Mass-Casualty Incidents and DVI Nursing Roles

Mass-casualty operations run through recognisable phases, and the forensic nursing contribution changes at each transition. Understanding these entry points matters for resource planning, team deployment, and documentation continuity.

The conflict between life-safety and evidence preservation is most acute in the first hours of a mass-casualty incident. Emergency responders have no choice but to move bodies, cut clothing, start IV lines, and contaminate scenes to reach survivors. This is ethically correct and legally protected. The forensic nurse's role is not to obstruct this work but to document it in real time, turning what would otherwise be unexplained alterations of the evidence into a recorded chain of interventions.

• Assign a body number (usually a DVI tag) to each victim at the point of first contact. This number follows the remains through every subsequent step and is the key linking ante-mortem data to post-mortem data.
• Document the position and condition of each victim before movement, even in an active rescue : a photograph taken in 10 seconds preserves information that cannot be recovered later.
• Note all medical interventions on each victim: IV placement, defibrillation, wound packing. These explain injuries and alterations the pathologist will find and must be in the documentation or the pathologist is interpreting them blind.
• Personal effects removed during triage (wallets, phones, jewellery, clothing) must be bagged, tagged with the victim's body number, and stored with the remains. This is the single most common chain-of-custody failure at MCIs.
• Body bags used for transport must be sealed and tagged before leaving the scene. An open, untagged bag that arrives at the mortuary with commingled remains or missing personal effects cannot be reliably reconstructed.

The DVI process requires ante-mortem reference information for each missing person: physical description, dental records, fingerprints if available, DNA reference samples from biological relatives, and a detailed account of what the person was wearing and carrying. Collecting this information from acutely bereaved families requires a structured protocol and clinical sensitivity in equal measure. A family member who is told their relative may be among the dead is in acute psychological distress; the nurse must manage that conversation while extracting the specific information the identification system requires.

1. Create a private, calm environment
   AM data interviews should not happen in a public waiting area or a busy hospital corridor. A quiet room with a dedicated nurse, an interpreter if needed, and written materials in the family's language sets conditions for a complete and accurate interview.
2. Use the INTERPOL Yellow Form systematically
   The Yellow Form covers: personal data, physical description (height, weight, eye colour, distinguishing marks), dental data if the family can identify their relative's dentist, fingerprint data if available, DNA reference sample collection consent, and a clothing and personal effects inventory from the last known sighting.
3. Collect DNA reference samples
   Buccal swabs from first-degree biological relatives are the preferred reference material for DNA comparison. If parents are unavailable, siblings, children, or other biological relatives can contribute. The nurse explains the process, obtains signed consent, and collects, labels, and seals the swabs with the missing person's case number.
4. Manage expectations honestly
   Families need to understand that identification may take weeks or months, particularly in incidents with fragmented remains or large numbers of casualties. The nurse's clinical background in delivering difficult news directly supports this conversation, and honest uncertainty avoids the false hope that causes secondary harm when timelines slip.

Personal effects, including clothing, jewellery, wallets, phones, keys, medical devices, and bags, serve two functions in a DVI operation. They are potential identification evidence and they are exhibits in any subsequent criminal or regulatory inquiry into the cause of the incident.

The documentation standard is the same as for any forensic exhibit: photograph in situ before removal, describe in writing, bag, seal, and tag with a unique identifier linked to the victim's body number. When personal effects are removed from a victim during triage, as often happens when clothing is cut away or phones are moved to locate emergency contacts, the forensic nurse ensures the documentation is made then, not reconstructed later.

Forensic nursing teams at mass-casualty events face a high and well-documented risk of secondary traumatic stress. Contributing factors include large numbers of dead (including children), fragmented remains in transport or blast incidents, prolonged operational duration, and the sustained intensity of family-liaison work.

Psychological first aid (PFA) is the evidence-informed immediate support framework endorsed by the WHO, Red Cross, and most national emergency-management systems. It is not a clinical intervention in the psychiatric sense; it is a structured way to provide safety, calm, and connection to people in acute distress. For responders themselves, the same principles apply: rest periods built into the duty roster, buddy systems for checking in, clear debriefing structures at the end of each operational day, and explicit normalisation of emotional reactions.

• Mandatory rest periods prevent the cognitive and emotional numbing that leads to documentation errors, which at a DVI operation translate directly into identification failures.
• Briefing and debriefing structures should be part of every operational shift, not optional. The debrief is both a safety check and a documentation verification: what was recovered, tagged, and transferred during the shift.
• Access to mental health support should be explicit and destigmatised. Peer support workers embedded in the team : trained responders who can identify early signs of acute stress reactions in colleagues : have been shown to increase uptake compared with external referral pathways alone.
• The operational commander is responsible for recognising when a team member needs to rotate off an especially distressing task (working with child victims, processing fragmented remains) and for making that rotation normalised rather than a mark of weakness.