Back ground

Forensic Odontology in Indonesia has been developed since the implementation of DVI Operation in 1st Bali Bomb Blast until 2nd Bali Bomb Blast. The result through dental identification was very significance in 1st Bali Bomb Blast more than 113 people or 56,5% of the 202 dead victims were succeeded to be identified.

Back ground (contd)

Many disaster cases in Indonesia especially bomb blast cases such as the J.W. Marriott Hotel Bomb Blast in 2003, the Australian Embassy Bomb Blast in 2004, etc need some dental identification as well. Indonesia until 2005 dont have a management protocol for Forensic Odontology procedure examination.

Back ground BACK GROUND

2nd BALI BOM BLAST

FOLLOW UP
2006 POLRI has made an SOP for examination in Forensic Odontology as a Standard reference for management in forensic odontology examination Aim : To identify the dead victim which is difficult to be identified either in single case or on a major disaster to gain the same perception and procedure in achieving the same result.

POLRI FORENSIC ODONTOLOGY STANDARD OPERATION PROCEDUR (SOP) IN DVI

MARKAS BESAR KEPOLISIAN NEGARA REPUBLIK INDONESIA PUSAT KEDOKTERAN DAN KESEHATAN b. Menyimak perkembangan situasi dan kondisi di Indonesia pada akhir-akhir ini, telah sering terjadi bencana, baik bencana yang dengan sengaja ditimbulkan, seperti yang terjadi pada tahun 2002 di Kuta, Bali, tahun 2003 di Hotel J.W. Marriott, Jakarta dan tahun 2004 yang terjadi di depan Kedutaan Besar Australia Kuningan Jakarta serta Bom Bali tahun 2005 maupun bencana yang tidak disengaja, yaitu terjadinya Gempa dan Tsunami di Aceh pada bulan Desember 2004, Gempa bumi di Yogyakarta dan Jawa Tengah tahun 2006 dan bencana-bencana alam lainnya serta bencana transportasi lainnya. Sehingga hal ini melahirkan sebutan Indonesia sebagai negara supermarket bencana, karena hampir segala jenis bencana terjadi di Indonesia. Hal ini menimbulkan banyak korban mati, sehingga membutuhkan sarana identifikasi yang tepat di dalam upaya membantu pihak keluarga untuk dapat menemukan keluarganya yang telah meninggal. Begitu besar pentingnya identifikasi yang memiliki tujuan antara lain bahwa identifikasi merupakan kebutuhan hak asasi manusia, kebutuhan etis dan kemanusiaan terhadap keluarganya, pemastian kematian seseorang secara resmi dan yuridis, kepentingan administratif, kepentingan klaim dalam hukum perdata maupun hukum pidana, klaim asuransi, pensiun dan lain-lain serta sebagai upaya awal dari suatu penyelidikan bila ada. Bertitik tolak dari pengalaman di atas, maka hal tersebut merupakan gambaran bagaimana pentingnya identifikasi forensik dalam memberikan dukungan kepada kepentingan identifikasi secara keseluruhan. Metode identifikasi terdiri dari beberapa : identifikasi menggunakan primary identifiers yang terdiri dari Finger Prints, Dental dan DNA serta identifikasi menggunakan secondary identifiers yang terdiri dari Medical, Property dan Photograph. Dental/gigi geligi merupakan salah satu primary identifiers yang penting terlebih jika korban sudah dalam keadaan termutilasi, hangus terbakar, dan sebagainya.

PANDUAN TEKNIS
tentang

PEMERIKSAAN KEDOKTERAN GIGI FORENSIK GUNA KEPENTINGAN IDENTIFIKASI

BAB I

c.

d. PENDAHULUAN

1.

Pendahuluan a. Bencana merupakan suatu kejadian yang mendadak, tidak terduga, terjadi pada siapa saja, di mana saja, kapan saja serta mengakibatkan kerusakan dan kerugian harta benda, korban manusia yang relatif besar baik mati maupun cedera. Bencana ini dapat bersifat tidak disengaja maupun disengaja, seperti : teror bom, sabotase transportasi masyarakat, kecelakaan tranportasi dan lain-lain.

PROSEDUR DVI

PHASE II

PHASE IV ANTE MORTEM PHASE III REKON SILIASI DE BRIFIENG PHASE V

TKP
PHASE I

POST MORTEM

PHASE I :TKP Bencana : PESAWAT JATUH

SUBSTANCE
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of : A. Early Warning System is a step by step procedure for collecting and analyzing data and dissemination of information regarding on emergency situation or crisis in correlation with the identification process from forensic odontology view.

SUBSTANCE
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of :

A. Early Warning System

B. Preparation Stage

C. Operation Stage

SUBSTANCE
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

B. Preparation Stage A stage where we could give a detailed preliminary activities/pre operation activities in a mass disaster situation which is the forensic odontology view being needed. Those activities are as follows :

SUBSTANCE
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

1. Request for identification support ( number of causalities, checking the victim labeling number, how long the victims has been at the scene, whether the victims could identified visually, name, rank and position of the officer who requesting the identification support )

SUBSTANCE (contd)
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

2.

Requirement for ante mortem data. It was important if Polri already has the dental ante mortem data of the victims. Quick information came and forth from other reliable institution were urgently needed in giving the information regarding the dental record.

SUBSTANCE (contd)
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

3.

A number requirement for forensic odontologist In a small/moderate scale disaster situation usually enough with 2 or more forensic odontologists. If the coordinator needs more forensic odontologists, they could make contact to the local DVI Commander to prepare more forensic odontologists which will support the operation.

SUBSTANCE (contd)
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

4.

Arrangement and time schedule for an autopsy Always contact the PM Coordinator to organize the exact time when the dental autopsy could be performed. In general cases or no suspicious of death, it is possible to do the dental autopsy before general autopsy, but always depending upon the approval from the PM Coordinator. In areas where the officers has no or have limited experience in disaster, so they couldnt applied the protocols then the forensic odontologist should be present at the general autopsy in order to preserve the dental evidence.

SUBSTANCE (contd)
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

5.

Coordination The forensic odontologist coordinator should make contact to all the team members and ascertain that they are capable experts and have a good knowledge about the situation and condition at the scene.

SUBSTANCE (contd)
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

6.

Equipments Most of the equipments used in dental autopsy are standard that being use at the mortuary. Forensic odontologist on duty at the mortuary must be responsible in monitoring a number of the equipments such as : the AM and PM dental data forms (Interpol standard), wrapping sheets, plastic bags, colour pens, label cards, radiographic items, mouth mirrors, tweezers, explorer probe, tooth brush and digital camera.

SUBSTANCE (contd)

This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

7.

Organizing the team If a major incident/disaster has happened with a relatively large casualty, the forensic odontologist team in the mortuary could be separated into 5 functional areas/groups ( resection group, radiology group, post mortem charting group ante mortem charting group and reconciliation group). Each group must have a group leader with its purpose to organize the work in each group and assist communication and activities between groups in the team.

SUBSTANCE (contd)

This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

7.

Organizing the team....... In a small/moderate scale incident, the number of groups doesnt reflect the total amount of its group member, but more to the steps/working order that has to be done by a few of people. The forensic odontologist coordinator has to be in close contact with the PM Coordinator.

SUBSTANCE (contd)

C. Operation stage Is the stage where all essential activities should be done during a mass disaster incident, which is forensic odontology aspect would be done by the entire forensic odontologists.

SUBSTANCE (contd)

1.

Post Mortem Charting Group This group must to be able to deliver early dental evidence for further examination and charting/odontogram. The corpses generally were in various condition, so the procedure to do the autopsy is to comply with the state of the corpse condition, with priority to protect and find out as much as possible the evidence from the teeth and oral cavity. Dental autopsy are usually destructive action, therefore it only could be done after having permission from the PM Coordinator also with the forensic pathologist in charge.

SUBSTANCE (contd)
1. Post Mortem Charting Group........ The dissection could be done after assuring all photography evidence, bite mark, saliva and other thing had been concluded. The operator equipments has to be completed in order to have a good autopsy, such as : having a lab coat, latex gloves, rubber shoes and dental autopsy instrument. The dental autopsy begins with resection at the mandible till the mandible condyle was separated. This needed to have a good and optimum result when doing the x-ray.

SUBSTANCE (contd)
This SOP guideline applicable in phase 2, 3 and 4 in DVI process and consist of ..............

2. Ante Mortem Charting Group This group availability is to gather all dental data from the victim during his/her live time which could be obtained from many sources including from the victims family. For foreigners/expatriates it could be done with the coordination from The Indonesian NCB Interpol Secretariat. All the ante mortem data that we collect has to be filled in to the F1 and F2 yellow form DVI Interpol and it was being done by 2 odontologists. Followed strictly the filling of the yellow form would make it easier when the comparison process had been performed.

POST MORTEM COLLECTING DATA

SUBSTANCE (contd)
By this process the post mortem charting was done by the forensic odontologist to duplicating the real condition from the corpse into a format that could be compared fast and consistent with the available ante mortem data. Charting has to be done by 2 odontologist and be written by using the F1 and F2 pink form (Interpol standard DVI form). The nomenclature format used was the FDI standard. The dental charting techniques should need to be strictly followed to get the same perception and to make easier when the matching process was done, such as : Amalgam fillings need to be noted using a black colour, Composite restoration has to be noted using a green colour, etc. Important to be noticed when filling in the form, was that all section of the form has to be filled completely, do not leave any blank spot. Radiographic image of the teeth would be very helpful in the post mortem investigation and often gift important information to the victim when compared with the ante mortem radiographic images.

2.

Ante Mortem Charting Group (see next)...........

ANTE MORTEM COLLECTING DATA CENTRE

SUBSTANCE (contd)
3. Reconciliation Group This group task was to accomplish the comparison between ante mortem data with the post mortem dental data record. The outcome from this procedure would determine the result whether it is positive, uncertain or negative. The basic principle for forensic odontology is elimination / exclusion.

REKONSILIASI

REKONSILIASI

DEBRIEFING

CONCLUSION
A good and integrated cooperation in a team was needed Make networking and building cooperation among all the dentists in Indonesia to standardized for the dental chart and storage dental data. Always work in a team work and doing according to the procedure and chain of command to avoid from some faction/group to take benefit from a mass disaster situation. Need sacrifices from all the team in all aspects, by always put up front the main goal.