One family buried their daughter, but she turned out to be alive. A second family kept a vigil over their daughter, who was actually laying in another person's grave. One can only imagine the sheer agony each family went through only to discover the truth weeks later.

Hospitals, law enforcement, coroner's office personnel, and EMS services need to look at this incident as a call to improve their identification protocols for all incidents, but this multi-fatality incident holds a serious warning for mass casualty incidents where the chance of error is compounded.

Errors Are Easy To Make

Investigators in this incident say that the misidentification of two accident victims was the result of a “perfect storm” of on-scene conditions, according to a June 2 report in the Fort Wayne, IN, News Sentinel.

In the confusion after the April 26 accident, in which a tractor trailer collided with a van carrying 10 people in Upland, IN,
18-year-old Whitney Cerak was identified as 22-year-old Laura VanRyn, killed in the crash.

Misidentification by onlookers, an emergency services worker who used a photo ID found at the site, and the decision of a family member not to identify the corpse at the behest of an official complicated an already confusing situation, says the story.

"It has since been reported that a Grant County deputy coroner persuaded Whitney’s sister not to view what was thought to be her body after the accident, saying it would be too hard for her to handle. Laura VanRyn’s Taylor University roommate also questioned her identity weeks before dental records finally proved the woman in the hospital was not [she]," the paper reported.

The issue here is not that a mistaken identity occurred.

A violent crash, massive injuries, and the rush to save those with a chance at life can often result in initial errors. It is not unusual for the massive force of such crashes, explosions, and air crashes may separates bodies and body parts from the clothing or purses where identification is carried.

Faces and distinctive marks such as tattoos and scars are often mutilated beyond recognition. Positions in the vehicle are mistaken. Bystanders are often upset and distracted by the carnage and can only be relied upon for tentative information.

The real question here is how the misidentification went undiscovered for so long.

Most EMS systems have no specific protocol for patient identification, and it is not unusual for "John Doe" patients to be delivered to hospitals on a regular basis.

There is room here for EMS systems to create protocols that improve initial identifications, but in the ultimate sense, scene investigation and identification of victims is not the role of EMS. Securing the scene for safety, rescue, rendering life-saving care, and evacuation of the patient to medical care are the top EMS priorities.

Delay for extensive identification is not the answer for EMS IN this situation or larger disasters. EMS is on the scene the least time, and has the least responsibility for identification. Air medical units have even less opportunity for on-scene information gathering.

Hospitals have limited independent information.

Like EMS, hospitals typically must act on information that is very limited. Most indentification information in the case of unaccompanied patients comes from EMS initially and from law enforcement later in the process. The hospital is charged by law with emergency care obligations that create a barrier to initial information gathering. When death occurs, legal authority passes promptly to the coroner and law enforcement officers. The hospital generally operates only on information provided by others.

The Coroner has ultimate legal authority -- and responsibility.

In most states, the Coroner or Medical Examiner takes over in death cases, and the hospital only serves as an adjunct to the investigation, identification, and autopsy procedures because that is often where the victim is located. Hospitals must observe the Coroner's protocols.

So, should the Coroner be faulted for not recommending family identification of the victim? From my experience as and EMS provider and as a state prosecutor who was in charge of the scene for many fatal accident investigations, families handle these situations in very different ways. The emotional state of the family would be a major factor in whether to expose them to horrific sights that might traumatize them or make the idenfication questionable. I cannot fault the Coroner's decision in this case, and there is no assurance that the identification would have avoided the mistaken identity that occurred.

In the absence of a realiable identification, however, there was a serious need for careful forensic identification. With multiple victims, this need seems more compelling. If potential criminal charges could arise, definite identification with forensic certainty may become crucial to a successful prosecution.

The obvious need for conclusive forensic identification should mandate careful protocols in death cases. In fact, most identifications are easily verified immediately. While tentative identifications need to be made in some cases, there appears to be little justification to allow inconclusive identifications to persist at the time of a funeral or cremation.

In Mass Casualty Incidents

Mass casualty accidents typically are handled with more attention to identity issues because of the readily apparent risk of misidentification. EMS often uses disaster tagging of each patient, and ultimately identities are matched up to the tag. Fatalities often wait for identification as teams carefully work-up and verify the victim's identity. State and federal officials, labs, and resources often are employed to complete the process. In the absence of those resources, local officials are responsbile to see that adequate resources and time is afforded to proper investigation and identification.