Mohd Shah Mahmood

Pattern of suicides in 2009: Data from the National Suicide Registry Malaysia

The National Suicide Registry Malaysia (NSRM) is a nationwide system that captures data on completed suicides in Malaysia from all forensic departments under the purview of the Ministry of Health Malaysia.

Reprint of: Cling film plastic wrap: An innovation for dead body packaging, preservation and transportation by first responders as a replacement for cadaver body bag in large scale disasters

Cadaver body bags are the conventional method to contain a human body or human remains, which includes the use for storage and transportation of the deceased at any crime scene or disaster scene. During disasters, most often than not, the first responders including the police will be equipped with cadaver body bags to do scene processing of human remains and collection of personal belongings at the disaster site. However, in an unanticipated large scale disasters involving hundreds and thousands of fatalities, cadaver body bags supplies may be scarce. The authors have therefore innovated the cling film plastic wrap as an alternative for the cadaver body bag used at the disaster site. The plastic wrap was tested on six different experimental subjects, i.e. both adult and child mannequins; body parts of the mannequin figure (arm and hand); a human adult subject and an unknown dead body. The strengths of the cling film plastic wrap are discussed in comparison with the cadaver body bag in the aspects of costing, weight, duration of the wrap, water and body fluid resistant properties, visibility and other advantages. An average savings of more than 5000% are noted for both adult body wrap and child body wrap compared to the cadaver body wrap. This simply means that the authors can either wrap 25 adult dead bodies or 80 children dead bodies with the cost of 1 cadaver body bag. The cling film plastic wrap has proven to have significant innovation impact for dead body management particularly by the first responders in large scale disasters. With proper handling of dead bodies, first responders can manage the dead with dignity and respect in an overwhelmed situation to facilitate the humanitarian victim identification process later.

The Clandestine Multiple Graves in Malaysia: The First Mass Identification Operation of Human Skeletal Remains

The first ever mass identification operation of skeletal remains conducted for the clandestine graves in Malaysia consisted of 165 individuals unearthed from 28 human trafficking transit camps located in Wang Kelian, along the Thai-Malaysia border. A DVI response was triggered in which expert teams comprising of pathologists, anthropologists, odontologists, radiologists and DNA experts were gathered at the identified operation centre. The Department of Forensic Medicine, Hospital Sultanah Bahiyah, Alor Star, Kedah, located approximately 75km away from Wang Kelian, was temporarily converted into a victim identification centre (VIC) as it is the nearest available forensic facility to the mass grave site. The mortuary operation was conducted over a period of 3 months from June to September 2015, and was divided into two phases; phase 1 involving the postmortem examination of the remains of 116 suspected individuals and for phase 2 the remains of 49 suspected individuals. The fact that the graves were of unknown individuals afforded the mass identification operation a sufficient duration of 2 weeks as preparatory phase enabling procedurals and daily victim identification workflow to be established, and the setting up of a temporary body storage for the designated mortuary. The temporary body storage has proven to be a significant factor in enabling the successful conclusion of the VIC operation to the final phase of temporary controlled burials. Recognition from two international observers, Mr. Andréas Patiño Umaña, from the International Committee of Red Cross (ICRC) and Prof. Noel Woodford from Victoria Institute of Forensic Medicine (VIFM) had proven the mortuary operation was in compliance to the international quality and standards. The overall victim identification and mortuary operation identified a number of significant challenges, in particular the management of commingled human remains as well as the compilation of postmortem data in the absence of antemortem data for future reconciliation. CF Index in this DVI operation is 9%, indicating the primary identifications in this operation were effective. Limitations and further improvements of the mass identification operation will be discussed. This paper details the planning, preparations and management of the mass identification operation on the exhumed human remains which was also a forensic humanitarian service for the dead with dignity and respect.

Underwater DVI: Simple fingerprint technique for positive identification

An underwater disaster can be declared when a maritime accident occurred or when an aircraft is plunged into water area, be it ocean, sea or river. Nevertheless, handling of human remains in an underwater recovery operation is often a difficult and demanding task as working conditions may be challenging with poor to no visibility, location of remains at considerable depths and associated hazards from surrounding water. A case of the recent helicopter crash, into a famous river in Sarawak, domiciled by huge crocodiles, is discussed in this paper. Search and recovery team as well as the combat divers from the Special Elite Troop Commando, known as VAT 69, were deployed to the scene to perform the underwater recovery to search for all the victims on board involving five Malaysians with a pilot of Philippines nationality. This paper highlights the limitations and challenges faced during the underwater search and recovery. All the bodies recovered were in moderate decomposition stage with crushed injuries and mutilated face and body. A simple and conventional fingerprint technique were used to record the fingerprint. The prints impressions were later photographed using a smartphone and transferred back to the RMP headquarters in Kuala Lumpur for fingerprint match by using WhatsApp Messenger, a phone application. All the first five victims were identified within an average of 10min. The last victim recovered was the pilot. For foreign nationals, the Immigration Department of Malaysia will record the prints of both index fingers only. The lifting of the fingerprint of the last victim was the most challenging in which only one index finger left that can be used for comparison. A few techniques were attempted using the black printers ink, glass and tape techniques for the last victim. Subsequently, images of the prints impression were taken using the same smartphone with additional macro lens attached to it to enhance the resolution. The images were transferred to the RMP headquarters through WhatsApp Messenger. The prints were confirmed to be the pilot 20min later.

The Effect of Cement and wrapping on the Decomposition rate of the Rabbit Carcasses

Taphonomic study was fi rst time conducted in Kuala Lumpur, capital city of Malaysia. In this research model, male Oryctolagus cunicullus weighed 1.8-2.6 kg each were killed by Dolethal intravenously at the ear region. In Phase 1 study, eight subjects were wrapped in a sack and cemented within a container to be compared with the other four controls at each location labelled A (ground) and B (manmade freshwater pond). Phase 2 involved duplicating set of 15 cemented samples comparable to 1 control made up to total of 32 subjects which were all put into a compact polytank containing freshwater to simulate a case study. Taphonomic changes were observed and scored using TBS system incorporating of fresh stage, early decomposition stage, advanced decomposition stage and skeletonisation stage. The ambient temperature of surroundings with 28.81C±4.21°C and 29.21°C±4.57°C (mean±S.D.) while relative humidity of air with 74.49 %±14.61% and 79.15%±16.32% (mean±S.D.) were recorded for Phase 1 and Phase 2 study respectively. Time taken for ground control exposed and wrapped carcasses to reach fi rst sign of skeletonised stage were four days and fi ve days respectively. Whilst freshwater controls reached initial skeletonised stage within one week for exposed carcass and two weeks for wrapped carcass. Within the control and cemented sample carcasses, TBS scores increased from initial stages of decomposition and become plateau after advanced decomposition. The cementing factor have superseded the wrapping factor due to its stronger physical barrier effect to slow down the decomposition more than half compared to controls based on Multiple way ANOVA test. Phase 2 study has demonstrated more accurately on the decomposition rate of the cemented samples. It showed that wrapping and cementing factors have delayed the decomposition process of the rabbit carcasses about 4 times to reach the initial stage of skeletonisation compared to the control carcasses. There was absence of insect activity within the cemented samples, hence the microorganism activity would be the only contributor to the decaying process within the cemented samples at slower rate comparing to the exposed or wrapped controls. Research Article The Effect of Cement and wrapping on the Decomposition rate of the Rabbit Carcasses Lai Poh Soon1*, Khoo Lay See1, Nazni Wasi Ahmad2, Azlina Zulkapli3, Nurul Kharmila Abdullah4, Mohd Shah Mahmood5 and Ahmad Hafi zam Hasmi5 1Forensic Scientifi c Offi cer of Institute of Forensic Medicine Malaysia, Kuala Lumpur Hospital, Malaysia 2Forensic Entomologist, Unit of Entomology, Institute of Medical Research, Malaysia 3Veterinary Offi cer, Unit of Animal Care, Institute of Medical Research, Malaysia 4Senior Lecturer and Forensic Pathologist, University of Science Islamic Malaysia, Kuala Lumpur Hospital, Malaysia 5Forensic Pathologist, Institute of Forensic Medicine Malaysia, Kuala Lumpur Hospital, Malaysia *Address for Correspondence: Dr. Lai Poh Soon, Forensic Scientifi c Offi cer of Institute of Forensic Medicine Malaysia, Kuala Lumpur Hospital, Malaysia; Tel: +603 2690 6694, Fax: +603 2694 1422; Email: roysonn1@hotmail.com Submitted: 08 August 2017 Approved: 15 August 2017 Published: 16 August 2017 Copyright: 2017 Soon LP, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Manifestation of Coronary Atherosclerosis in Klang Valley, Malaysia: An Autopsy Study

Aims: The present study aimed to determine the epidemiological aspects of medico-legal autopsies and manifestation of coronary atherosclerosis. Methods: This was a cross sectional study involving 222 cases recruited from National Institute of Forensic Medicine (NIFM) Hospital Kuala Lumpur (HKL) and Department of Forensic Medicine Hospital Sungai Buloh (HSgB) for a period of 15 months, from December 2012 to April 2014. Sociodemographic and autopsy findings, including the cause and manner of death were documented. Results: Male and female subjects aged 18–70 years were recruited. Males contributed to 86% of the total subjects and comprised 61% of young adults. Road traffic accidents were the primary cause of death, contributing almost 50% of the subjects. One third of the cases comprised of death due to natural causes, wherein almost 75% of the subjects within this category succumbed to sudden cardiac death. Coronary artery disease (CAD) contributed to 60% of the sudden cardiac death (SCD). Single and double-vessel diseases were the most common pattern of atherosclerosis. In almost 80% of CAD cases, atherosclerosis affected the left anterior descending artery (LAD). Conclusion: Cardiovascular diseases were the most significant natural cause of sudden death with a staggering figure of 75%. CAD was the single most commonly encountered pathology within the SCD. Most cases presented with single and double-vessel diseases, observed in all subjects, as well as the young adult population.

Oryong 501 sinking incident in the Bering Sea—International DVI cooperation in the Asia Pacific

On December 1st, 2014, the sinking of Oryong 501 occurred in the Bering Sea off the east coast of Russia. A total of 60 crew members, including 35 Indonesians, 13 Filipinos, 11 South Koreans and 1 Russian inspector were on board out of which only seven survived. Through an international rescue operation, the dead bodies of 27 were found and the remaining 26 crew are still missing. After transferring the dead bodies to the Busan Harbor in South Korea, the operation to identify the deceased began involving DVI teams from three countries: Korea, Indonesia and the Philippines. When a deep sea fishing boat sinks, it is very difficult to obtain antemortem data of the crew who had been on board for a long time. This is especially so if the crews are multinational. Further, the accuracy of the antemortem data provided by the families may be questionable, and the provided data is often not standardized. Despite the fact that the antemortem data were received in different formats, the identification process for the bodies of the 27 crew from the Oryong sinking was quickly completed through the cooperation among the three DVI teams. This case is an excellent example of how efficiently a DVI operation can be conducted in the Asia Pacific region. Issues raised during this operation should enable even better preparation for similar events in the future.

Secondary identifier for positive identification in DVI

In the context of mass fatality incident, it is of utmost importance to identify the victims rapidly and accurately, both for judicial reasons and to provide closure for family members. Disaster Victim Identification (DVI) work is an interdisciplinary manner, engaging the services of experts in various disciplines, comprising of pathologists, anthropologists, odontologists, radiologists, fingerprint and DNA experts to work collaboratively towards the identification of victims. The DVI process is conducted by adopting the fundamental principle where the highest possible quality standards should be applied and victims are to be treated with dignity and respect, in accordance to the internationally recognised INTERPOL DVI guide. The primary identifiers are the most reliable means of identification. They are fingerprint analysis, comparative dental analysis and DNA analysis. Secondary means of identification include personal description, medical findings and medical records as well as evidence and clothing found on the body. Most often than not, secondary identifiers are often used to complement the primary identifiers. However, there is always an exception. This paper highlights a case of the Dauphin helicopter crash in which identifications for all the victims were done using only secondary means of identification. Having said that, victims’ bodies were released to family members without awaiting the DNA result. 24 hours later, the DNA analysis results were matched and confirmed the identity of the victims to be correct. Correspondence to: Lay See Khoo, National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia, E-mail: khoolaysee@yahoo.com