and Jasdeep Kaur1
(1)
Earth and Life Sciences Vrije Universiteit Amsterdam and ILEWG, Amsterdam, The Netherlands
16.1 Introduction
16.4.1 Surveillance
16.4.2 Referral of Patients
16.4.3 Diagnosis and Monitoring
16.4.4 Triage
16.4.5 Immunization and Medications
16.4.6 Infection Control
16.4.7 Definitive Treatment
16.6.3 Steps in Identifying Bodies
16.8 Conclusions
Abstract
Mass disaster attacks are the real dangers staring mankind in the face. Dentists are not perceived as much of help in the event of any disaster. Adequate victim identification management follows a strict methodology and set of protocols. This requires adopting and applying standard operating protocols. This chapter evaluates the role dentists and forensic odontologists can play in disaster response.
16.1 Introduction
The world has experienced an excess of mass disasters in recent years: acts of terrorism, bombings, earthquakes, hurricanes, typhoons, air crashes and other transportation mishaps, not to mention armed conflicts and migrants drowned in various bodies of water. A major disaster may be defined as any event that occurs with little or no warning causing death or injury, damage to property or the environment, and disruption of the community, and the effects of which are of such a scale that they cannot readily be dealt with by local services and authorities as part of their everyday activities (McLay 2009). Typically, emergency medical services (EMS) will be the first to respond and mainly comprise the ambulance service, local hospitals, and civil defense, with further extension. These services would be easily accessible, however, in the event of a large-scale mass casualty or disaster circumstances such as the Asian tsunami in December 2004, which affected hundreds of thousands of people in India, Thailand, Sri Lanka, and Indonesia, among other countries very difficult to manage and implement properly (Hinchliffe 2011; Rai and Anand 2007). The terrorist attack on the Twin Towers in New York City on September 11, 2001, heralded a new era of urban warfare on a truly global scale. Whereas the urban conflict in Northern Ireland in the 1970s and 1980s was more or less localized to the United Kingdom, “9/11” showed that terrorism was worldwide and could strike anywhere and at anytime (Hinchliffe 2011). The Bali Bombings in 2003 and the London bombings on July 7, 2005, bear terrible witness to this. Situations like these would place considerable strain on EMS resources in different countries and would be an opportunity for general dentists and forensic odontologists as health professionals to expand their capabilities in times of emergency and disaster. This chapter reviews the current literature and highlights potential areas in which the general dental practitioner and forensic odontologist may contribute during mass disasters.
16.2 Types of Mass Disasters (Levinson and Granot 2002)
Mass disasters typically are one of the following types:
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Natural disasters: These include hurricanes, tornadoes, floods, volcanoes, earthquakes, tsunamis, and any other natural phenomena that cause destruction.
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Transportation accidents: This type includes accidents involving airplanes, trains, as well as passenger ships.
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Terrorism: The most common form of terrorism seen in current times involves some kind of explosive device used to kill and wound large numbers of people.
Additionally, according to Hinchliffe (2011), additional classifications of mass disaster are the following:
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Closed type: Identifying information or a potential list of those involved is available.
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Open type: At first, there is no idea who may be involved.
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Mixed: This is a combination of open and closed.
16.3 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
16.4 Disaster Site/Crime Scene Management (Colvard et al. 2006; Guay 2007; Markarian et al. 2006)
The prime purpose of engaging the support of dentists or forensic odontologists in responding to mass disasters is to allow catastrophe managers to use scarce physician resources in the most effective manner possible by having some services they would ordinarily provide be successfully provided by dentists or forensic odontologists where possible. There are several general areas of response activity in which dentists or forensic odontologists can be helpful, as described next.
16.4.1 Surveillance
Many mass disasters are discrete entities easily recognized and of easily defined duration and effects on a population, while some disasters, predominantly bioterrorism attacks and pandemics, often have relatively indistinguishable beginnings and ends and unpredictable effects on a population. Because of the different incubation periods of infectious agents, the time of exposure can be estimated only after disease has manifested (Guay 2007; Markarian et al. 2006). It also may take valuable time to determine that a population-wide problem actually exists. Dentists or forensic odontologists can be part of a successful surveillance network because they are scattered throughout a community much as the general population is. Observations of intraoral or dental lesions when they are present and the notification of health authorities on these observations may assist in the early detection of a bioterrorism attack or the spread of a pandemic infection. Early detection of an infectious agent in a population may help reduce the number of casualties by the prompt initiation of preventive and therapeutic intervention.
16.4.2 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 (Guay 2007).
16.4.3 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 afflicted 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 (Guay 2007; Markarian et al. 2006).
16.4.4 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 (Guay 2007).
16.4.5 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 (Guay 2007; Markarian et al. 2006).
16.4.6 Infection Control
Dentists or forensic odontologists perform sound infection-control procedures in their offices on a daily basis. 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 (Guay 2007; Markarian et al. 2006). These remains most likely will be contaminated and will require careful management to prevent further disease spread.
16.4.7 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 (Guay 2007; Markarian et al. 2006).
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