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?