A mass fatality incident can be defined as: ‘An incident where more deaths occur than can be handled by local resources’.17 Mass disasters/fatalities such as transportation accidents, explosions, fires, volcanic eruptions, mass murders and mass suicides often leave many bodies in poor condition for identification. The National Disaster Medical System (NDMS) is a federally coordinated system and is a part of the Department of Health & Human Services that augments the Nation’s medical response capability.40 NDMS has five response teams: Disaster Medical Assistance Team (DMAT), Disaster Mortuary Operational Response Team (DMORT), National Veterinary Response Team (NVRT), National Nurse Response Team (NNRT), National Pharmacy Response Teams (NPRTs).41
DMORT is the federal level response team designed to provide mortuary assistance in the case of a mass fatality incident or cemetery related incident. In the event of flooding, it is sometimes necessary to recover caskets, re-identify displaced individuals and disinter the remains.17 DMORT works under the local jurisdictional authorities such as Coroner/Medical Examiners, Law Enforcement and Emergency Managers and is only deployed when local authorities request assistance.17 There are ten regions within DMORT and each region consists of a team from certain states; which is displayed in Figure 7.17
The DMORT team is made up of various professions which includes: Medical Examiner/Coroners, Forensic Pathologists, Forensic Anthropologists, Fingerprint Specialists, Forensic Odontologists, Dental Assistants/Hygienists, Funeral Directors/Embalmers, X-ray Technicians, Photographic Specialists, Heavy Equipment Operators, Mental Health Specialists, DNA Specialists, Computer Specialists, Medical Records Technicians, Transcriptionists, Administrative support staff, Security personnel, Investigative personnel, Evidence Specialists, and Facility Maintenance Personnel.17 This whole team is needed in order to set up the temporary morgue and get it operational to collect post-mortem data and documentation. The dental team is responsible for setting up their area in the morgue and ensuring the equipment is ready to be utilized. For example, is the main computer server working properly for the post-mortem dental computers to communicate with the ante-mortem computers in order to conduct a dental comparison?
The equipment utilized in the dental post-mortem section is a digital camera, laptop computer with WinID and DEXIS Forensic installed, portable radiographic unit (NOMAD), and the armamentarium (mouth mirror, gauze to clean on the teeth, etc.) utilized to view the teeth of the unknown person. Depending on the morgue set and the disaster, the number of tables being used for dental varies for example: after the Joplin F5 tornado of 2011, there were two dental tables running with three to four people per table. There is a person that enters the data into the computer, a person taking digital photos, a person examining the mouth and calling out dental record information to the computer entry person and another person taking radiographs. Once the information is collected on the unknown individual, the computer entry person calls back the information entered in the computer. This is done to ensure all data entered is done so correctly.
Also, there is an ante-mortem dental station where dental team members are organizing the dental records being submitted. These records are being reviewed by the dental team members and the ante-mortem paper record is utilized to document the dentition and verify before entering into WinID. Any film-based radiographs or printed photos are scanned into the computer. If there are digital radiographs and photos that were submitted electronically, they are also integrated into the ante-mortem record on WinID. Once there are records entered into the computer system then dental personal can begin making comparisons.
There are state level response teams within each state that function in a similar manner as DMORT. An example of state teams would be the Missouri Emergency Response Identification Team (MERIT)42 or Illinois Medical Emergency Response Team (IMERT).43 In addition there are regional/local teams such as the Kansas City Regional Mortuary Operational Response Group (KCR-MORG).
Dental forensics played a key role in identification of individuals during the Oklahoma City bombings where 70-80% were identified, the Tragedy of 9-11 where 20% were identified,40 the Asian Tsunami where 90% were identified and about 15-20% were identified after Hurricane Katrina.30,44 In the case with Joplin, Missouri a lot of dental offices were destroyed when the F5 tornado hit, which made it difficult to locate records, especially if they were paper records. Those dental offices that were destroyed that utilized computerized management systems and had remote computer backup systems were beneficial with supplying ante-mortem records.