Forensic Magazine® | Articles | Forensic Disaster Response: The Crash of Comair 5191

Forensic Disaster Response: The Crash of Comair 5191

Douglas Page
February/March 2007

Challenges, issues, and solutions of identification in mass disasters differ with the type and
scope of the catastrophe.

At approximately 6:10 A.M. on Sunday, August 27, 2006, Comair Flight 5191 taxied into takeoff
position at Blue Grass Airport in Lexington, Kentucky. Neither tower controllers nor the crew on the
flight deck noticed the aircraft had turned on to unlit secondary Runway 26 — only half as long as
intended 7000 ft. primary Runway 22.

Too soon after the Bombardier CRJ-100ER began its takeoff roll the 50 seat commuter aircraft ran out
of concrete. With the crew fighting to get the doomed plane airborne, the plane’s landing gear clipped
an 8 ft. perimeter fence at 158 mph with its tail dragging the ground. The plane failed to clear a nearby
grove of trees; the tail separating from the fuselage. The aircraft then slammed into a hillside no more
than 1000 ft. from the end of the runway and exploded.

A PLANE IS DOWN
Less than 90 minutes later, University of Louisville dentistry professor Mark Bernstein, DDS, and a
diplomat of the American Board of Forensic Odontology, home asleep in nearby Borden, IN, is
informed by Tracey Corey, MD, the Chief Medical Examiner (CME) of the Commonwealth of
Kentucky, to assemble his odontology team. A plane is down at Bluegrass Airport, 50 onboard, one
survivor.

“Although I lecture on mass disaster preparedness as a component of a University of Louisville

Bioterrorism grant, and recently participated in a mock disaster exercise at the Greater Cincinnati
Airport, the immediate reaction to such news is momentary confusion and inaction,” Bernstein said.

The shock is transient. Bernstein immediately passes the word to faculty colleague Ryan Noble, DDS.
Within minutes the remaining members of Bernstein’s odontology team – Drs. James Woodward,
William Lee, and Corky Deaton – are also notified, as is Virginia Woodward, the team’s dental
hygienist. All are to report to the medical examiner’s facility in Frankfort, 18 miles from the crash site.

Bernstein and Noble first swing by the University School of Dentistry to gather supplies and equipment
that have been stored for just such events. There is one snag. The mobile x-ray unit is not exactly
portable — it weighs 500 pounds and must be dismantled, then somehow maneuvered into

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Forensic Magazine® | Articles | Forensic Disaster Response: The Crash of Comair 5191

Bernstein’s SUV. Campus police help hoist the unit. Other gear in the emergency cache includes
antemortem and postmortem dental charting forms, a computer, a Dexis digital x-ray probe and
software package, miscellaneous containers, and a digital camera.

The odontologists depart for the state forensic laboratory in Frankfort, arriving by noon, before the
bodies.

“A perimeter of security surrounds the building but we are anticipated, and promptly admitted,”
Bernstein said.

Meanwhile, Corey and Fayette County coroner Gary Ginn have activated the remainder of the mass
disaster team, including 22 coroners, seven pathologists, and Emily Craig, Ph.D., the state
anthropologist.

BODY RECOVERY
Members of the Kentucky Mass Disaster Team (KMDT), a group of county coroners from the
Kentucky Coroners Association formed in the early 1990s to respond to state mass fatality incidents,
are already at the crash scene, removing bodies from the wreckage. First members of KMDT are on
the scene within 30-45 minutes.

“Coroners do the body recovery,” said Lee, who happens to be the coroner of Hardin County (and the
only coroner-dentist in Kentucky).

Corey said Kentucky is lucky that it already had in place a mass fatality response team of experienced
death investigators.

“When I arrived at the scene many of them were already on hand,” she said.

Over the years, the medical examiner’s office and KMDT had trained and formulated disaster plans
and procedures. Plans must be flexible.

“Every mass fatality incident is going to be unique, and although you can have policies and
procedures you are always going to have to modify those procedures to fit the situation that arises,”
Corey said.

Unlike Hurricane Katrina, where victims were widely scattered, here crash victims are confined,
facilitating recovery. By 4 P.M., remains begin arriving at the Frankfort morgue, where they are
logged, placed on gurneys, and rolled into refrigerated trucks positioned earlier in a secure area.

“Sometimes, you might have to work in a tent or temporary facility, but here we were fortunate to be
so close to the Medical Examiner’s Office in Frankfort,” Lee said.

Once the morgue operations are ready, bodies are brought in groups, tagged, photographed, and
personal effects catalogued.

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Forensic Magazine® | Articles | Forensic Disaster Response: The Crash of Comair 5191

Mistaken identity of the dead at mass fatality incidents is always a risk. In April, 2006, a terrible
mistake was made after two Indiana college students who resembled each other were involved in a
car crash near Fort Wayne, Indiana. One died, one survived comatose. The family of the deceased
was told their daughter had died in the crash, only to learn five weeks later that the victims had been
misidentified at the scene.

Lexington circumstances are different, but Corey takes no chances; she requires that a coroner
accompany each victim to each station during identification, eliminating any potential for mislabeling
or loss. Days later, as the bodies are released to families, Corey double checks each body bag, just to
be sure.

IDENTIFICATION PROCESS
“ All victims display varying degrees of fire effect,” Bernstein said. “Many have blunt force trauma.”

Clothing is removed first and autopsies performed by the pathologists, who not only look for
identification clues but attempt to determine cause of death. While all deaths are related to the crash,
specific cause for each individual – whether from injuries from the impact or smoke inhalation – must
be ascertained for the death certificate.

“A person might have had a heart attack and be dead before the crash,” Lee said.

After autopsy, the remains go to dental processing, where Bernstein exposes the dentition, noting
fracture patterns, dental damage, airway soot, color of tissues.

“These factors may help reconstruct the cause of death,” he said. The hygienist, who serves a scribe,
records the findings. Odontology teams photograph the dentition and chart the dental findings on
standard postmortem forms.

Victims are then returned to the trucks.

The forensic teams work until 9:30 P.M. Sunday night and return at 7 Monday morning. By Monday
evening all 49 decedents have been examined.

“Remarkably, almost no teeth or jaw fragments are lost or co-mingled,” Bernstein said. One segment
of an upper jaw not present with its remains is found at the scene two days later.

FAMILY ASSISTANCE
Elsewhere, Comair arranges for the victims’ families to gather at a Lexington motel. FEMA’s Disaster
Mortuary Operational Response Team (DMORT) family assistance crew, along with the Fayette
County coroner’s office, are busy collecting medical and dental records of those on Flight 5191’s
manifest.

Family assistance is critical.

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Forensic Magazine® | Articles | Forensic Disaster Response: The Crash of Comair 5191

“Someone must sit down with 49 emotionally charged families and ask them detailed questions to
help identification – color and length of hair, color and length of fingernails, and so forth,” Lee said.
“You need people who are trained for this.”

All crash victims are adults, most are locals, and most have considerable dental work – factors that
contribute to rapid acquisition of antemortem dental records. The local medical community responds
compassionately, Bernstein said.

“Indeed, 47 antemortem records were received by Tuesday,” he said. By Tuesday evening

antemortem records and postmortem records are matched and tentative identifications are being
made.

Bernstein organizes the antemortem records into two groups, male and female. The most
characteristic feature of each victim is selected, then postmortem records from that gender group are
visually scanned to find matching characteristics.

“If only one postmortem record showed a similar characteristic, it was considered a tentative
identification,” Bernstein said. If more than one victim shared the characteristic, a second
characteristic is selected for comparison.

Bernstein said that for each tentative identification made, confirmation is established by comparing all
charted dental features, noting any dental similarities while accounting for any discrepancies. Most
identifications are straightforward.

“Some are difficult, either because of little dental work or the antemortem records are old and
temporal changes have occurred,” he said. In these instances, digital postmortem radiographs are
used to compare with antemortem films.

“Radiographs provide specific dental silhouette patterns and show subtle anatomic features that can
be objectively compared with precision to ensure identification,” Bernstein said.

In the end, dental comparisons establish 47 identifications. Of the two individuals on whom no dental
records are obtained, one is identified by fingerprints and the other by a radiographic comparison of
an antemortem x-ray of a previously damaged finger bone.

All 49 victims are positively identified by Wednesday evening.

DEJA VU
The loss of Flight 5191 is the first mass fatality incident in Kentucky since a 1988 bus crash.

“Comparison of each accident illustrates why it is axiomatic that no single protocol for managing mass
fatalities is appropriate in all situations,” Bernstein said.

In both incidents, victims were burned but remained relatively intact, and dental records were quickly
recovered. However, because the bus victims were children, there was very little dental work.

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Forensic Magazine® | Articles | Forensic Disaster Response: The Crash of Comair 5191

“Children lose teeth and new ones erupt so rapidly, their antemortem radiographs of only a few
months earlier appeared much changed from current dentitions,” Bernstein said. This mandated
making dental radiographs on each victim and copying antemortem radiographs on each patient so
that subtle anatomic features of teeth and bone could be compared, a difficult and time consuming
task.

Flight 5191 response was managed differently.

The decision to delay making dental x-rays and not to copy all of the antemortem x-rays was made
because clinical attributes quickly documented by digital photography rendered so much dental
information that these comparisons alone allowed unconditional identification in most cases. In cases
where there was any uncertainty, radiographic comparisons were performed.

“This modification saved time while not compromising accuracy, thus optimizing the identification
effort,” Bernstein said.

Dental results were presented to Corey, who cross-checked them against suspected identification
based on personal effects, medical records, and anthropologic data.

“The rapidity and effectiveness of the response allowed us to release the remains to families as
quickly as possible without compromising accuracy,” Bernstein said.

Corey said her strongest advice to other CMEs or disaster planners who may have to direct a
response is to find the right people.

“The most important thing in planning is to have contacts with forensic people with experience and
expertise who you will need to call on,” she said.

Identification Clues, Like the Phoenix, Rise from the Ashes

Forensic science can sometimes fail to identify disaster victims.

Explosions and intense fires leave precious little to work with. Traditional
dental x-ray comparison may be unsuccessful if structural relationships of
the jaw are lost. When airplanes crash soon after takeoff with a full load of
fuel, ensuing fires are long and hot. Teeth warp, making traditional forensic
identification impossible.

In a new development, University at Buffalo (UB) forensic dental

researchers have found that evidence still exists among the ashes when all
else – flesh, bones, teeth, DNA – is lost. Researchers there have
demonstrated that inorganic resins that make up the central matrix of dental

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Forensic Magazine® | Articles | Forensic Disaster Response: The Crash of Comair 5191

fillings not only withstand temperatures of 1,800°F, they can be recovered

and identified.

“When fire burns hot enough and long enough, all other clues are
destroyed,” said Mary Bush, DDS, assistant professor of Restorative
Dentistry, UB’s School of Dental Medicine. Identification at this point can
only be made from nonbiological evidence found with the victim. Dental
prosthesis, such as crowns and partial dentures, are examples of
nonbiologicals that survive inferno conditions, she said.

Bush found that not only are resin fillings retrievable, but they can be
identified by brand or brand group. Brand groups are important because
some manufacturers use the same inorganic elemental formulations.

“Inorganic elements stay virtually unchanged even after cremation

conditions,” Bush said.

These materials can then be checked against dental charts to provide

identifying information when other means of identification are exhausted.
Or, it can provide ancillary certainty if other clues remain.

Odontologists have noticed this work. “Forensic dentists have all seen the
effects of high heat on filling materials, but this research documents these
effects for use by odontologists,” said forensic odontologist Ann
Norrlander, DDS, a University of Minnesota assistant professor of
Diagnostic and Biological Sciences.

In most cases where destruction of dental evidence is minimal to moderate,

odontologists will continue to rely on dental radiographs alone for
comparisons, but with severe dentition destruction, information collected
through the Bush method may make the difference between a possible or
positive identification and one where determination is impossible,
Norrlander said.

Arnold S. Hermanson, a Prairie Village, Kansas, dentist, and member of the

American Society of Forensic Odontol-ogy, said Bush has created a
taxonom-ic chart of the composite kingdom.

“This database will allow investigators to speciate every resin ever placed
in a tooth,” Hermanson said. “With portable equipment, on-site brand
identification can be made.”

So far, Bush’s technique works well in the lab, but further work remains

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Forensic Magazine® | Articles | Forensic Disaster Response: The Crash of Comair 5191

before it appears in the field. In a new paper (Journal of Forensic Science,

Jan 2007) Bush reports the possibility of using a portable x-ray
fluorescence detector to perform field analysis.

“This hair-dryer sized machine will show a spectrum in about six seconds,”
Bush said. The spectrum is based on elemental composition, which are
compared to known compounds.

Identification of restorative material is rendered useless, however, if

dentists don’t accurately record type and brand of material used.

“Quality dental record-keeping has been a historic problem facing forensic

odontology,” said UB researcher Raymond Miller, a UB clinical assistant
professor of Oral Diagnostic Sciences.

Miller said dental education needs to emphasize the importance of

maintaining accurate dental records, including not just procedure but
materials and brands.

“Restorative dentists need to understand the forensic value of this

information,” he said. “The circumstance may be rare, but the results may
bring justice or closure to a complex case.”

–DP

Douglas Page writes about forensic science and medicine from Pine Mountain, California. He can be
reached at douglaspage@earthlink.net.

Copyright © 2009 Vicon Publishing, Inc.

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