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We will now present some of the core assumptions underlying the approach of this book. Our approach places an emphasis on predis-aster preparedness via school-based multisystemic activities that will enhance children’s coping and adjustment in the event of a disaster. Further, this approach focuses on school personnel and families, both to foster their own resilience and adaptation, and to empower them to carry out a variety of ongoing and dynamic preventive and therapeutic interventions, when and after disaster strikes, designed to enhance recovery via the natural support systems. The exposition of our ten core assumptions, next, can serve as a rationale and an introduction to our mindset concerning the school-based multisystemic preventive approach to disaster.

School-based response to a disaster is generic in nature. The generic approach focuses on the characteristic course of the particular crisis, rather than on the unique response and the unique needs of each individual in crisis. The generic approach purports that an individual-focused approach - emphasizing individuals' unique, diverse intrapsychic and interpersonal processes and needs - can always be initiated later on if necessary, based on a careful screening and referral process. Yet, the generic approach first recognizes certain common response patterns to mass disaster, that is, normal reactions to abnormal circumstances. According to this approach, an intervention should therefore first be directed toward an adaptive resolution of the crisis. This is not to say that psychological problems associated with maladaptive coping will not evolve, but rather that the intervention must first ensure that people's adaptive coping is activated. Moreover, individual-focused intervention in the early phase of the disaster may be premature or undesirable because it can amplify a problem that may disappear spontaneously or through generic intervention, and thus lead to unnecessary psychological labeling and stigma. Thus, large-scale school-based intervention measures employed immediately after a disaster should be designed to be effective for all members of a given group, rather than to focus on the unique attributes of each individual (Aguilera & Messic, 1978). The individual-focused approach is used subsequently if individuals fail to respond to generic measures, and thus complements the generic intervention.

DNA analysis is one of the primary methods of identification in DVI practices. The external environment of a mass disaster often results in severe fragmentation, decomposition and intermixing of the remains. However, DNA profiling still can be achieved even on cases involving partial, severely decomposed remains. This report shows the DNA profile of shipwreck victims using identifiler plus marker from tissue sample exposed to environmental conditions.

This paper summarizes the results of systematic studies published in peer-reviewed journals from 1999 to 2002 addressing post-traumatic stress reactions in children after mass disasters. Children's post-traumatic reactions are considered in five different contexts--natural disasters, large-scale human-induced accidents, spree shootings, war, and terrorism. Association of these reactions with gender and age, as well as longitudinal course, is addressed. Other post-traumatic reactions in children after a mass disaster, as well as the comorbidity of these with stress reactions, are reported. With this as background, the most relevant epidemiologic investigations conducted after the World Trade Center attacks are then described. It is expected that new knowledge in the area of children's post-traumatic reactions to disasters will result from the research initiatives launched after September 11, 2001.

We describe the investigation of the 1999 collapse of an apartment building in Foggia, Italy. Sixty-one victims were recovered in the rubble of the building, and five people were unaccounted for. All the bodies were well preserved except for two who had been burned. The majority of the victims were identified visually or by comparing body features, clothing, or personal effects with information collected from relatives or friends. Positive identifications of the two victims who were burned were obtained by dental comparison and DNA analysis. Approximately half of the victims (51.6%) sustained fatal injuires, while the remainder died from asphyxia. The injuries were characterized using the Abbreviated Injury Scale (AIS) and the New Injury Severity Score (NISS) systems. Injury severity associated with the location of victims inside the apartment may provide useful information for those involved in building design and/or search and rescue operations. Engineers determined that the collapse was the result of the use of inappropriate foundation material.

Radiography can play an important part in forensic odontology, mainly to establish identification. This may take the precise form of comparison between antemortem and postmortem radiographs. Radiographs may also be taken to determine the age of a minor victim and even help in the assessment of the sex and ethnic group. Comparable radiographs are an essential factor to confirm identification in a mass disaster.

In any mass disaster condition, identification of the person is most important. For this purpose, the forensic investigators use different methods for identifying the dead. They consider skeletal remains of the dead as the initial step in identification. Radiographs carry great evidence to act as antemortem records and also assist in identifying the person, age, gender, race, etc. Forensic dentistry is also emerging as a new branch in forensics. So, the forensic dentist must be aware of different techniques, developments, and resources to incorporate the technology in order to achieve success in human identification. So, our aim of the present review is to focus on different radiological techniques and new developments available for successful identification of the dead.

This paper is to establish the present state of things in the country in terms of legal framework and the availability of personnel with a view to presenting an overview of proper mass disaster investigations. This is a retrospective review of mass disasters in Nigeria that occurred within the last 20 years. The study therefore reviews the state of the forensic investigation of the mass disasters as well as the efforts made to identify the victims of the disaster. The process of proper forensic investigation from the stage of evaluation of the scene and recovery process to the final identification of victims are presented to serve as a protocol for the country. The assessment of the present state of preparedness in Nigeria is also examined with a view to improving the practice to international standards. Data were retrieved from official documents from the aviation industry as well as Nigeria news reports. The standard protocols for disaster victim identification were retrieved from the guide released by the INTERPOL. The state of preparedness of the country and recommendations for improvement are presented. The Federal government and the states of the federation should without further delay put in place the process of reviewing the law of Coroner's system and provide the enabling environment for the proper forensic investigation. The training curriculum of the first responders should incorporate mass disaster investigations in order to produce efficient officers and personnel. A functional disaster victim identification (DVI) team is strongly advocated to incorporate different professionals involved in mass disaster management.

The purpose of this article is to discuss various factors associated with successful handling of mass casualties in the field with special reference to the airborne military operations. Various limitations specific to airborne operations are highlighted. Stress is laid on the importance of variables as they effect medical support and planning. Various analgesics, both opiates and non opiates including role of subanaesthetic doses of ketamine are discussed. Adequate knowledge and experience in wide ranging field techniques including improvisations is stressed. The facts are placed in a specific, original context through which new insight can be derived. The feasibility of incorporating light weight modern equipments in field anaesthesia are also brought out.

Mass disaster can involve natural or non-natural catastrophes: each incident has its own characteristics and will involve a different approach. Following our experience in Thailand and in Sharm el Sheikh (Egypt), in Italy it has been formally instituted a DVI group in April 2006. The Italian Police DVI group is constituted of 12 sub-groups. Every sub-group is composed of 10 different professionals. All these figures come from the Italian National Police so the DVI group is almost independent and could work either by itself or in collaboration with other groups.

Between 1993 and 1995, 14 suicidal terrorist bombings took place in Israel; 86 victims perished in these attacks, which were carried out by militant Palestinian organizations that oppose peace treaties between the state of Israel and the Palestinian people. The modus operandi of the perpetrators was detonating, in a public area, an explosive device carried on or in close proximity to the terrorist's body. We reviewed the postmortem examinations and identification procedures performed by the medical and law enforcement personnel involved in mass disaster management. The types of injuries sustained by the victims and perpetrators include body disruption, explosive injuries, flying missile injuries, and blast injuries. Blunt trauma directly produced by the explosion and flying missile injuries account for 80.1% of the wounds. The number of fatalities was more closely related to the type of the attack rather than to the amount and type of explosives used. Swift identification of all victims and perpetrators was obtained through collaboration between the different professional teams involved: forensic scientists, law enforcement agencies, and secret service investigators. Based on the analysis of the data obtained from the necroscopic examinations, we observed that most of the wounds sustained fall within the realm of blunt force injuries; emergency medical facilities that might be faced with similar situations should prepare accordingly. Collaboration between the various forensic and law enforcement teams results in swift resolution of disaster management. Prompt identification of the perpetrators allows the authorities to apprehend any accomplices and to prevent similar attacks.

Anesthesia mortality is remarkably low [1], and thus mass disasters can be discounted. Therefore, it is our task today to analyze rare adverse outcomes [2] so that we can identify some basic, still existing causes for morbidity and mortality and thus be able to overcome thses dangers and approach the infinitely distant goal of zero mortality in our speciality. Regarding safety in anesthesia, the words of an American anesthetist should be quoted [3]: We don’t need more powerful narcotics! We don’t need more sophisticated formulas for the kinetic modeling! We don’t need more studies to substantiate the studies that verified the studies that supported the studies that proved something in 1969! What we desperately need is information about how to better use the data and devices we already have!

Dentistry has much to offer law enforcement in the detection and solution of crime or in civil proceedings. Forensic Odontology though a known but is relatively unexplored science that utilizes the dentist's knowledge to serve the judicial system. Most often the role of the forensic odontologist is to establish a person's identity, for which other clues of biometric identification (e.g., fingerprint, face, etc.) may not be available in case of mass disaster or after an accident or a victim of homicide etc. The teeth may also be used as weapons and under certain circumstances, may leave information about the identity of the biter. Forensic odontology has an important role in the recognition of abuse among persons of all ages. Dental professionals have a major responsibility to play in keeping accurate dental records and providing all necessary information so that legal authorities may recognize malpractice, negligence, fraud or abuse, and identify unknown humans.

The accompanying paper in this issue describes work conducted during a collaborative effort to identify the victims of a mass disaster that occurred on the 19th of April 1993 near Waco, Texas. The DNA identification programme was also used partly as an exercise to further investigate the robustness and reliability of a recently developed STR quadruplex. The preceding paper provides details of the loci used and also deals with efforts to assess the applicability of STR profiling and its suitability for forensic investigations of this nature. In this paper, we present the results obtained from 61 Waco bodies. Using reference blood samples and family trees 26 positive identifications were made using a ‘paternity style’ analytical approach. Worked examples, representing a range of casework situations, are used to illustrate the kind of approach taken in interpretation of the data and highlight factors which affected its success. Additionally, we report on the successful application of a PCR-based gender test to 24 of the Waco bodies.

On July 12, 1993 at 22:17, the earthquake in southwest off Hokkaido occured at 60 km north undersea of 34 km in depth of Okushiri island which places at southwest of Hokkaido (Fig. 1). Okushiri island is about 20 km long north to south, 10 km wide east to west, where approximately 5000 people are living.

The authors report on the contribution of odontological identification of the flight AI. IT 5148 air disaster victims, which occurred on 20th January 1992. The identification procedure was difficult due to large numbers of bodies and mutilations and required the involvement of multidisciplinary teams composed of odontologists, forensic pathologists, radiologists and biologists. The authors set up a simple, discriminant classification which was easy to handle by a multidisciplinary team. Four groups were defined according to the matching characteristics between ante and post mortem data. Perfect matching characteristics between ante and post mortem data were achieved in only 44 cases (Group A). Partial matching characteristics between ante and post mortem data were achieved in 12 cases (Group B). In 29 cases, the insufficiency or absence of odontological data (Group C and D) did not enable the victim to be identified. The results of the investigations showed that the dental examination alone enabled 17 victims to be identified and by including a morphological examination the figure reached 33. By the end of the investigations, 85 of the 87 victims were positively identified. Odontological identification is an essential, accurate and rapid method with allows a body to be identified from its dental characteristics. This anthropometrical method of identification is included with the descriptive and the biological methods. The authors present their experience in performing a formal identification of 44 victims in less than 15 days.

On 26 May 1991, a Lauda-Air airliner crashed after take-off at Bangkok from an initial height of ∼ 8000 m. The plane came down in inaccessible jungle terrain, so that the difficulties of locating and salvaging the victims were considerably increased by the tropical conditions and the looting that had occurred. Identification of the victims took place in extremely adverse working conditions in the pathological department of the Police Hospital in Bangkok. The technique developed by the first author for the identification of persons in the light of their smoking habits by determining the existence of the so-called smoker cells was used to subdivide the entire autopsy material into ‘smokers’, ‘non-smokers’ and ‘incidental or passive smokers’. This allows the division of mass disaster victims into smaller specific groups and the application of further identification procedures within these groups in a shorter time. The findings of the cytological examination carried out locally were compared with the police investigations regarding the individual victim's smoking habits, and the method, quick and simple to use even in ‘field conditions’, proved highly efficaceous.

Identification of highly decomposed remains of a corpse can be accomplished by DNA-typing (1). In some cases the only source of DNA is sceletal bones. A simple and rapid DNA-extraction method for bone tissue would have use in routine casework as well as in working with a large number of mass disaster victims. In this work we have compared three methods to extract DNA from compact bone tissue.

Sex determination is a vital part of the medico-legal system but can be difficult in cases where the body is damaged. The purpose of this study was to develop a technique for sex determination from three arm-bone dimensions (wrist circumference, arm length and arm span). This knowledge can be applied in cases of mass disaster, homicide and events such as sports. Data were collected for 95 Nigerian male students and 90 Nigerian female students using physical anthropometry. Discriminant function presented the wrist dimension as the dominant contributor in this study. Combination equations for both the wrist and arm-span dimensions correctly classified sex (male/female) with an accuracy rate of 84.9%. On cross-validation, sex was also established with the same 84.9% accuracy rate. Sex determination was higher in males. Sexual dimorphism was established in this study, although the wrist circumference was more distinct than arm span; a combination of both generated sex with an accuracy prediction rate of 84.9%.

Conventional radiographic techniques are used commonly to aid forensic pathologists in establishing a biological profile of unknown individuals. Mortuary-based CT scanning has now become a standard component of death investigation. This section of the workshop will examine the ability of CT to estimate sex and age, and the detection of unique biological or physical features that might be valuable in narrowing search parameters for identification of the deceased. The specific focus will be on experience gained in heavily burnt and highly fragmented human remains as may occur in fires.

The initial phase of a major emergency is crucial for the survival of victims and for determining the future path of assistance to the stricken community. The absence of a common, standardized technical tool for damage and needs assessment in this initial phase may result in contradictory information being channeled to national and international humanitarian agencies. Rapid health assessment is a complex task fraught with difficulties and one that carries heavy responsibilities. Therefore, whenever possible, it should be under taken only by a team of qualified and experienced specialists.

To reinforce awareness among dentists about their role in person identification and the importance of maintaining dental records of all their patients. The article reviews basic procedures of dental identification and some cases where dental identification played a key role in eventual identification of the person. Forensic odontology is an integral part of forensic sciences. Forensic dental identifications, especially in times of mass disasters, depend mainly on the availability of ante mortem dental records. It is the social responsibility of each and every dentist to maintain dental records of their patients for the noble cause of identification in the event of mass disaster.

Every major mass disaster challenges the health care services, especially in the third world. These challenges include the expected situations mainly pertaining to the overload of patients and the stretching of hospital facilities. We report our experiences about several unforseen challenges faced by our hospital in the 2005 earthquake that struck the Kashmir region.