1.

Definitions:
Critical incident, major accident, and
disaster are often used interchangeably

Major incident, including but not limited to:
Emergency which requires the
implementation of special arrangements
by one or more emergency services (health
services, govt agencies etc.) to:
o Rescue & tpt large no. of casualties
o Involve (directly or indirectly), large
no. of people from various services
o Handle large number of enquiries from
public and media (usually by police)
o Mobilise and organize emergency
services & supporting orgs to cater for
the threat of death, serious injury and
homelessness, to a large no. of people
Disaster Management (Adapted from Prof Cuthbert Teos lecture notes + supplements)
4. Command and Control
Command
IC for the incident management usually
police or civil defence force

Control
Hands on control in each particular
organization (coming under overall command)

Some police forces use integrated
management, a methodology to separate
commands (gold, silver and bronze):
Gold (strategic)
Overall command to establish policy network
Within which silver cmd will work
Support silver cmd by providing resources
Prioritize demands from silver cmders
Determine plans for return to normality
when incident is brought under control

Silver (tactical)
Usually refers to key coordinators
Consults others to determine priority of
resource allocation, plan and coordinate
when and where a task will take place, and
obtain resources as required.
Manage physical running of site so it
operates efficiently, while taking into
account conflicting interests (e.g., safety,
evidence gathering, rescue, body recovery)

Bronze (operational)
Usually refers to initial action of particular org
E.g., for police - set up incident access ctrl,
establish inner and outer cordons, site
security, traffic mgmt, evacuate survivors
New bronze roles may appear as scene
devs, e.g., during body recovery phase,
search & body recovery manager = cmder
3. Roles:
Agencies involved should have agreed to roles
in broad terms:
Civil Defense/ Fire Authority:
o Dealing with fire
o Neutralise dangers frm chem spillage
o Rescue trapped persons
o Use specialist rescue equipment
Ambulance Service
o Casualty evacuation
o On site paramedical & emergency svcs
Health authorities
o Alert hospitals
o Activate health care svcs
o Allocate health svcs to avail hospitals
Police
o Saving lives
o Protect property
o Coordinate emergency svcs
o Take charge of site
o Protect & Preserve Scene
o Investigate incident
o Collation and dissemination of info
o IC for coordinating identifcatn of dead
Forensic scientists
o Identify dead
o Scene and incident investigation
Others
o Emergency feeding
o Housing victims
o Clearing up operations
o Restoration of normality

Each agency should have emergency response
plans (should be regularly exercised & revised)
2. Types of Disasters:
Based on whether numbers and identities of
casualties (NIC) is known
Closed
NIC known (e.g., aircraft, factory explosn)
Opened
NIC unknown (MRT, shopping centre)
Mixed
Some NIC known, but also unknown
E.g., 9-11 (workers in building, pp in
aircraft known, visitors unknown)



5. Contact methodology
Time sequence in which various specialists
come into contact with incident site

Immediate scene, e.g.:
Rescue and recover living. Treat injuries
Assume that incident is crime scene.
Protect and preserve the scene
Body recovery may be delayed to preserve
evidence, unless there is risk of body being
lost or damaged (e.g., by fire)
Medical staff pronouncing death at scene

Hospital, e.g.,
Receiving injured& non-injured survivors
Establish comm. lines with other hospitals,
mortuaries, major incident ctrl room
Ensure continuity for coroner when
survivors die

Body recovery, e.g.,
Pronouncement of death at the site
Locating and tagging dead at the site
Scene investigation by police, forensic
pathologists, forensic scientists, coroner
Recovery of bodies and body parts
Setting up a temporary body holding area
at the site
Document sketches, photos, video, GPS etc
Health and safety arrangements for body
recovery team member
Deal w intense media, political and family
pressures to recover, identify bodies asap

Command centre, e.g.,
Repository for information on missing pp
Collate and process info on survivors,
injured and dead
Provide info to media and family
Control release of remains of deceased

11. Identification Commission
Usually headed by Coroner
Formulates identification criteria and
evidential requirements that will be met to
ensure that deceased is correctly identified
Supervising members from forensic team
(e.g., pathologist, odontologist, DNA
scientist) are usually part of e commission

10. Investigation
To determine cause of disaster
Multi-agency affair (police, forensic
scientists, SCDF)
Airline crash CAAS, FAA, Boeing etc.
Identify identities/ cause of death, e.g.,
Jewelry, clothing, personal prop on body
6. Management of Dead at Scene
Systematic search in a grid system
Predetermined numbering system for
recovery of body parts
Proper tagging of bodies and parts
Chart/ document where body found
Prelim identifictn at scene/ temp mortuary
Refrigerated containers
7. Mass Disaster Scene
Zoning
Hot
Disaster scene
Warm
Decontamination area
Screening point for law enforcement
Victims to remove personal defects for
signs of bio/chem. hazards
Law enforcement to separate, catalogue,
identify and package pot hazardous materl
Cold
Area where protective equipment is
available or may be required
Personnel here provide support to those
entering hot and warm zones
Secures scene security
Provides triage assistance to fire and EMS
8. Scene of accident (hot zone)
Safety Issues
Danger to helpers
Confined space
o Lack of O
2

o Presence of noxious fumes (e.g., CO)
Fire
Falling masonry
Biological & chemical hazards
9. Temporary mortuary (TM)
Purpose
To protect bodies from the elements
Stop decomposition by refrigeration
NO AUTOPSIES DONE AT TM



12. Disaster Victim Identification (DVI)
Aim/ Principle
Matching ante-mortem w post-mortem data:
Ante-mortem: yellow forms
Post-mortem: pink forms
(as devised by Interpol)

Two teams:
Ante-mortem team
Responsible for compiling reports of
missing persons believe to be involved in
the incident and not acted for
Post-mortem team
Responsible for performing post-mortem
examinations (e.g. autopsy), documenting
features that may help in the identification
of unknown deceased persons

Issues
Complicated if place is a tourist/ business spot
Results in deaths of many non-nationals

For major disasters, infrastructure is damaged
One country has insufficient resources
Need to collaborate with internatl commty
speeds up victim recovery + ID process

Interpol member nations can activate DVI sys:
DVI guide + forms (see above)
Provides Incident Response Team and
liaison between disaster site & Interpol
databases
Standing Committee on DVI focuses on
provision of capacity-building tools
o DVI assistance
o Victim care & fam supprt/ DVI welfare
o Quality mgmt guidelines
o Training
o Info-sharing and exchange

13. Issues arising (for helpers) during DVI
+ victim recovery

Post-traumatic stress disorder for helpers
Stress
Helpers stress rxns can be acute/ delayed
Acute
Mainly physio-psychological
o Insomnia
o Hyper-arousal
State of increased psychological and
physiological tension
o Somatisation
Physical symptoms that involve more
than one part of the body, but no
physical cause can be found
Can also be behavioural
o Social withdrawal
o Increased alcohol and tobacco use
o Declining performance
o Work-relationship issues
Psychiatric illness rare
o Major depression
o Hallucinations
o NB: Pharmacologic cause should be
excluded (e.g., use of mefloquine)
Delayed
Mainly seen in front-line personnel
Life-threatening or extremely grotesque
situations
Moderated through
Organisational approaches
Predeployment
o Contd preparation for disaster resp
o Pre-deploymt orientatn & education
o Briefings
o Delegating deployed pps usual work
Deployment (on-site)
o Team work
o On site buddy support
o Frequent breaks
o Short shifts
o Clearly delineated roles and resps
o Appropriate logistic support
o Ensuring contact with family @ home
o Support from leaders & mgmt
Post-deployment
o Recognition from
Peers, Organisation & Society
Individual approaches
o Managing workload (work plans)
o Balancing lifestyle
Eating regularly
Getting enough rest & sleep
o Stress reduction
Maintaining social contact
Using time-off
Talking abt work with colleagues
Participating in memorials
Writing a journal
o Being self-aware
Knowing ones limitations
Recognising stress rxns
Re-ordering personal prejudices/
cultural stereotypes

Team leaders
Must be able to:
Temper stressful reactions
Recognise stress reactions
Help team-members cope
Must consider, when personnel shows signs of
not coping:
Time-outs
Attachment to a more experienced buddy
Professional consultation
Redeploy to less stressful role
Send back to SGP
Other stressors include:
Environment
Pre-deployment uncertainty
Unfamiliar environment
Cultural differences
Local political concerns
Media pressures
Communication
Lack of coordination
Poor communication
Inadequate information flow
Work related
High or uneven workload
Time vitalness
Long working hours
Erratic schedule
Gruesome sights
Dangerous situations
Exhaustion (aggravated by use of
protective clothing)
Burn-out
Tail-end slow-down of work
Organisational
Post-deployment reimbursement negos

Emotional/ Psychological
Inaccessibility/ unwillingness to access
recreational facilities
Contact with angry, bereaved or anxious
relatives and/or survivors
Over-identification with victims
Inabiilty to fulfill ones role
Home-sickness



14. Objectives of Autopsy
Identification
Document/charting injuries
Examining internal organs
o Document natural diseases
o Establish cause of death (COD)
Collect specimens for toxicological,
histological or serological purposes
o Blood, bile, urine
o Carboxyhaemoglobin
o Drug screen
Estimate time interval between moment of
disaster and death
Exclude foul play
o Injuries inconsistent with accident
For two or more members of family
travelling together, identify order of death
o For wills (recall rule in Equity)
Obtain forensic, scientific & other evidence
o Suspected criminal involvement as
cause of the disaster, e.g., terrorism
o Coroners inquest, crim/ civil litigation,
national/ international inquiries
o Reconstruct accident
Assist in finding cause of disaster
o Mechanical causes
o Environmental causes
Lightning
Air, e.g., presence of HS, CO, CN
o Human causes
Operator intoxicatn (drugs/ alcohl)
Disease
Psychological/ psychiatric causes
NB: Excluding disease impt for compensation
(reduced life expectancy/ early death etc.)
17. Inquest/ inquiries
Following a major incident, Coroners
inquests are held.
There is usually some form of formal
inquiry as to how the incident occurred.
15. External Examination
Not ideal to only do an external examination
But may not be physically feasible
May only be possible for those not
involved in the causation of disaster
e.g., passengers in transportation accident
Must remember primary objective:
IDENTIFICATION

Chart external injuries
Detect injuries inconsistent with accident
o E.g., gunshot wound in aircraft crash
Reconstruction of accident
Excludes foul play
Correlate with internal injuries

NB: FULL AUTOPSY should be done for
operators of transportation accidents
Toxicology (intoxication)
Exclude disease states
Reconstruct + exclude foul play
16. Identification Methods
Includes:
Personal characteristics, e.g.,
Visual identification, unique physical
features, fingerprints, DNA profile, dental
evidence, radiological evidence
Circumstantial evidence, e.g.,
Jewelry, clothing, personal prop on body

Obtained through:
Interviews with NOK
o Obtain medical (x-ray) + dental records
o Unusual physical features (tattoo,
amputations, deformities etc.)
Photography
Visual (the deceased as he/she is)
The deceaseds body

NB:
Visual identification rarely possible because of
extent and numbers involved. Other info need
(as above) to make conclusive identification