Thai Tsunami Victim Identification

The Journal of Forensic Odonto-Stomatology, Vol.23 No.1, June 2005

EDITORIAL

In recent years there have been localized natural disasters and terrorist acts which have high-lighted Forensic Odontology within forensic science, police departments and the wider commu-nity. The Asian tsunami of 26 December 2004, however, is surely the biggest international disas-ter victim identification effort that we have faced.

The effects of the tsunami were felt in countries around the Indian ocean, with an estimated300,000 people missing or dead. International efforts have been concentrated in Thailand, wheremany foreign tourists, as well as large numbers of Thai nationals, were killed. The sheer magni-tude of the disaster, combined with the number of countries suffering lost citizens, has producedan unparalleled effort from DVI teams from over 30 separate countries. Odontologists from coun-tries including Australia, Austria, Belgium, Canada, Denmark, France, Finland, Germany,Greenland, Iceland, Italy, Japan, The Netherlands, New Zealand, Norway, Singapore, South Korea,Switzerland, Sweden, United Kingdom & United States of America have joined Thai dentists inthe DVI process. This has thrown a spotlight onto forensic odontology procedures and empha-sized the need for co-operation, standard operating procedures, early quality assurance mea-sures and much good humour.

Professor Kieser, from New Zealand, recently reminded me of an article published in 1988 inwhich Brown said “Finally, it requires action and financial support by the governments of everycountry to establish within their borders a central identification agency and procedures that areinternationally compatible. Well organized protocols will not only expedite the identification processand improve morale of the personnel involved, but more importantly, will project an image ofprofessionalism that will inspire the confidence of the relatives of the deceased, thus minimizingtheir mental trauma and distress.” (Brown KA. International Communication and Cooperation inForensic Odontology. J Forensic Odonto-Stomatol 1988;6:29-34.) This disaster has forced theinternational community to come to terms with that challenge.

If there can be considered to be an upside to such a disaster, it would have to be the internationalgoodwill that has been generated, combined with the invaluable expertise that has been gainedby those participating in such a huge undertaking. Simulated training exercises are undertakenby most national organizations, but are no substitute for reality.

In Thailand, over 5000 dead, from 44 countries, have stretched forensic odontology resourcesand personnel; with many odontologists already on their second or third rotation to Thailand. Thishas substantially increased the workload of all involved, making journal publication low oneveryone’s priority list, and an editor’s nightmare. Consequently, I have accepted a series of un-refereed short reports from some of the many odontologists involved and, with their permission,I have produced a composite article to give you a picture of developments to this publicationdate. My heart-felt thanks to all contributors.

The poem on page 18 was composed by an Australian interpreter and read at a memorial servicefor the dead at Patong Beach.

Helen


Keywords: Forensic Odontology, Disaster Victim Identification, Tsunami

ABSTRACTABSTRACTABSTRACTABSTRACTABSTRACTThe boxing day tsunami of 26 December 2004 caused devastation and loss of life around the Indian ocean.International disaster victim identification efforts were centred in Thailand, with many odontologists from over 20countries contributing to the examination of deceased, collection of antemortem information, comparison andreconciliation of data. The contribution of forensic odontology to the identification process conducted in Thailandin response to the tsunami devastation is presented in a composite of short reports focused on the five phasesassociated with disaster victim identification. To date 1,474 deceased have been identified. Dental comparisonhas been the primary identifier in 79% of cases and a contributor in another 8%, a total of 87%.(J Forensic Odontostomatol 2005;23:1-18)

THAI TSUNAMI VICTIM IDENTIFICATION -THAI TSUNAMI VICTIM IDENTIFICATION -THAI TSUNAMI VICTIM IDENTIFICATION -THAI TSUNAMI VICTIM IDENTIFICATION -THAI TSUNAMI VICTIM IDENTIFICATION -OVERVIEW TO DATEOVERVIEW TO DATEOVERVIEW TO DATEOVERVIEW TO DATEOVERVIEW TO DATE

James H, EdForensic Odontology Unit, University of Adelaide, Australia

ContributorsBall J, Centre for Forensic Science, University of Western Australia, AustraliaBenthaus S, Xanten, GermanyCiaccio FJ, Regional Vice President, The Americas, Kenyon International Emergency Services, USACraig, P, School of Dental Science, University of Melbourne, AustraliaFirth N, Department of Oral Diagnostic and Surgical Sciences, University of Otago, New ZealandGriffith D, Australian Federal Police Consultant, Canberra, AustraliaGrundmann C, Duisburg, GermanyHashimoto M, Dept. of Forensic Anthropology, Tokyo Dental College, JapanJames H, Forensic Odontology Unit, University of Adelaide, AustraliaKhouri Z, Forensic Odontologist, Hamilton, New ZealandKieser J.A, Department of Oral Sciences, University of Otago, New ZealandKvaal S, Dept of Pathology and Forensic Odontology, University of Oslo, NorwayLain R, Oral Surgery Department, Sydney Dental Hospital, AustraliaLaing W, Forensic Odontologist, Family Dental Centre, Morrinsville, New ZealandLessig R, Institute of Legal Medicine of the University of Leipzig, GermanyLorentsen M, Dept of Pathology and Forensic Odontology, University of Oslo, NorwayMeldrum R, Department of Oral Sciences, University of Otago, New ZealandPeter J, Department of the German Federal Police, Wiesbaden, GermanyPorntrakulseree N, Dental Department, Lumphun Hospital, Muang, Lumphun, ThailandRowlings K, Forensic Odontology Unit, University of Adelaide, AustraliaSaka H, Dept. of Anatomy, Tokyo Dental College, JapanSaunderson W, Department of General Dentistry, Sydney Dental Hospital, AustraliaSolheim T, Dept of Pathology and Forensic Odontology, University of Oslo, NorwayStene-Johansen W, Dept of Pathology and Forensic Odontology, University of Oslo, NorwaySuksudaj S, Faculty of Dentistry, Thammasat University, Patumtani, ThailandSweet D, Bureau of Legal Dentistry, University of British Columbia, CanadaTaylor J, Oral Health University of Newcastle, AustraliaWilliams G, Wellington Central Police Station, Wellington, New Zealand

James, Ed 1


INTRODUCTIONTsunami is a Japanese word meaning “harbourwave”.1 They can be caused by a variety of phe-nomena, including undersea volcanic eruption,coastal landslides or earthquakes, resulting in shiftsto the tectonic plates and displacement of millions oftonnes of water to produce devastating waves.

At 0800 on 26 December 2004 an earthquakemeasuring 9 on the Richter Scale occurred, with theepicentre of the earthquake off the west coast ofSumatra, Indonesia. The sea floor was disrupted for960 km and tsunami waves produced the “BoxingDay Tsunami”.

The closest population base, Aceh at the northerntip of Sumatra, was inundated by waterapproximately 15 minutes later (estimated 130,000dead). Waves radiated progressively across theIndian ocean, striking Malaysia (68), Thailand (5,400),Myanmar (90), Bangladesh (2), India (11,000), SriLanka (38,000), the Maldive (82) & Seychelle (2)Islands, and the East African coast of Tanzania (10),Kenya (1) and Somalia (300).2

Six coastal provinces in the south of Thailand werehit and consequently posed considerable social andeconomic impacts on the country. Many local peopleand tourists who came to appreciate the beautifulThailand Andaman coast, were injured or lost theirlives. Official reports3 stated there were 8,457 injured,of which 72% were Thais and 28% were foreignersand 5,395 dead of which 37% were Thais, 42% for-eigners and 21% unidentified. This incredibly highhuman cost was far beyond the expectation andexperience of the nation, where a massive scaledisaster had never happened before and a system-atic management plan had never been set up.

According to Thai law, the Royal Thai Police Forceis in charge of victim identification. Since there arefew forensic pathologists and only one forensicdentist in the organization, the task of identifying thou-sands of tsunami victims was considered beyond thecapability of the Royal Thai Police Force alone. On27 December the Thai government issued anurgent request for assistance in view of the scale ofthe disaster and the number of foreign touristsaffected. World-wide humanitarian relief, as well asDisaster Victim Identification plans, was activated inmany countries affected by the tragedy.

The Ministry of Public Health contacted the ThaiDental Council to recruit Thai dentists throughout the

country to help in the body identifications. As aresult, more than 500 Thai volunteer dentists anddental personnel from both public and private sec-tors have participated in the tsunami dental forensicinvestigation, a well as an estimated 200 internationaldentists.

The traditional five phases structuring a DVI incidentwere put into place as a joint venture between Thaiand Australian DVI experts – scene assessment,postmortem examination, antemortem recordcollection, reconcilliation to identify victims anddebriefing.4

PHASE 1: THE SCENEDamageThe damage to Phuket Island was variable and notevenly distributed. Patong Beach was largelydestroyed, while several of the resort hotels alongthe coastline were back in full operation after 24 hoursof frantic clean up. Phi Phi Island was totallydevastated with large loss of life, but the most affectedarea was along the Khao Lak coast north of PhuketIsland right up to the Burmese border, a distance ofsome 150 km. Along this coastline there werepockets of normality mixed with total devastation.There is only a small coastal plain, in some areasonly 300 metres wide, backed by sharply rising hills.The tsunami rapidly inundated the coastal plain andfinding its path blocked by immovable hills, turnedback on itself, creating the classic maelstrom effectand massively increasing the damage. The coastalroad was impassable in many places, being buriedunder two metres of sand and debris, with thepowerlines that ran alongside the road also cut. Carswere picked up and carried great distances and somecould be seen buried deep inside the first floorstructure of the few remaining buildings. Severalboats, of significant tonnage, were deposited half wayup the hillsides, some almost 750 metres from thesea.

The vegetation rapidly died due to the massiveincrease in salinity and while a significant number ofpalm trees had demonstrated their ability to surviveby flexing the way of the forces applied to them, mostwere bent at odd angles. The property damage alongthis stretch of coastline was extreme with entire hotelsreduced to two courses of brickwork (Fig.1).

The loss of life was assessed as severe and whilemost deaths were expected to be by drowning, it wasobvious from the property damage that injuries and

Thai Tsunami Overview2


probably death from physical trauma would also befound.

A priority was identified as the opening of the coastalroads and re-establishment of power supplies withthe setting up of refugee camps in the affected areasas soon as practicable.

A secondary, but no less significant, need was tocollect the deceased and bring them to central holdingareas before disease and contagion spread. This wasan area in which the Thai authorities soughtinternational help. Strong representations were madeto the Thai authorities to establish a single bodycollection and mortuary site at or near the airport,and to this end QANTAS, the Australian nationalairline, was approached for the use of one of theirhangars at Phuket International Airport. However,initially, the Thai authorities were unable tocountenance such a massive movement of bodies,in a manner which may have proved offensive to theBuddhist faith, and the idea of a central facility wasrejected by them.

The Thai authorities decided to utilise the variousBuddhist temples or Wats, which abound in Thailand.These places have the advantage of being easilyfreed from their normal usage, and often have theirown crematorium attached. In all societies, temples,churches and mosques are a source of comfort andsolace in such situations. They are also used asinformation centres and as collection points for thedead. This was the case in Thailand, a predominantlyBuddhist society and the attitude of the Buddhistmonks should be highly praised.

Mortuary SitesMortuary sites were subsequently established atTakua Pa (Sites 1A & 1B), Mai Khao (Site 2), andKrabi (Site 3).

Site 1A was established at the temple complex ofWat Yan Yao and 1B at Wat Ban Muang.

Under the leadership of Thai pathologist Dr PornthipRotjanasunan, teams scoured the affected area forbodies and brought them to central holding areas.Given the large area involved and difficulty oftransport along a still badly affected single road adecision was taken to establish local holding areasand in the earliest times many small body holdingareas existed.

Initially there were over 500 bodies, mostlyuncovered, lying in the sun or under primitive open-air shade at Wat Yang Yao (Fig.2). There was

advanced bloating and decomposition evident withall the bodies. An additional 1500 bodies weredelivered overnight, with a further 1500 bodies thenext day. A precise count of the number of bodieswas not possible until they had all been tagged andrefrigerated and this took almost 2 weeks to complete,with more bodies arriving in varying numbers daily.Wat Yang Yao rapidly became the prime site in PhanhNga province.

PrioritiesGiven the large number of bodies lying in the openwith little or no protection from the elements and adaytime temperature above 30C with high humidity,several critical decisions had to be taken immediatelyupon arrival at Wat Yang Yao.

The major concern was identified as that of diseaseand this was recognised as being far more importantthan commencing identifications, especially as it wasalready very clear that the identification process

Fig 1: Destruction on the coast road to Takua Pa

Fig 2: Bodies at Wat Yan Yao

James, Ed 3


would take many months. The priorities for containingdisease were identified as:1. Implement some sort of body cooling process in

situ by the use of dry ice or other agent2. Obtain refrigerated containers as soon as

practicable3. Commence achieving some semblance of order

at the site by tagging, recording and baggingbodies prior to refrigeration.

4. Clear parts of the site to allow easy access to thebodies

5. Commence a clean up of the site as soon asspaces were cleared to remove the alreadysignificant contamination caused by discardedgloves, masks and other debris

6. Identify a suitable site for the temporary mortuary7. Commence construction of the temporary

mortuary

The entire team set to work tagging, recording andbagging bodies, aided by many volunteers, while thesite commander set about organizing refrigeration,power and identifying a suitable mortuary site.Truckloads of dry ice arrived at the site, followed byrefrigerated containers which were immediatelyplaced by the Thai army and connected to powersupplies (Fig.3).

PersonnelThe initial dental DVI team consisted of two forensicodontologists from Australia. They were joined 48hours later by a dentist from New Zealand, followedrapidly by the Dutch, Belgian, Singaporean andSwedish teams. French and German teams alsoarrived on site shortly after and the entire operationgrew in 6 days from a solo Australian response to atruly international effort.

Early problems and solutionsThe Australian Rapid Response kit consists of acache of pre-packed, containerised and air portable

equipment and is designed to allow the team tooperate in the field for 7 days before resupply. Thisallows for full field operations of a forensic and/orDVI nature for a week. The time frame wasdeliberately chosen, as this is the time it will take toassemble and deploy the larger teams needed andto arrange effective resupply. The DVI component ofthe kit includes portable dental X-ray machines,X-ray developing machines, and all the necessarydental mortuary equipment including personalprotective equipment. It was never designed to supplythe needs of dentists from 10 countries for 7 days,but sadly, with the exception of the superbly organisedand equipped Dutch team, many National teamsturned up woefully under-equipped for an operationof this nature and scale.

The Australian Department of Foreign Affairs andTrade signed a contract with Kenyon International tosupply and maintain a mobile mortuary facility at WatYang Yao and thus took on the responsibility andcost of all international mortuary operations there.The Australian Rapid Response kit allowedimmediate and effective aid to be given to the Thaiauthorities and greatly enhanced the speed at whichthe Australian team was able to deploy andsubsequently reach full function. Re-supply was leftto Kenyon International.

The mobile mortuary kit provided by Kenyon wasimpressive in size and scope, but customs andtransport difficulties meant that its promised 24 hourdeployment time was not achieved and when the kitfinally arrived it was lacking in some critical areas.The provision of all electrical equipment to operateon 110V power supply meant transformers wererequired. The need to carefully check the voltagerange of every piece of equipment was a severelimiting factor. The failure of the provided X-raymachine to function and the poorly designed standmeant that additional radiographic machines had tobe sourced urgently from Australia. The initialprovision of only two mortuary tables was a problem,given that the size of the disaster was well knownbefore the kit was deployed. Praise must be given tothe efforts of the Kenyon staff on the ground whoworked tirelessly to establish infection control anddecontamination areas.

Body handling provided its own special difficultieswith different nations having varying standards,although the accepted standard for the operation wasthe Interpol DVI standard. The accepted protocol ofhaving a unique number for each body was adoptedand extreme care was taken to ensure that thisnumber was not re-used. The unexpected

Fig 3: Bodies waiting for container storage, Wat Yan Yao

Thai Tsunami Overview4


commencement of postmortems at other sitescaused immense concerns and the unique numberwas rapidly modified to contain information about thesite the postmortem was completed at and thecountry responsible for tagging the body initially.

Once a body was tagged with a durable tag markedwith indelible ink attached with electrical ties to theleft wrist, it was placed in a body bag which was thensealed and another tag marked with the body numberplaced on the zipper tag with an electrical tie. Thebody number was then recorded on the body bagwith an indelible pen, and the head of the bodyindicated. The body bag was then transferred underescort to a pre-determined container and thecontainer number noted on the post mortem form. Itwas stressed to all who performed this vital task thatonce the body had been assigned a number it waslegally in their care and it was their responsibility toensure correct storage.

While this protocol was adhered to, body trackingwas simple. However there was sometimes a desireto sacrifice accuracy for speed and as a result somebodies were temporarily mislaid. This should neverhappen and would never have happened had allparticipants adhered to the guidelines.

An unforeseen and initially insoluble problemsurfaced early on with the local Buddhists asking forand receiving permission to start decontaminatingthe site. This they did with a delightful orange scentedspray which has special significance to Buddhists;however it also has a special affinity to indelible inkon body bags that rendered many of the numbers onthe exterior of the bag unreadable. The wisdom oftags inside the bag on the body, as well as tagsoutside the bag, became abundantly clear.

Later decontamination was accomplished with moreconventional chemicals; however the use of largeamounts of hypochlorite bleach and formaldehydedid raise significant occupational health and safetyissues and this was brought to the attention of theThai authorities.

PHASE 2: POSTMORTEMSite 1Design requirements for an emergency mortuaryThe design of a mortuary from scratch using onlylocally available materials and able to serve the needsof many disciplines while handling a large number ofbodies, was a complex task and was made no easierby mounting political pressure to commencepostmortem operations.

A list of requirements was established in order ofimportance:-1. Adequate protection and decontamination for all

staff2. Optimum working conditions to allow maximum

efficiency3. Management of liquid waste was critical to avoid

contamination of local water supplies and thenearby river

4. The mortuary had to be secure and easilyprotected from unwanted intrusions by journalistsor members of the public

5. Areas had to be designated for specificprocedures

6. An unrestricted flow of bodies had to be achieved7. The flow and number of work stations had to

reflect the time taken at each stage8. Body handling had to be well coordinated with

mortuary activities given the distance the bodieshad to be moved from storage

With these requirements in mind it was determinedthat the best site was in the lower temple building.While the upper temple building was better situated,it was full of bodies still to be processed, and it wasaccepted that the time taken to remove these bodieswould cause an unacceptable delay to thecommencement of postmortem operations.

The flow of bodies was designed to accommodatethe various disciplines, with each disciplinedetermining their specific requirements.Fingerprinting was identified as the first stage andthis was established in an air conditioned tent at theentrance to the fixed mortuary. The bodies were thenmoved on the same table into the mortuary.Pathologists opted for a visual examination forsurface features and a laparotomy to determine ifany organs had been surgically removedantemortem. The next stage established was toharvest a sample of femur or rib for subsequent DNAanalysis. A decision was taken to deglove the faceand resect the mandible in a manner which wouldallow later replacement with minimal evidence ofinterference.

The dental station was next where a full dentalpostmortem was performed with specifiedphotographs.

The body then left the air conditioned area and wentto dental radiography. Once the radiographs werechecked and approved, two teeth were extracted forDNA analysis and the body returned to the care ofthe body handlers for placement in its designated

5James, Ed


container. It was identified that the dental radiographyprocess was the time limiting factor and a large areawas therefore allowed for body holding.

The mortuary was constructed of plywood on a pinestud frame, within the temple building. The floor wasconcrete and many options were canvassed beforedeciding that a floor covering would prove counterproductive, but provision was made for specialisednon-slip mats if they proved necessary. The wallswere lined with plastic to stop contamination andimprove ease of cleaning. A large number offluorescent lights were installed to give optimallighting, and three large air-conditioning units wereinstalled to give a reasonable working temperature.

Supply of running water and fully plumbed sinks waseasily achieved, although the need to rely on the localwater tower for supplies meant that arrangementshad to be made with the local fire brigade tosupplement the actions of the meagre pump. Of fargreater concern was drainage for the sinks and forthe mortuary floor. This necessitated a penetrationof the concrete slab, which had been specificallyrequested to be left intact by the Buddhist monks. Asalways the monks rose to the occasion and grantedimmediate permission for further desecration of theirtemple in the interests of the living. Havingestablished the drainage capacity the problem ofwhat to do with the waste was then paramount. Anoriginal idea to build a large soak away pit wasrejected on the grounds of potential contaminationof the ground water and an ingenious cascadesystem of septic tanks was designed and installed.This resulted in no contamination whatsoever of theground water and nearby river.

Construction of the mortuary took 36 hours andresulted in a fully plumbed, air-conditioned, lined andwell lit facility (Fig.4). The design and constructionphase was challenging, not least of all because wewere to be working in a Buddhist prayer house andthe image of the Buddha was to remain and had tobe respected.

PersonnelOn day one at Wat Yang Yao over 50 Thai dentistsarrived ready and willing to work. In keeping with thedirective that the Australian team was to aid and notcontrol the Thai effort Dr Russell Lain was taskedwith conducting a rapid training course in basic dentalpostmortem procedures. This proved to beexceptionally successful and the Thai dental teamscommenced their post-mortem examinations on daytwo, in sub optimal conditions, but with access tofunctional x-ray machines on site. When full mortuaryoperations commenced on day four, dentists fromaround the world had arrived to join the identificationefforts.

Non-dental volunteers from Canada, USA, UK,Australia, Scandinavia and Thailand also arrived tohelp in the early days and without them the operationwould have been seriously hampered. The roleplayed by the Thai army cannot be overstated assquads of soldiers toiled tirelessly moving bodies andpositioning containers. Most of the electricians onsite were Thai volunteers as were the plumbing crewsand these people were the unsung heroes of our earlysuccesses.(Fig.5)

Fig 4: Mortuary in operation, Site 1A

Fig 5: Thai volunteers

6 Thai Tsunami Overview


Development of the Standard OperatingProcedures (SOP)Standard operating procedures for dentalpostmortem examination were written on day threeby consultation between Australian and Dutch teams.The SOP established two-person teams to covereach phase of the dental postmortem with one pairbeing responsible for the postmortem examination,another pair responsible for the radiographicexamination and harvesting teeth for DNA analysis.Each mortuary line was accorded its own dedicateddental team. It was decided that accuracy wasparamount and that if necessary, speed should besacrificed for accuracy. To this end a slightly top-heavy team structure was organised with a heavyemphasis on quality assurance. The need to ensureaccuracy led to a requirement for regular breaks tobe taken and the teams to be regularly rotated. Thecreation of a ‘super dentist’ to oversee each lineproved to be an essential tool in the days to comewhen different nations started arriving to help.Incorporated within the identified dental duties,merely because of the position of the final dentalprocedures in the mortuary line, was enforcement ofinfection control and mortuary security.

Awareness of the cost of the operation and theinevitable political backlash when these costsbecame clear, led to a decision to avoid full mouthradiographic examinations and settle for bitewingradiographs and radiographs of any other featureidentified as interesting by the charting team.Photographs were required of the anterior dentition,left and right molars and the occlusal surfaces ofteeth. Polaroids had the advantage of being instantlyready and assessable, did not require a computerand were nowhere near as easy to lose as flash cardsfrom digital cameras. It was decided that posteriorteeth without restorations would be extracted for DNAprofiling. This was later changed, against our advice,to anterior teeth.

The dental team was formed into the required groupsto carry out the SOP effectively and it was decidedat once that unless the dental group could be unifiedoutside strict Nationalistic boundaries that it’seffectiveness would be diminished. This led to theadoption of pre and post work team meetings whereissues were aired, new members welcomed and aco-operative team framework built.

In mid-March New Zealand police carried out an auditto establish how many deceased persons remainedto be examined at Site 1. The Thai government seta date for closure of the site and therefore all teamswere aware of the workload for the days prior to

closure. Efficiency lifted in all aspects over thesedays. The critical factors were timing of bodytransportation so that teams could commence workearly. In the dental examination area, the Dutch teamarrived earlier than the Australian and New Zealandteams, dissecting mandibles so that examination ofthe deceased persons could commence as soon asthe Australian and New Zealand teams arrived. Asense of satisfaction was felt by all when allexaminations were completed a day ahead of thescheduled closure.

Problems encounteredSome of the problems encountered were oldfavourites of the forensic dental world, such as theability to detect tooth coloured restorations in difficultlight conditions.

One area of potential problem was identified earlywhen Thai authorities required a separation to bemade of Thai and western bodies. It was suggestedto them that such separation would at best be proneto error and this later proved to be the case.

Relieving teams took over from teams who wereextremely tired. As a consequence there was limitedtime for briefing before the handover. While standardoperating procedures (SOP) were available in writtenform, taped to walls of the temporary mortuary andto the desk in the Quality Assurance section at Site1, smooth transition was hampered by lack of time.

Maintenance of the dental SOP at Site 1 was nevera significant problem with rigorous enforcement beingcarried out by the ‘super dentists’, the team leaderand his deputy. The same SOP, however, was notapplied at the other sites with the same vigour andthis resulted in variable post mortem results andstandards.

With the generation of large numbers of radiographs(up to 200 per day) there were problems with filmprocessing and film mix-ups. Assigning a singleindividual to accept, log, and process all radiographsresolved this issue. Ideally, this individual shouldadopt a quality assurance role that includes machineand chemical maintenance.

The need for one single dental DVI commander wasrapidly identified, but never achieved except for abrief period at Site 1.

Site 2On 31 December a provisional mortuary near theinternational airport in the area of Wat Tha Chat Chaiwas established. German and Austrian DVI teams

7James, Ed


examined victims who had been stored at the hos-pital in Phuket Town. The conditions at this locationwere problematic as there were no hand-washingfacilities. Furthermore, the work had to be stoppedafter sunset because no electricity was available tooperate spotlights. Three days later the DVI teamsmoved to Site 1B, and then to 1A.

Site 2 was later selected as the site for the new centralautopsy facility near the airport. Norway wasapproached to provide financing for the centre andthe Norwegian company Normeca was contractedto provide the construction. Normeca construct andbuild temporary hospitals in areas of crisis. Theyhave gained experience and built their reputation fromBosnia, Kosovo, Afghanistan and a number of othercountries. The Norwegian government is coveringall expenses of running the Site, includingresponsibility for supplies, security and cleaning.

The normal temporary hospital design consists ofunits of about 3 metres, which can be easilyconnected to form a long building. This concept was

redesigned as a mortuary. Three such buildings(Fig. 6), with capacity for two examination lines per“tunnel” (Fig. 7), were set up in late January.

Advantages compared with the early sites includesufficient space in the tunnels to reduce bottle-necks.Since, again, no dedicated radiography area wasincorporated into the design, the length of the tunnelat least allowed improved radiation hygiene. Therooms were fully air-conditioned, an important factorin improving working conditions, with sinks, runningwater and electricity available for lighting andcomputer terminals. The location had the advantageof proximity to the airport and accommodation,removing the long travel times that featuredprominently at Site 1.

Currently, personnel at Site 2 are undertaking aninventory of bodies remaining at the site. The purposeof the Final Inventory Procedure (FIP) is to checkthat the available postmortem information is accurate,that the dental charting is correct and that good qualityphotographs and radiographs exist prior to bodiesbeing sealed. Odontologists at the Thai TsunamiVictim Identification Information Management Centreassess existing postmortem records and issue targetrequests for any deficiencies. For example, extraradiographs may be requested of root filled teeth orfor age estimation. Once the FIP is complete work atthe site is expected to cease, except for therepatriation of bodies.

Site 3At Krabi (Site 3), one of the major disaster sites inThailand, operations by a combined InternationalDisaster Victim Identification Team started on 5January 2005. This team consisted of representativesfrom six countries: Israel, Switzerland, Canada, Italy,Portugal and Japan. The members of the teamincluded dentists, forensic pathologists andanthropologists, DNA experts and police personnel.(Fig.8) Only two dentists from Thailand were at Site3 since most of Thai dentists were involved at Site 1at Takua Pa.

Each body was examined using the followingprotocols:1. Two dental radiographs (bitewings) of right and

left molar regions were taken on each bodybrought from the freezer container, and developed.

2. The body was then brought to a team. Dentalexamination (the status of each tooth) includinganatomical features were done and the DVI dentalform completed. Not all countries sent dentists tothe site, therefore one dentist worked for a numberof country teams.

Fig 6: Temporary mortuary consisting of three buildings

Fig 7: Interior view of one of the tunnels. Connectingunits can be seen and the total length of the room wasabout 40 metres



Physical characteristics such as tattoos, evidence ofsurgery and so on were recorded. If possible, fingerprints were also taken by the police. Clothes werewashed and photographed. Personal belongingswere also photographed. Lastly, two intact teeth wereextracted for further examination of DNA.

After each day’s operation a meeting was held at thehotel, where the number of bodies examined and theschedule for the following day were discussed. Thetotal number of the bodies examined until 13 January2005 was about 350. Bodies from Site 3 wereeventually moved to the new Site 2 facilities.

Occupational Health, Safety and WelfareOccupational health, safety and welfare issuesassociated with disaster management can be dividedinto three stages: pre-deployment, whilst on rotationand post-deployment.

For example: the pre-deployment information advicefor the Australian contingent included advice onhealth, hygiene and acclimatization as well as cultural

and religious information. Awareness of theoccurrence of additional earthquakes/after shockswas noted.

Given that information about local conditions wasinitially uncertain, mandatory vaccinations for Hepa-titis A & B, diphtheria, tetanus, meningitis, typhoidand polio were arranged. Anti-malarial treatment, inthe form of oral doxycycline, was also prescribed.Impregnation of work clothing by immersion inpermethrin was deemed appropriate for protectionagainst mosquito borne dengue fever and malaria.

Initial concerns at Site 1 included infection controlmeasures. Protective clothing, rubber boots andgloves were commonly used; protective eye wearand masks were less common due to the extremeheat. Attempts to demarcate clean from dirty areas,by use of bleach boot wash, change areas, etc wasnot always successful. (Fig.9)

Awareness of injury, from fragmented bones and theuse of “sharps” – scalpel blades and dental probes,was emphasized. The experience of those involvedresulted in few incidents amongst dental staff.

Radiation hygiene was of concern to a number ofteams. It was, however, agreed that radiographswere essential to complete examinations and for thereconcilliation process. Proximity and direction fromthe cathode tube was emphasized, given the lack ofa dedicated lead-lined area. (Fig.10)

Given that many odontologists arrived from a North-ern Hemisphere winter, heat stroke and dehydrationwere potential problems in the hot, humid environ-ment. Bottled water for drinking had to be taken tothe sites on a daily basis.

Fig 8: Body examination at Krabi

Fig 9: Disinfection measures Fig 10: Radiation Hygiene

9James, Ed


The devastation of the local infrastructure meant thattravelling times of 2-3 hours each way fromaccommodation added to fatigue when combinedwith work shifts of six hours. Initially, work-free dayswere haphazardly arranged, but this was soonrecognized as counter-productive to a steadyworkrate.

An unexpected problem was the frequency ofvisitors, including political dignitaries, mediapersonnel and high-profile sightseers. On the otherhand, local and expatriate volunteers who movedbodies, developed radiographs and provided foodrendered considerable assistance.

By the time the new Site 2 mortuary was created,most of these hazards had been recognized andappropriate safety measures documented to briefincoming staff. Two new problems were quicklyidentified – sharps left in body bags from previousexaminations and hazardous fumes emitted whenre-examining bodies preserved with formalin.

Trauma counsellors and chaplains were availableduring deployment and many teams underwentcompulsory psychological debriefing at the end oftheir rotations.

PHASE 3: ANTEMORTEMThe antemortem and reconciliation phases of theprocess were co-ordinated at the Thai Tsumani Vic-tim Identification Information Management Centre(TTVI-IMC). The building was lent to the process bythe Telecommunications Organization of Thailand,(Fig.11) and with some quick additional wiring, wassuitable for the computer-linked phases of the

operation. Those working in the building includepolice investigation teams, Interpol representatives,forensic odontologists, fingerprint and DNA experts,country liason officers and representatives of KenyonInternational. (Fig.12)

In any disaster, dental identification relies on thematching of postmortem records with their respec-tive antemortem counterparts. Postmortem recordcreation will usually be reasonably straightforward,although possibly unpleasant, to achieve as the body(or parts thereof) is at the disaster site. Antemortemrecords present a far greater challenge to obtain,collate and standardise for incorporation into the DVIprocess. This can be very difficult in the “closed”-type of disaster, where a definitive victim list exists,such as with an aircraft crash. However, thedifficulties are greatly magnified in the “open”-typeof disaster, where no such list exists.5 The DVR(Disaster Victim Register) process is required here,which attempts to create a victim manifest byrequesting information from all interested parties toan incident. The resulting information is subject toinaccuracy, duplication and frank omission withregard to possible victim presence. Nevertheless, thisis the information from which the antemortem recordcollection process must begin. This process iscomplicated enough when occurring in a singlecountry, whereas an international incident introducesan exponential elevation to the situation. Such wasthe case in Thailand.

Antemortem record collection was the responsibilityof the respective countries police agencies, co-ordinated by Interpol. For example: The Bureau ofLegal Dentistry (BOLD) took an odontologyleadership role in the identification of 17 Canadian

Fig 12: TTVI-IMC personnelFig 11: Thailand Tsumani Victim Identification InformationManagement Centre



citizens missing from several southern Thailandbeach resorts following the tsunami. The dentalrecords for all missing Canadians were received intocustody at the laboratory. This was accomplishedprimarily by BOLD’s interaction with provincial dentalassociations and by the Royal Canadian MountedPolice (RCMP) Task Force through contacts with themissing persons’ families. High-resolution digitalimages of all dental records were produced asinsurance against loss when the records weretransported to the response area.

The digital dental records produced at BOLD becameextremely important when difficulties wereexperienced in getting the original records to theTTVI-IMC. Part of the lab’s website was encrypted,and secure usernames and passwords were suppliedto Canadian odontologists. Thus, the electronicversions of the dental records and subsequentlydigital fingerprint records and photographic evidencecould be supplied very quickly using the Internet. Thiswas a significant development that expedited theentry of data in Phuket.

Unfortunately, record collection in many othercountries was not as efficient. Often, dentalinformation was scanty. Antemortem F1 and F2 formswere completed, not by experienced forensicodontologists, but by general dentists or, occasionally,by police officers. Forms completed in a languageother than English had to be sent for translation.Information was difficult to verify without originaldental records. In several instances, radiographshad been scanned in the reverse orientation.

Thai records were received from public clinics andprivate practitioners. However, a propensity to recordonly treatment received, together with few dentalradiographs, meant that they were not a good sourceof identifying material.

When either antemortem or postmortem recordswere received at the TTVI-IMC, they followed thepathways shown in Fig.13. Prior to any dental datainput, the antemortem information was analysed andstandardised for inclusion into the program. This wasdone by two forensic dentists, as mistakes are easilymade (with unacceptable results to the DVI process)by a solo operator.

The file management system selected by DVIcommanders for use was Plass DataTM DVI SystemInternational, a Danish software program based onthe Interpol DVI forms. It is the standard DVIcomputer operating system of many of the Europeanand Scandinavian countries and, since use in

Thailand, had generated considerable interest in anumber of other countries.

The sheer scale of the tsunami disaster meant thatan electronic system was needed in order to processthe large number of antemortem and postmortemdata sets. Plass DataTM offered a system that wasWindows*-based and staff were able to operate itwith a minimum of training.

The system allows retention and electronic transferof all antemortem and postmortem data includinggeneral information, photograph files, dentalcharting, x-rays and notes, electronic fingerprintrecords and DNA information. Data can be remotelysent to an information management centre from thecountry where the missing person lives. The systemruns automatic matching routines for dental and DNAinformation and can be used by forensic dentist, DNAexperts and law enforcement officers to generatesearches for probable matches.

A problem that became apparent at the TTVI-IMCwas the forwarding of “processed” data for directinclusion into the computer program, with originalantemortem data being retained by host countries.This was deemed unacceptable, regardless ofassurances from representatives from those coun-tries as to the excellence of their forensic recordcompilers, as errors were noted in the very first suchrecords brought up for comparison.

Another common noting was incomplete antemortemrecords, with chart information alluding to radiographswhich were not supplied. Such happenings werereferred to Interpol, for liaison with the respectivepolice agencies and hopeful collection of therequested data.

So far, approximately 2200 antemortem records areon file at the TTVI-IMC, with over 4200 postmortemrecords also present. However, as the total mootedvictim list is around 5300, the likelihood exists thatmany of the antemortem records may refer to victimswhose remains have not been recovered.Nevertheless, as the overwhelming majority of theidentifications have been achieved through dentalmeans, the indisputable importance of antemortemdental records is obvious. This reinforces the onuson all dentists to ensure that their patient recordsare as complete as possible and retained for themaximum possible time.

* Microsoft Corporation, Redmond, WA, USA

11James, Ed


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Fig.13: Thai Tsunami Victim Identification - Information Management Centre: Layout and File Movement

Legend: AntemortemPostmortem



Kenyon DeploymentWithin 48 hours of the tsunami, Kenyon InternationalEmergency Services, a worldwide premier disastermanagement company, responded to the incidentand established a coordination center in Bangkok,Thailand. The initial response group consisted of 11disaster management experts, a forensic odontolo-gist and a mortuary-operations specialist deployedfrom Kenyon offices in Singapore, London, Houstonand Sydney.

As political issues mounted in Thailand, the Thaigovernment was pressured to identify the humanremains and return them to their families as quicklyas possible. Although the Thai government declinedany international financial assistance for the disaster,the Thai Prime Minister was quick to accept help withthe identification effort. With the generous offer bythe Australian government to partially fund theidentification process and international effort, the Thaigovernment brought in Kenyon InternationalEmergency Services.

Kenyon initiated deployment of many of its forensicteam members from around the world. The task athand was to provide logistical support to the threeremote mortuary sites, establish and staff therepatriation center and offer technical, administrative,and logistical support to the Thai Tsunami VictimIdentification Information Management Centre.

Kenyon maintains a significant number of dentalequipment kits in its mobile mortuary; however thenumber of dental radiograph machines, light viewboxes and computer equipment was not sufficient tohandle the massive case-load. It was recognizedimmediately that Kenyon needed to locate andoutsource additional dental equipment that could beused to allow the forensic odontologists to effectivelydo their work. Catering to the personal preferencesin protective clothing for a wide spectrum of dentistsalso provided a challenge.

Managing a disaster of this magnitude depends uponthe ability to process antemortem and postmorteminformation to determine positive identifications.Kenyon provided the resources, technology andPlass Data™ software application to handle suchextensive information. Forensic dentists were trainedon Plass Data™, a sophisticated computer applica-tion that mirrors the Interpol DVI forms. Having theability to provide and maintain a computer softwareapplication like Plass Data™ reduces the time spenton hand-collating information and reconciling theinformation for positive identification.

Information management is crucial and vital to theoutcome of a disaster. Having protocols, procedures,and processes in place is paramount to obtainingpositive identifications. Maintaining a cache ofcomputers and supplies, along with the ability toacquire additional equipment helps expedite theidentification process. Locating functional computerequipment was another challenge, especially whileworking in a facility that did not have the appropriateinfrastructure in place. Having information technologystaff on site enabled the infrastructure to be installedand the appropriate equipment put in place.

With over 75 years in business, Kenyon hasknowledge, expertise and experience in managingvarious disasters on an international level. The abilityfor a private company to work harmoniously with thepublic sector is a credit to both in achieving thecommon goal. The commitment to obtaining positiveidentifications was the highest priority for everyoneworking in the Thai Tsunami Victim IdentificationInformation Management Centre.

PHASE 4: RECONCILIATIONThe task of Reconciliation is to find consistenciesbetween specific antemortem and postmortemrecords and investigate these consistencies furtherwith the ultimate aim of confirming the identities ofthe deceased based on the comparison ofantemortem records with postmortem records.

In the early days, fortuitous examinations wieldedsome positive identifications. In one case,antemortem information, including a dental record,for a missing 10 year old boy was collated andtransferred to Thailand. Examination of a youngvictim at Site IB matched concerning the age, heightand clothing (swimming trunks). The postmortemdental examination showed a typical mixed dentition,with deciduous and permanent teeth. Age wasestimated at 10 years +/- 3 months. Tooth 35 wascongenitally missing (Fig.14). The antemortem recordalso indicated that tooth 35 was congenitally missing.Identification, based on dental and physical evidence,was accepted and allowed early repatriation of thischild.

Reconciliation procedures were soon located at theTTVI-IMC and using the Plass DataTM program togenerate potential matches. The reconciliation workarea was separated from the antemortem/postmortem data entry areas in order to preventpotential loss or contamination of files and to maintaina more transparent chain of evidence so that the

13James, Ed


antemortem and postmortem files could be easilylocated and updated if required.

From a reconciliation perspective, the Plass DataTM

program has a most important search function whichruns during the night. This searching of potential linksbetween certain antemortem and postmortemrecords allows for the process of data mining to occur.Data mining involved further investigation of the linksbetween particular antemortem and postmortemrecords already made by the Plass DataTM programto assess whether these particular records warranta thorough examination by a member of the ForensicOdontology reconciliation team. The method of datamining has evolved with time. Originally the datamining was done by non-dental personnel but thiswas discontinued in favour of using the ForensicOdontology reconciliation team. This had theadvantage of being able to spread the workload tohelp improve productivity and, with the initialsearching being done by the Odontologists, thoserecords requiring more thorough examination couldbe more efficiently targeted. In recent weeks thissearch capacity had been discontinued due to thepotential for unbiased data mining and the fact thatmany found the search facility a little clumsy. A newadd-on search too is currently being trialed whichallows searching for particular aspects of dentaltreatment such as root canal fillings in specific teeth.

Once a search had been made in the system andwhen there was a valid reason for thoroughlyinvestigating a comparison between a particularantemortem and postmortem file, the hard copies ofthese files were requested. The comparison wasmade based on the antemortem and postmortemevidence made available, such as dental charts,dental records, photographs, radiographs and

perhaps study models. This is where real difficultiesin the comparison often surfaced. With regard to thepostmortem dental evidence, the problems mostoften encountered were due to radiograph quality.There were cases in which an insufficient number ofradiographs were taken, or were of diminished usedue to problems with orientation and film quality.However it was more common for problems to occurwith the antemortem evidence and this appears tobe a recurring theme in disasters.6

The types of problems encountered with antemortemdental evidence were numerous but includedinadequate or poor quality record keeping and a lackof good quality radiographs as well as the problemof unmarked dentures. These problems which havebeen identified were compounded by the fact thatthe radiographs were often scanned into the PlassDataTM program which further decreased the quality.Often there were no hard copies of the antemortemradiographs and dental charts available due todiplomatic difficulties in obtaining records from certaincountries. This highlighted another difficulty, whichnot only affected reconciliation but also the entry ofantemortem and postmortem dental data, being thatof deciphering the different dental nomenclature,charting methods and language used in dentalrecords from different countries. The difficultiesassociated with this were averted by having animportant multi-national presence in both thereconciliation area as well as in the antemortem/postmortem data entry area. Deciphering dentalrecords from Germany is made just a little easier witha German forensic odontologist sitting alongside you.

Initially, Plass DataTM could only show one scannedor digital image at a time. This meant that there couldnot be an antemortem radiograph or photographdisplayed at the same time as postmortem radiographor photograph. This problem has been resolved.

For Reconciliation to work effectively, quality controlsneeded to be in place and the Dutch command hasprovided strong leadership and support in this regard.When a conclusion had been reached about aparticular antemortem and postmortem filecomparison it was assessed and checked by one ofthe Dutch odontologists. When making a conclusionregarding a particular antemortem and postmortemfile comparison, there were five potential outcomesof this process. They were Established, Probable,Possible, Insufficient Evidence and Excluded. Anexample of a comparison where the identity couldbe established would be where there are many pointsof concordance between antemortem and

Fig.14: Status of the lower jaw and the radiograph of the35 region

14 3Thai Tsunami Overview


postmortem radiographs and dental records with anypoints of discrepancy being easily explainable. Whenthe points of concordance were less due toinadequate antemortem information or a lack ofantemortem radiographs, it was unlikely for theidentity to be able to be established and perhaps onlya probable or possible identity could be reached. Inthese cases additional methods of identification suchas fingerprints, DNA or physical evidence would berequired to help establish the identity.

Once enough evidence had been gathered toestablish the identity of one of the deceased, the casereport was prepared outlining the methods ofidentification used and the reasons for theconclusions being made. The case could then bepresented before the Reconciliation Board of the ThaiTsunami Victim Identification Commission. Ifidentification was accepted by the Board then therepatriation process could begin.

One of the tragedies within this disaster has beenthe number of children who lost their lives.Unfortunately from a forensic odontology perspectiveit is difficult to identify children due to the lack of dentaltreatment performed in young children with littleantemortem dental information and few radiographsavailable. The use of age estimation techniquesbased on dental development has been helpful andmay certainly be of use in at least making anidentification possible. Having said this, thesetechniques need to be used cautiously as they canbe only give a possible range of age for an individualand therefore are only an estimation.

The scope and complexity of the operation at handin Thailand, with regard to the identification andeventual repatriation of the deceased, was evidentafter working in the Reconciliation wing of the TTVI-IMC. It evoked a greater appreciation of not only theimportance of good quality dental evidence in theidentification of the deceased but also thecorroboration of this dental evidence with otheridentification methods including fingerprints, DNA andphysical evidence. There have been and will continueto be many lessons learnt in the reconciliation of thedeceased in mass disasters such as this one. With adisaster of this magnitude it has certainly extendedour knowledge of the best way to approach and copewith other disasters in the future. It can only be hopedthat international efforts are made to encourage thekeeping of good dental records and the marking ofdentures which is a view that has been expressedfrom other disasters that have occurred in recenttimes.7

Progress to dateForensic odontology is well recognized as regularlymaking a significant contribution to positiveidentifications in mass fatality incidents. The valueand accuracy of dental evidence is acknowledged inthe Interpol Disaster Victim Identification Guide8

where it is noted that if dentistry can provide aconfirming identification, this can be regarded as astand alone identification, not requiring additionalcontributing evidence from other scientific disciplines.Numerous authors9-12 have reported the contributionof forensic odontology to the identification processin mass disasters, with contributions ranging from22 - 100% of identifications in a number of disasters.

Recent advances in DNA technology and capabilitieshave led many to speculate that traditional methodsof identification will be superseded, and ultimatelyrendered redundant. Sole identification via DNA hasbeen employed in a number of recent disasters,including the Kaprun Cable car fire disaster.13-15 Inactuality, the majority of major incidents use acombination of all available identification techniquesto confirm the identity of the deceased.10, 12, 16, 17

By 11 May 2005, 1,474 bodies had been identifiedthrough the formal processes of the IdentificationBoard. The vast majority of these were identified bydental comparison. Table 1 shows the distribution ofidentifications by primary identifier. This indicatesthat odontology had provided 1,163 (79%) of theseidentifications, and contributed in part to another 125(8%). Overall, odontology has played a role in 87%of identifications

Also observable is the low level of identificationsconfirmed by the other major identifiers, fingerprintsand DNA. Fingerprints had contributed to 129 (9%)of identifications as sole identifier, and made acontribution to an additional 109 (7.3%)identifications. To this date, DNA had confirmed onlyseven (0.5%) of identifications. It is reasonable toassume that these disciplines will contribute to moreidentifications as the process continues. Reviews ofidentifications at future dates should indicate a moreeven distribution of the contribution of the differentprimary identifiers.

The significant contribution of odontology, particularlyearly in the identification process is consistent withfindings in other disasters.17 The merit of forensicodontology as a valuable tool in the identificationprocess in mass disasters is reinforced by thestatistics of confirmed identifications completed bythe Thai Tsunami Victim Identification Commission.There is no evidence to support the utilisation of

James, Ed 15


single methods of identification where large numbersof victims, from various countries, are involved.

PHASE 5: DEBRIEFThe debrief phase of the DVI process involvesexamination of work practices to establish theefficiency and effectiveness of the DVI response andto identify any positive or negative aspects thatenhance or impede the response.4 In addition to theofficial Thai Tsunami Victim Identification debrief,there must be discussion of the role of odontologistsin this disaster at upcoming meetings such as IAFSand AAFS.

Obvious areas for discussion include:1. The desirability, from the outset, to co-operate with

local community leaders to accommodate localreligious and cultural issues that may not beimmediately apparent to overseas visitors, suchas display of national flags without thecorresponding host flag.

2. Standard Operating Procedures for internationalincidents. It is clear that standards of postmortemexamination, and quality assurance checks, havebeen irregular, in spite of standard operatingprocedures. A number of national identificationteams included dentists with minimal experiencein both the theory and practice of identificationwork. Language difficulties have also contributedto problems. These issues need to be addressedat national levels; a major disaster is not the placeto learn the theory of DVI.

3. Use of English for all data entry, as recommendedby Interpol. There were numerous instances of

antemortem and postmortem F1 and F2 forms notcompleted in English. Written descriptors (formF2 sections 87 and 88), potentially extremelyuseful sources of information, were often left blank.In future the need for some details in these sectionscould be emphasised.

4. Consistent rostering of odontologists from differentcountries to allow a steady daily work load. Onsome days there were a lot of dentists availableand on other days only a few dentists were present.

5. Recognition of the requirements of originalantemortem data. Each country of origin shouldappoint one or two trained forensic dentists tocollate all antemortem records and to transcribethese to an acceptable standard prior to forwardingthem to another country. There were instances ofreluctance or refusal by treating dentists to supplyoriginal records. Such instances may beconsidered reportable to the Dental Board of theparticular country.

6. Data file management. Numerous filesmysteriously disappeared/reappeared.

7. The use and effectiveness of the PlassData™computer program.

The Canadian team experienced a remarkablesituation during the response, which may be regardedas an example of “disaster tourism“. A retired dentistfrom Vancouver who lives near Phuket was able toinsert himself into the response. He dropped thenames of Canadian odontologists to gain accessthrough the fairly loose security checkpoints. Sincethis dentist had no previous DVI training, problemsthat reflected poorly on the rest of the team ensued.The dentist’s personality caused considerable stress

Table 1: Identified bodies by primary evidence as at 11 May 2005. (Total bodies identified 1,474).

Dental

Fingerprints

Physical

DNA

Dental +Fingerprints

Dental +Physical

Dental +Physical +DNA

Dental +Physical +Fingerprints

Physical +Fingerprints

Physical +DNA

0 200 400 600 800 1000 1200

Dental + Physical

Dental + Physical

Dental + Fingerprints

DNA

Physical

Fingerprints

Dental

Physical + DNA

Physical + Fingerprints

Dental + Physical + DNA

+ Fingerprints



and embarrassment to the team. The dentistdeveloped a relationship with family members of amissing Canadian that came to the site and thiscaused numerous concerns and problems.Eventually Interpol personnel removed him from thesite. This highlights the stringent need for teamsecurity and the use of fully-qualified odontologists.

Prior to the tsunami disaster, forensic odontology inThailand had played a relatively minor role in the fo-rensic sciences and was not considered to be of im-portance, comparing with other dental clinical sub-jects. The subject is allotted only two to three hoursin a six-year undergraduate dental curriculum anddoes not appear in any post-graduate dental pro-gram. National standards or guidelines for forensicodontology had never been established. This disas-ter has increased awareness and highlighted the im-portance of forensic odontology in the Thai dentalprofession. They are determined to use this crisisas a chance to develop knowledge, experience andskill in forensic odontology and raise standards toan international level by development of a nationalprotocol on forensic odontology and promotion ofpostgraduate study for specialised dentists in thisarea.

The Boxing Day Tsunami is the largest single eventever requiring a modern DVI response and the earlydays of the operation were a vast learning curve forall concerned. The fact that so many lessons wereavailable and for the most part learnt, will stand theforensic dental community in good stead for anyfuture operations. Never before have so many nationsfrom different parts of the globe come together inone single operation and the term “Global Citizenship”has taken on a new meaning.

As a final comment, we have introduced a new wordto DVI experts. All those who have been involved inthis incident will recognize this word. “Manky” will fromnow on be associated with dirty, smelly workconditions, and a reminder of a job that had to bedone in Thailand.

ACKNOWLEDGEMENTSThe Thai dental forensic team and Thai DentalCouncil would like to thank dental colleagues fromthe many countries that have provided help when itwas so badly needed and, in particular, Dr. RussellLain, specialized forensic dentist from Australia.

Contributors to this article would like to thank ColonelPornprasert Kanjanran, Joint Chief of Staff, Thai

Tsunami Victim Identification Operations forpermission to reproduce the table included in thearticle, and Australian Federal Agent Julian Slater,Manager Forensic Operations, Forensic andTechnical, Australian Federal Police for advice andbackground information.

Thanks to all who have provided photographs forpublication.

REFERENCES1. The University of Washington Department of Earth and

Space Sciences.http://www.ess.washington.edu/tsunami/index.htm

2. Sources: Associated Press; Australian Department ofForeign Affairs and Trade. March 6, 2005.

3. Department of Disaster Prevention and Mitigation,Ministry of Interior. May 7 ,2005 http://hazard.disaster.go.th/overall.php?pack=report_10

4. Australasian Disaster Victim Identification StandardsManual. Australasian DVI Committee 2004.

5. Poisson P, Chapenoire S, Schuliar Y, Lamant M,Corvisier JM. Four major disasters in Aquitaine,France. Am J Forens Med Pathol 2003;24(2):160-3.

6. Brannon RB. Problems in mass-disaster dentalidentification: A retrospective view. J Forensic Sci1999;44:123-7.

7. Clark DH. An analysis of the value of forensicodontology in ten mass disasters. Int Dent J1994;44:241-50.

8. Disaster Victim Identification Guide. InternationalCriminal Police Organisation. 1997.

9. Haines DH. Dental identification in the Rijeka airdisaster. Forens Sci 1972: 313-21.

10. Lunetta P, Ranta H, Cattaneo C, Piccinini A, NiskanenR, Sajantila A, Penttila A. International collaborationin mass diasters involving foreign nationals within theEU. Int J Legal Med 2003;117:204-10.

11. Soomer H, Ranta H, Pentilla A. Identification of victimsfrom the M/S Estonia. Int J Legal Med 2001;114:259-62.

12. Valenzuela A, Marques T, Exposito N, Martin-De LasHeras S, Garcia G. Comparative study of efficiency ofdental methods for identification of burn victims in twobus accidents in Spain. Am J Forens Med Pathol2002;23(4):390-3.

13. Hoff-Olsen P, Mevag B, Ormstad K. The rapididentification of railway disaster victims by DNAanalysis. Int Congress Series 1239 2003:895-6.

James, Ed 17


14. Meyer HJ. The Kaprun cable car fire disaster – aspectsof forensic organisation following a mass fatality with155 victims. For Sci Int 2003;138:1-7.

15. Hsu CM, Huang NE, Tsai LC, Kao LG, Chao CH,Linacre A, Lee JC. et al. Identification of victims of the1998 Taoyuan Airbus crash accident using DNAanalysis. Int J Legal Med 1999;113:43-6.

16. Krompecher T, Brandt-Casadevall C, Horisberger B,Perrier M, Zollinger U. The challenge of identificationfollowing the tragedy of the Solar Temple (Cheiry/Salvan, Switzerland). For Sci Int 2000;110:215-26.

Address for correspondence:Dr Helen JamesForensic Odontology UnitThe University of Adelaide, 5005Adelaide, AustraliaTel: +61 8 8303 5431Fax: +61 8 8303 4385Email: [email protected]

Hello my friend from distant lands.I see you without my eyes andStill you look upon my face asThough I am watching you.I feel your touch without my sensesAnd still you treat my body withUnbridled kindness.I hear you even though I amWithout ears, and still you speakSoftly to me as you do your work.I know I am not what I used to be,But please remember me as I was.You may mourn my passing butYou must not be saddened by it.As my life began, so must it end.Know that your work for me,My family and my country willNever be forgotten.Know that your smile throughoutAdversity lifts my spirits, as well asThose of your friends and othersAround you. Always live your lifeAs though it may end at anytime,For it is then that you will truly live.My eternal Love and Blessings.

The unknown dead.

17. Ludes B, Tracqui A, Pfitzinger H, Kintz P, Levy F,Disteldorf M, Hutt JM, Kaess B, Haag R, Memheld B.Medico-legal investigations of the Airbus A320 crashupon Mount Ste-Odile, France. J For Sci 1994;39(5):1147-52.

LETTER TO THE LIVINGLETTER TO THE LIVINGLETTER TO THE LIVINGLETTER TO THE LIVINGLETTER TO THE LIVING

Barham J.R. Ferguson12 January 2005


Documents

Thai Tsunami Victim Identification