে ১৯৭২ সাদল ত্রাণ ও পুনবাসন ি
মন্ত্রণালে এবাং খােয মন্ত্রণালে নাদম েুটি পৃথক মন্ত্রণালে গঠন করা হে।
 ১৯৮২ সাদল েুটি মন্ত্রণালে একীভূ ত হদে খােয মন্ত্রণালদের অধীদন
খােয র্বভাগ এবাং ত্রাণ ও পুনবাসন ি র্বভাগ নাদম েুটি র্বভাগ হে।
 ১৯৮৮ সাদল পুনরাে ত্রাণ ও পুনবাসন ি র্বভাগদক ত্রাণ মন্ত্রণালে
নামকরণ করা হে।
 ১৯৯৪ সাদল ত্রাণ মন্ত্রণালদের নাম হে েুদ্াগ ি বযবস্থাপনা ও ত্রাণ
মন্ত্রণালে।
 ২০০৪ সাদল েুদ্াগ ি বযবস্থাপনা ও ত্রাণ মন্ত্রণালে এবাং খােয
মন্ত্রণালেদক একীভূ ত কদর খােয ও েুদ্াগ ি বযবস্থাপনা মন্ত্রণালে করা
হে।
 ২০০৯ সাদল খােয ও েুদ্াগ ি বযবস্থাপনা মন্ত্রনালদের অধীন খােয
র্বভাগ ও েুদ্াগি বযবস্থাপনা ও ত্রাণ র্বভাগ গঠন করা হে।
 ২০১২ সাদল েুদ্াগি বযবস্থাপনা ও ত্রাণ র্বভাগদক পুনরাে েুদ্াগ ি
বযবস্থাপনা ও ত্রাণ মন্ত্রণালে র্হদসদব রূপান্তর করা হে।
Disaster Management Machanism in
Bangladesh..
Regulatory Framework…
Disaster Management in
Bangladesh..
Institutional Structure for
Bangladesh.
National Policy, Planning and Act on
Disaster Management
 A disaster management regulatory framework is established
under which the Bangladesh disaster management frame
work is implemented.
The framework is comprised of:
Standing Orders on Disaster- SOD
Draft National Disaster Management Policy
National Plan for Disaster Management 2010-2015;NPDM
Guidelines for Government at all Levels -Best Practice
Models (2010)
Disaster Management Act, 2012
Disaster Management Act, 2012

 Disaster Management Act, 2012

The Disaster Management Act was approved by the
Parliament on 12 September 2012 and then came to
effect from 24 September 2012 after having signed by
the by the President.
The seventeen page Act is comprised of six chapters, 60
sections and one schedule.
Challenges and Recommendations
for Disaster Management…
Challenges and Recommendations
for Disaster Management…
 What are the projected side-effects of global
warming?
 Sea-level rise (SLR)
 A 2-4 degree Celsius rise in Sea Surface Temperature
(SST)
Some Days to be Remembered..