61 Lost: Mass Casualty Identification of Human Remains. Kevin Whaley MD
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1 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 Chicago, IL 60603
2 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.
3 Mass Casualty Identification Kevin D. Whaley, M.D. Assistant Chief Medical Examiner Richmond, Virginia Assistant Chief Medical Examiner, Central District Pathology Section Chief, DMORT 2011 ASCP Annual Meeting Faculty 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 1
4 Levels of Identification Primary DNA Fingerprints Odontology Unique medical features Secondary 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 2
5 Optimal Flow of Modalities Admitting DNA Photography Fingerprinting X Ray Odontology Pathology Anthropology Admitting Documentation Maintaining integrity of remains Ramifications of 95% certainty of identification Photography Remains pouch with number Clothed remains Cleaned personal effects 3
6 Personal Effects Clothing Dry cleaning tags Sizes Associated with significant event Personal Effects Clothing Jewelry Family heirlooms Class rings Wedding bands Retirement watches Clothing Jewelry Wallet / Purse contents Driver s license Social Security card Credit cards Telephone numbers Family photographs Personal Effects 4
7 Personal Effects Clothing Jewelry Wallet / Purse contents Firearms Radiological Assessment Primary Surgical hardware Sternal wires Geometry of surgical clips / screws Pacemaker Hip replacement Radiological Assessment Primary Surgical hardware Unique osseous morphology Frontal sinus pattern Osteodegenerative changes Healed/healing fracture morphology 5
8 Radiological Assessment Primary Secondary Calcaneal spurs Single clips/nails Myositis ossificans Healed/healing fracture morphology Physical Features Caveats Hair color Photodegradation Thermal exposure Eye color Corneal clouding Contact lenses Skin color Mixed race Decompositional changes Thompson & Black, Forensic Human Identification Sex Height Weight Body habitus Anthropometrics 6
9 Caveat to Photographs and Visual Identification Kubler-Ross stages of grief: Denial Anger Bargaining Depression Acceptance Scientific Visual Identification 1 st Stage Major discrepancies Scientific Visual Identification 1 st Stage 2 nd Stage Facial Landmarks 7
10 Scientific Visual Identification 1 st Stage 2 nd Stage Photogrammetric facial landmark alignment 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 Sternal rib ends, 4 th Juveniles Union of primary ossification centers Dental eruption Long bone length Epiphyseal closure 8
11 Anthropological Basic Assessment Sex Age Stature Long bones Anthropological Basic Assessment Sex Age Stature Geographic ancestry Caucasoid Anthropological Basic Assessment Sex Age Stature Geographic ancestry Caucasoid African-American 9
12 Anthropological Basic Assessment Sex Age Stature Geographic ancestry Caucasoid African-American Asian Pathological Assessment Body Modification Piercings 10
13 Body Modification Piercings Branding Body Modification Piercings Branding Tattoos Decomposition 11
14 Decomposition Adipocere Obscured tattoos Acquisition of new antemortem data 12
15 Decomposition Adipocere Mummification Insect activity Forensic value Ocular prostheses 13
16 Ocular prostheses Intraocular lens implants Ocular prostheses Intraocular lens implants Scars Ocular prostheses Intraocular lens implants Scars Suitability for fingerprinting 14
17 Ocular prostheses Intraocular lens implants Scars Suitability for fingerprinting Occupational stigmata Ocular prostheses Intraocular lens implants Scars Suitability for fingerprinting g Occupational stigmata Surgical scars Autopsy prognostication Internal Examination Fibrotic disease processes 15
18 Internal Examination Fibrotic disease processes Surgical procedures Appendectomy Vasectomy / tubal ligation Gastric bypass Odontology Challenges to Dental Identification Obtaining records Adequate charting 16
19 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 Characteristics Teeth present. Erupted. Unerupted/impacted. Missing teeth. Congenitally missing. Lost antemortem. Lost perimortem/postmortem. Tooth Type Permanent. Mixed dentition. Retained primary teeth. Supernumerary teeth. Malpositions facial/linguoversion rotations supra/infra positions diastemas. 17
20 Dental Characteristics Dental Restorations Metallic restorations: amalgams, gold or nonprecious metal crowns/inlays Posts, pins, fixed prostheses, implants. Nonmetallic restorations Partial 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 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. 18
21 Fingerprinting Postmortem Fingerprints Methods of obtaining Postmortem Fingerprints Complicating factors 19
22 Postmortem Fingerprints Characteristics Method of comparison Utility in identification DNA Acquisition DNA Identification 20
23 DNA Reference Samples Personal Effects Toothbrush Hairbrush Razor Unwashed undergarments Soiled personal hygiene products 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 DNA Reference Samples Thank You Questions? 21
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