DISASTER VICTIM IDENTIFICATION, BOAT EXPLOSIONS AND TERRORIST BOMBINGS

20/Apr/2009

The boat explosion on Thursday in which five foreign nationals were killed and another 41 injured, some seriously, highlights some of the difficulties that we face in Disaster Victim Identification. According to media reports 23 casualties were being treated in Perth; 12 in Darwin; and 7 in Brisbane. There are three confirmed dead with two still missing. The bodies of the three dead victims are under the jurisdiction of the Northern Territory coroner. Most of the seriously injured are males from Afghanistan (1, 2).

It would appear that there was the potential for all people on board this vessel to have been killed as a result of this explosion, subsequent fire, or possibly drowning. Attending to the identification of a large number of deceased asylum seekers in these circumstances would indeed be extremely challenging. As it is, the passengers and crew who were on this vessel are yet to be positively identified, including those who may potentially succumb to their injuries in hospitals across Australia. Obtaining the relevant information regarding these people will require a great deal of cooperation and coordination between the respective State and Territory coroner’s, forensic specialists, police, federal government departments and authorities overseas.

There is no denying this was a tragic incident. However, there is an opportunity for us to learn from this boat explosion and consider some aspects that may be applied to the nebulous world of terrorism and how it could impact on our response in the disaster victim identification arena. Contemporary planning for disaster response to terrorist events frequently assumes there will be the use of chemical, radiological, or biological weapons. Historically, most victims of terrorist attacks are injured by the use of conventional explosives rather than weapons of mass destruction (3).

Daily, media reports from around the world describe the carnage and mass murder of terrorist bombings. The 2004 Madrid train bombings and the 2005 London transport bombings are contemporary examples of how terrorists are able to coordinate attacks across cities. The terrorist attacks on the United States embassies in Kenya and Tanzania in 1998, and the 11 September attacks in the United States in 2001, provide evidence of the ability of terrorist groups to coordinate attacks, not only across cities, but across countries thousands of miles apart. Terrorism is a mobile battle field that can be imported without warning to any city in the world (4).

Australia is not exempt from the terrorist threat. Al Qa’ida has stated specifically that Australia is a target (5). The potential for a bomb attack being carried out in Australia, in particular one involving a large conventional explosive device, or series of devices, is not restricted to terrorist groups alone. Future attacks may be carried out by individuals who have a criminal agenda, are psychologically unbalanced, or who are sympathetic to a particular cause.

Thursday’s boat explosion highlighted the difficulty in providing emergency treatment for people with severe thermal injuries. In a terrorist bombing, the fireball that emanates from an explosion can reach several thousand degrees in temperature and lasts for approximately 500 milliseconds. This may produce flash burns over large body surface areas. A second scenario resulting in burn injury is a structure or vehicle fire caused by the bomb blast (6). Burns in victims located further away can result from clothing ignition, structure fires caused by the blast, or rupture of vehicle fuel tanks with subsequent fuel ignition. A well-known example of this is the 2002 Bali bombing which consisted of a series of three bombs, including a
vehicle bomb.

The Royal Australian Air Force had to evacuate 66 critically wounded victims from Bali to Australia for treatment. Twenty-eight of the 61 patients seen at the Royal Darwin Hospital had major trauma. The full range of blast injury sequelae were seen, including severe burns, missile injuries from shrapnel, limb disruption and pressure-wave injury to ears, lung and bowel. Once the extent of the disaster was known, it was evident that patients would need to be evacuated from Darwin to specialist burns units throughout the country (7). This evacuation of the Bali burns victims to other centres is similar to the case with the burns victims from Thursday’s boat explosion.

Both the Bali bombing and Thursday’s boat explosion serve as examples of what we may face if a terrorist bombing attack is carried out in Australia. Palmer, Stephens and Fisher reported in their research that no single hospital in Australia has the capacity to effectively manage 61 patients with severe burn and blast injuries (8). Should there be a terrorist bombing or series of coordinated bombings in Australia, there will be secondary triage and redistribution of patients to other burn centres throughout the country. From the Disaster Victim Identification perspective, it may be that we will be called upon to assist with the identification of any number of unidentified victims of a terrorist bombing who have been transferred for medical treatment from another State or Territory.

Keith Loft

REFERENCES:

1. Brisbane Times. 2009. Asylum seekers to undergo burns surgery – 19 April 2009.
http://news.brisbanetimes.com.au/breaking-news-national/asylum-seekers-to-undergo-burns-surgery-20090419-ab2d.html..
Accessed 19 April 2009.
2. ABC News. 2009. Six badly burnt blast survivors land Brisbane
http://www.abc.net.au/news/stories/2009/04/18/2546471.htm?section=australia.
Accessed 18 April 2009.
3. J Burn Care Res. 2006;27:576–588 cited in Crabtree, J. 2006. Terrorist Homicide Bombings: A Primer for Preparation
4. Medhurst. P. 2002. Global Terrorism. United Nations Institute for Training and Research. New York. USA. p9.
5. ASIO. 2008. Report to Parliament 2007-2008: Part One – Threats to Australia. Department of the Attorney General. Australian Government. Canberra. p4.
http://www.asio.gov.au/Publications/Content/CurrentAnnualReport/Content/Cover.aspx
6. Crabtree.J. 2005. Terrorist Homicide Bombings: A Primer for Preparation. Journal of Burn Care and Research. Vol 27, Number 5. p582
7. Palmer D, Stephens D, Fisher D et al, 2003. The Bali Bombing: The Royal Darwin Hospital Experience. Medical Journal of Australia Vol 179 6 October 2003 pp 358 –361
8. Ibid.

(Tags: dvi)