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Mass Disaster: Past and Present Current Trends: 5th Annual Conference December 1, 2004

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Title: Mass Disaster: Past and Present Current Trends: 5th Annual Conference December 1, 2004


1
Mass Disaster Past and PresentCurrent Trends
5th Annual ConferenceDecember 1, 2004
Terrorism is the unlawful use of force or
violence against persons or property to
intimidate or coerce a government, the civilian
population, or any segment thereof, in
furtherance of political or social objectives
-Federal Bureau of Investigation
  • Nizam Peerwani, M.D.
  • Chief Medical Examiner
  • Tarrant-Denton-Parker Counties, Texas
  • Wednesday, December 1, 2004
  • peerwani_at_aol.com

Anthrax Bacilli Gram Stain
2
Objectives
  • Mass Fatality Legal Authority at Local Level
  • Role of Medical Examiner in Mass Fatality Event
  • Types of Events resulting in Mass Fatalities
  • and Human Identification
  • Bioterrorism a different model necessitating
    different approach

3
Definition
  • Mass trauma is the term used to describe the
    injuries, death, disability, and emotional stress
    caused by a catastrophic event, such as a
    large-scale natural disaster or a terrorist
    attack
  • Mass Fatalities Any situation in which there are
    more human bodies to be recovered and examined
    that can be handled by the resources of the
    existing facility.
  • Mass Fatalities in Tarrant-Denton-Parker Is
    defined as any event where there are more than 10
    casualties resulting from a single event

4
Legal Authority
  • In Texas, the medical examiner is empowered by
    Statute 49.25 of the Code of Criminal Procedures
    which requires a duly appointed medical examiner
    to conduct inquest or inquiry into certain
    types of death including
  • Deaths due to unnatural causes
  • Unattended deaths
  • Deaths that occur within 24 hours of admission

5
Medical Examiners in Texas 2003
  • Facts
  • Texas has no State Medical Examiner (ME)
  • Texas has a mixed ME and Coroner system
  • 13 MEs in Texas
  • MEs are located in 15 counties
  • Population served by ME counties is 13 million
    (58 of state)
  • In Texas - Medical Examiners are
  • Appointed Physicians licensed by the State Board
    of Medical Examiners
  • Trained and experienced in pathology, toxicology,
    histology, and other medicolegal sciences
  • Appointed by the County Commissioners Court

Source Bureau of Epidemiology and Bureau of
Vital Statistics
For more information david.zane_at_tdh.state.tx.us
6
Tarrant County Medical Examiners District -
  • Serves Tarrant, Parker
  • and Denton Counties
  • Jurisdiction 3,000 SM
  • Population 2.1 million
  • Cities served 60
  • Law Enforcement Agencies 63
  • Inquests 8,000/year (40 of all deaths)

7
Commissioners Court
Table of Organization
8
Four Forensic Pathologists Forensic
Anthropologist Forensic Dentist Forensic
Toxicologists Criminalists Latent Print
Examiner Forensic Death Investigators Full-service
Toxicology Lab Reference Crime Lab (52 full-time
employees)
9
1st Major Terrorist Attack in the United States
April 19, 1995
Murray Federal Building 5000 lbs of Ammonium
Nitrate fertilizer in a Truck
10
National Defense Policy Against Terrorism
Counterterrorism
  • The policy (June 21, 1995) evolved in the
    aftermath of Oklahoma Bombing on the 2nd
    anniversary of the Waco Disaster on April 19,1995

FBI
Crisis Management
Homeland Defense
President
Consequence Management
FEMA
Role?
State/Local Agencies
County Medical Examiners
11
Role of Medical Examiner in Mass Fatality Event
  • Assessment of the Event
  • Death Scene Investigation
  • Body Recovery
  • Examinations
  • Identification of Human remains
  • Establishment of Cause and Manner of Death
  • Protect Personal Property and Evidence
  • Disposition of Remains to Loved Ones

12
Mass Casualty Involvement by Tarrant County Staff
  • Delta Airline Crash at DFW Airport,1985
  • Delta Airline Crash at DFW Airport, 1986
  • Waco Disaster, 1993
  • International
  • Rwanda Genocide Investigation, 1996
  • Bosnia Kosovo, 1996-1997
  • Guatemala, 1997 2002
  • Afghanistan Iraq Mass Graves, 2002- 2004

13
Types of Mass Fatality Events
Natural
Man-Made
Fire Hotel, School, Church Transportation
Aircraft, Bus etc Industrial Chemical Terrorism
Domestic or Foreign
Weather Tornado, Flood Fire Forest
fire Earthquake
14
Notification
  • Emergency Operations Center (EOC)
  • Police Law Enforcement
  • News Media

15
Koresh Compound on Thursday, April 22, 1993
16
Bunker
Water Tower
Kitchen/Dining Area
17
(No Transcript)
18
(No Transcript)
19
Modes of Identification
  • Visual Body Intact
  • Fingerprints
  • Dental
  • Body X-Rays
  • DNA

20
Fingerprint Comparison AFIS
21
Dental
22
X-Ray Comparison
23
DNA A Definitive For IdentificationGenomic
(STR) or Mitochondrial
24
911 Taught Us That We Remain Unprepared
25
Recovery Efforts Can Be Extremely Hazardous
Destruction May Be Widespread
Dense Smoke Debris Several Days After The
attack (September 15, 2001)
26
Shifting Paradigm
27
In a Bioterrorist Attack.
  • In most cases, the cause of death will be
    clearly established by Hospital or Public Health
    Department
  • There will be involvement of FBI (as the lead law
    enforcement agency)
  • All deaths will be classified as homicides
  • Number of casualties will continue to arrive in
    reverse order
  • The major responsibility of the medical examiner
    will be to
  • Take custody of the remains to establish the
    identity
  • To issue Death Certificate
  • Dispose remains to designated location or for
    burial

28
Category A/Diseases Agents
  • Anthrax (Bacillus anthracis)
  • Botulism (Clostridium botulinum toxin)
  • Plague (Yersinia pestis)
  • Smallpox (variola major)
  • Tularemia (Francisella tularensis)
  • Viral hemorrhagic fevers (filoviruses e.g.,
    Ebola, Marburg and arenaviruses e.g., Lassa,
    Machupo)
  • Highest Priority Agents
  • Can be easily disseminated or transmitted from
    person to person
  • May cause high mortality, and have the potential
    for major public health impact
  • Might cause public panic and social disruption
  • Require special action for public health
    preparedness

29
Category B Diseases Agents
  • Multstuberculosis
  • Nipah virus
  • Tick-borne encephalitis)
  • Melioidosis (Burkholderia pseudomallei)
  • Psittacosis (Chlamydia psittaci)
  • Q fever (Coxiella burnetii)
  • Ricin toxin from Ricinus communis (castor beans)
  • Staphylococcal enterotoxin B
  • Typhus fever (Rickettsia prowazekii)
  • Viral encephalitis (alphaviruses e.g.,
    venezuelan equine encephalitis, eastern equine
    encephalitis, western equine encephalitis)
  • Water safety threats (e.g., Vibrio cholerae,
    Cryptosporidium parvum)
  • Second Highest Priority Agents include those
    that
  • are moderately easy to disseminate
  • cause moderate morbidity and low mortality
  • require specific enhancements of CDC's diagnostic
    capacity and enhanced disease surveillance

30
Category C Diseases Agents
  • Hantaviruses
  • Multidrug-resistant tuberculosis
  • Nipah virus
  • Tick-borne encephalitis viruses
  • Tick-borne hemorrhagic fever viruses
  • Yellow fever
  • Third Highest Priority Agents include emerging
    pathogens that could be engineered for mass
    dissemination in the future because of
  • availability
  • ease of production and dissemination
  • potential for high morbidity and mortality and
    major health impact.

31
Inexperience Most medical examiners have no
field experience
Anthrax Vascular Thrombosis
Anthrax Bacilli
Smallpox Pustules Early Scarring
32
Large-scale Act of Bioterrorism
  • Federal and/or State Emergency
  • Local jurisdiction may be suspended and the
    medical examiner in a local area may play a
    supporting role only
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