By Ruwan Laknath Jayakody
First responders to mass disasters, namely Army soldiers, were found to display considerable knowledge gaps and deficiencies regarding certain important aspects in the management of dead bodies during such disaster situations, according to a research article published recently in the Sri Lanka Journal of Forensic Medicine, Science, and Law.
The research article states that knowledge was poor in certain aspects such as wearing face masks by personnel involved in the recovery of bodies, taking photographs, spraying disinfectant on bodies, and using ambulances for their transport.
The article, titled “Management of the dead in disasters: Knowledge, attitudes, and self-reported practices among a group of Army soldiers in Sri Lanka”, is authored by U.G.G. Chaminda, who is attached to the Southern Province Department of Health Services, and J. Warushahennadi, who is attached to the Department of Forensic Medicine at the University of Ruhuna.
A majority of first-responder Army personnel had more favourable attitudes to many aspects of the management of the dead in disasters, although there were some negative attitudes to a certain extent, such as where a minority of first responders believed that funeral rites are not important in the management of the dead in disasters.
However, the level of overall knowledge was found to be satisfactory, with the majority (93.6% of the study population) having either a moderate (115 subjects – 61.2%) or good (61 subjects – 32.4%) level of overall knowledge on the management of the dead during disasters.
The level of education – in this case, where the majority has passed the GCE Ordinary Level examination (122 subjects – 64.9%) – was significantly associated with the overall knowledge on the management of the dead in disasters. On the level of work experience, even though the same number as the latter had over 10 years or more in the military service and the majority had experience in the management of dead bodies, there was insufficient evidence to suggest a significant association between service duration in the Army and the overall knowledge level.
The study was carried out in two Army camps in the Galle District, with a sample of 188 male soldiers. The majority (97 subjects – 51.6%) were between 31 and 40 years of age, while 59 subjects (31.4%) were of 30 years of age or below.
Data was collected through a self-administered questionnaire, a section of which contained 33 true/false-type questions, each of which was given one mark that in turn was converted into a percentage (a score over 70% being categorised as “good”, between 50% and 70% as “moderate”, and below 50% as “poor”).
The article states: “The majority have answered correctly to the false statement that ‘dead body recovery is the most urgent task in a disaster’; they knew that the establishment of a scene management team is necessary; were aware that a body receiving point has to be determined, and a body recovery register should be maintained before dispatching the bodies from the scene; knew that a unique reference number should be given to each body, and that the number tags should be attached to the wrist or ankle of a complete body; agreed that the bodies should be released after confirming identification; and responded correctly to the false statements that every attempt should be made to identify the bodies, and that all attached personal belongings should be removed at the scene itself.”'
[caption id="attachment_112702" align="alignright" width="637"]
Sri Lanka Army soldiers managing the bodies of the dead during a disaster situation[/caption]
Misbeliefs among first responders
However, with regard to photographing bodies, only a lesser number of participants responded correctly to the false statement that obtaining a single photograph of a body is adequate.
Regarding fragmented bodies, it stated: “A lesser number of participants stated that every body part should be considered as a separate individual, while the majority thought that all fragmented pieces in a particular area could be collected into a single container. Furthermore, the majority have responded correctly to the false statements that the recovery team should attempt to match body parts at the scene, and that the personal belongings separated from the body belong to the closest body.
“The majority also stated correctly that the bodies should be placed in separate body bags with personal belongings, sealed, and that plastic sheets, bedsheets, or other available material may be used as an alternative, if body bags were not available.”
Only a lesser number of participants knew that ambulances should not be used to transport bodies.
In relation to the storage of bodies, the majority were aware that refrigeration between 2 and 4 degrees Celsius is the best option, while a lesser number of participants were aware that temporary burial is also a good option when no other method is available. Furthermore, in this regard, while the majority knew that laying bodies on top of each other with an intervening layer of soil in temporal burial is wrong, only a lesser number of participants knew that using iced water is not useful.
Concerning the possibility of infection, the majority knew that handling dead bodies carries only a small risk of infection through contact with blood and faeces, but only a few knew that wearing a face mask and spraying disinfectants to dead bodies is not essential during body recovery.
Administrative and management issues
The study also dealt with administrative issues commonly faced by first responders to the scene of mass disasters. The majority were aware that legal problems arise to relatives as a consequence of the mismanagement of the dead. Although the majority also correctly responded to the false statement that “politicians can participate”, the flipside was true with regard to the false statement that “direct communication with outsiders/media should be done”. The majority, however, knew that journalists should not be allowed on the scene immediately after the disaster.
Attitudes on the management of the dead in disasters were also considered in this study, specifically through statements such as “whether the dead bodies of children should not be given priority”; “there is no need to respect dead bodies, as they are dead”; “identification of the dead is not important in disasters, as there are large numbers of casualties”; “funeral rites are unimportant”; “mistaken identity is not a big issue to be worried about”; “pre-planning for disasters is a waste of money and time, as disasters are unpredictable”; “the necessity of members of the affected families to know the fate of their loved ones should not be a priority”; “following guidelines is impractical”; “unidentified bodies should be buried in common graves to save time and money”; and “the management of bodies of foreign nationals should be treated better than the locals”.
Discussing further, the authors, Chaminda and Warushahennadi, explained that face masks do not filter or provide protection for a considerable period of time, and can slow down some tasks of the users, such as moving, storing, and preparing corpses. Moreover, the danger of contamination via respiratory tract is minimal, since there is no respiratory function in dead bodies.
According to the authors, a noteworthy finding was the attitude of more than half (52.1%) of the study subjects that the management of the bodies of foreign nationals should be treated better than those of locals. In this regard, guidelines laid down by the College of Forensic Pathologists of Sri Lanka state that “every victim, foreign or Sri Lankan, would be treated equally”, while the field manual for first responders notes: “Pressure to prioritise the finding of foreign nationals must not be allowed to distort the priorities of a systematic local approach to identifying all the dead.”
There is space for improvement in certain practices pertaining to the management of dead bodies, Chaminda and Warushahennadi observed, and therefore they recommended the improvement of training opportunities afforded to Army soldiers to enhance their knowledge and experience on the management of the dead in disasters, as well as for increased consideration to be given during training programmes to offer specific instructions on different aspects of the management of dead bodies.
The way human remains are managed in a disaster situation has a significant impact on the wellbeing of survivors. The improper management of the dead in such situations can lead to the loss of forensic evidence, delay in the identification of the deceased, and preclude dignified burial. Thus, the inappropriate management of the dead has social, psychological, economic, and legal consequences on the survivors, which in turn exacerbates the damage caused by the disaster itself.
Learning from disaster
Experience from natural disasters such as the 2004 Indian Ocean tsunami has shown that first responders play an important role in managing the dead in disasters, as they can do a lot to give the best possible opportunity to investigators to identify the remains of those deceased, and to clarify the fate of missing persons. The early work of first responders in a disaster determines the success of much of the work done by medico-legal experts later.
Among the stakeholders involved in a disaster response, the Army and its soldiers, who are among the first responders in disasters, play a key role. Their role in disaster response has increased due to the incidence and magnitude of natural disasters and the interest of military institutions in the disaster response.
In the Sri Lankan setting, Army soldiers play a vital role in the process of the management of dead bodies in disasters, because they act as either responsible persons or supporting persons in almost all activities in the management of dead bodies in disasters – as evident during the recovery of human remains in disaster situations in the recent past, such as the collapse of the garbage dump at Meethotamulla as well as the landslides in Meeriyabedda and Aranayake.
When contacted by The Morning yesterday (7), Col. V.M.N. Hettiarachchi attached to the Army Headquarters Media Directorate said that in addition to the human technology aspect, in the wake of the Meethotamulla garbage mound disaster, where the urgent circumstances forced a haphazard search and made it challenging to identify precise locations of victims, commandos, with assistance from the University of Colombo, had trained canines (caddy dogs) to aid the search in a targeted manner using their olfactory sense.
Furthermore, he noted that apart from the Army, quick response teams engaging in combination training, including in water bodies, and troops were provided with postgraduate and master’s degree study courses in disaster management.
Sri Lanka Army soldiers managing the bodies of the dead during a disaster situation[/caption]
Misbeliefs among first responders
However, with regard to photographing bodies, only a lesser number of participants responded correctly to the false statement that obtaining a single photograph of a body is adequate.
Regarding fragmented bodies, it stated: “A lesser number of participants stated that every body part should be considered as a separate individual, while the majority thought that all fragmented pieces in a particular area could be collected into a single container. Furthermore, the majority have responded correctly to the false statements that the recovery team should attempt to match body parts at the scene, and that the personal belongings separated from the body belong to the closest body.
“The majority also stated correctly that the bodies should be placed in separate body bags with personal belongings, sealed, and that plastic sheets, bedsheets, or other available material may be used as an alternative, if body bags were not available.”
Only a lesser number of participants knew that ambulances should not be used to transport bodies.
In relation to the storage of bodies, the majority were aware that refrigeration between 2 and 4 degrees Celsius is the best option, while a lesser number of participants were aware that temporary burial is also a good option when no other method is available. Furthermore, in this regard, while the majority knew that laying bodies on top of each other with an intervening layer of soil in temporal burial is wrong, only a lesser number of participants knew that using iced water is not useful.
Concerning the possibility of infection, the majority knew that handling dead bodies carries only a small risk of infection through contact with blood and faeces, but only a few knew that wearing a face mask and spraying disinfectants to dead bodies is not essential during body recovery.
Administrative and management issues
The study also dealt with administrative issues commonly faced by first responders to the scene of mass disasters. The majority were aware that legal problems arise to relatives as a consequence of the mismanagement of the dead. Although the majority also correctly responded to the false statement that “politicians can participate”, the flipside was true with regard to the false statement that “direct communication with outsiders/media should be done”. The majority, however, knew that journalists should not be allowed on the scene immediately after the disaster.
Attitudes on the management of the dead in disasters were also considered in this study, specifically through statements such as “whether the dead bodies of children should not be given priority”; “there is no need to respect dead bodies, as they are dead”; “identification of the dead is not important in disasters, as there are large numbers of casualties”; “funeral rites are unimportant”; “mistaken identity is not a big issue to be worried about”; “pre-planning for disasters is a waste of money and time, as disasters are unpredictable”; “the necessity of members of the affected families to know the fate of their loved ones should not be a priority”; “following guidelines is impractical”; “unidentified bodies should be buried in common graves to save time and money”; and “the management of bodies of foreign nationals should be treated better than the locals”.
Discussing further, the authors, Chaminda and Warushahennadi, explained that face masks do not filter or provide protection for a considerable period of time, and can slow down some tasks of the users, such as moving, storing, and preparing corpses. Moreover, the danger of contamination via respiratory tract is minimal, since there is no respiratory function in dead bodies.
According to the authors, a noteworthy finding was the attitude of more than half (52.1%) of the study subjects that the management of the bodies of foreign nationals should be treated better than those of locals. In this regard, guidelines laid down by the College of Forensic Pathologists of Sri Lanka state that “every victim, foreign or Sri Lankan, would be treated equally”, while the field manual for first responders notes: “Pressure to prioritise the finding of foreign nationals must not be allowed to distort the priorities of a systematic local approach to identifying all the dead.”
There is space for improvement in certain practices pertaining to the management of dead bodies, Chaminda and Warushahennadi observed, and therefore they recommended the improvement of training opportunities afforded to Army soldiers to enhance their knowledge and experience on the management of the dead in disasters, as well as for increased consideration to be given during training programmes to offer specific instructions on different aspects of the management of dead bodies.
The way human remains are managed in a disaster situation has a significant impact on the wellbeing of survivors. The improper management of the dead in such situations can lead to the loss of forensic evidence, delay in the identification of the deceased, and preclude dignified burial. Thus, the inappropriate management of the dead has social, psychological, economic, and legal consequences on the survivors, which in turn exacerbates the damage caused by the disaster itself.
Learning from disaster
Experience from natural disasters such as the 2004 Indian Ocean tsunami has shown that first responders play an important role in managing the dead in disasters, as they can do a lot to give the best possible opportunity to investigators to identify the remains of those deceased, and to clarify the fate of missing persons. The early work of first responders in a disaster determines the success of much of the work done by medico-legal experts later.
Among the stakeholders involved in a disaster response, the Army and its soldiers, who are among the first responders in disasters, play a key role. Their role in disaster response has increased due to the incidence and magnitude of natural disasters and the interest of military institutions in the disaster response.
In the Sri Lankan setting, Army soldiers play a vital role in the process of the management of dead bodies in disasters, because they act as either responsible persons or supporting persons in almost all activities in the management of dead bodies in disasters – as evident during the recovery of human remains in disaster situations in the recent past, such as the collapse of the garbage dump at Meethotamulla as well as the landslides in Meeriyabedda and Aranayake.
When contacted by The Morning yesterday (7), Col. V.M.N. Hettiarachchi attached to the Army Headquarters Media Directorate said that in addition to the human technology aspect, in the wake of the Meethotamulla garbage mound disaster, where the urgent circumstances forced a haphazard search and made it challenging to identify precise locations of victims, commandos, with assistance from the University of Colombo, had trained canines (caddy dogs) to aid the search in a targeted manner using their olfactory sense.
Furthermore, he noted that apart from the Army, quick response teams engaging in combination training, including in water bodies, and troops were provided with postgraduate and master’s degree study courses in disaster management.