Nursing Roles and Competencies in Disaster Victim Identification: A Scoping Review

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Yanuar Saifudin, Rika Sarfika, Hema Malini, Ferry Efendi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9536048/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Disaster victim identification (DVI) is a critical component of forensic and humanitarian disaster response. Although nurses constitute the largest segment of the global health workforce and are frequently mobilized during disasters, their roles in DVI and mass fatality management remain poorly defined in international standards and disaster nursing frameworks. Main body: This scoping review aimed to map the available evidence on the roles, competencies, and contributions of nursing professionals in DVI. The review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guideline. Searches of MEDLINE (via PubMed), Web of Science (Core Collection), and Scopus were conducted, supplemented by citation chasing, a grey-literature search across six organizational repositories, and targeted handsearching of forensic nursing reference texts. Three reviewers independently screened records and extracted data. Six sources met the inclusion criteria: two peer-reviewed primary studies and four grey-literature sources, including two nursing competency frameworks, one professional standards document, and one forensic nursing textbook chapter. The primary studies documented nursing participation in mass fatality operations in two distinct contexts: a nurse formally integrated into a Belgian DVI team during the 2004 Indian Ocean Tsunami response, and nurses and nursing assistants redeployed to decedent handling during the COVID-19 pandemic in New York. The most comprehensive operational account was a forensic nursing textbook chapter describing nursing roles across all four INTERPOL DVI phases and their formal integration into the US Disaster Mortuary Operational Response Team and Family Assistance Care Team. Across sources, two themes were identified: (1) nursing roles and transferable competencies relevant to DVI, including evidence handling, documentation, family liaison, specimen collection, and culturally sensitive care; and (2) persistent gaps in policy, education, and formal role recognition. Notably, neither the INTERPOL DVI Guide (2023) nor the ICN Core Competencies in Disaster Nursing (2022) formally defines nursing roles in DVI. Conclusion: The evidence base on nursing in DVI is extremely limited, but the available literature indicates that nurses possess competencies directly relevant to forensic identification and mass fatality response. Formal integration exists in selected national forensic response structures, yet this is not reflected in international DVI standards. Recognizing nursing within DVI frameworks, developing DVI-specific education, and generating empirical evidence are necessary to strengthen global forensic preparedness, particularly in low- and middle-income settings. disaster victim identification forensic nursing disaster nursing nursing competencies forensic preparedness Figures Figure 1 Figure 2 INTRODUCTION Disasters are generating increasingly complex medico-legal and humanitarian challenges for health and forensic systems worldwide. Climate-related hazards, rapid urbanization, population growth, protracted conflict, and technological risks have increased both the frequency and operational complexity of events that may result in multiple fatalities. (Centre for Research on the Epidemiology of Disasters, 2025 ; United Nations Office for Disaster Risk Reduction, 2022 ). In 2024 alone, 393 natural hazard-related disasters were recorded worldwide, causing 16,753 deaths and affecting more than 167.2 million people (Centre for Research on the Epidemiology of Disasters, 2025 ). In such contexts, the management and identification of the dead are not peripheral activities but critical components of disaster response, public accountability, and family rights. Disaster victim identification (DVI) is the structured process used to establish the identity of individuals who die in disasters through scientifically robust, legally defensible, and ethically sensitive procedures. Beyond its technical function, DVI has humanitarian importance because identification enables death certification, supports criminal or civil investigations where relevant, facilitates repatriation and burial, and provides families with certainty after traumatic loss (Adamovic et al., 2023 ; Morgan et al., 2006 ). The INTERPOL DVI Guide is widely recognized as the international reference standard for this work and organizes DVI into four phases: scene, post-mortem, ante-mortem, and reconciliation (INTERPOL, 2023 ). Each phase requires coordinated contributions from multiple professional groups, including forensic pathologists, odontologists, anthropologists, fingerprint specialists, DNA analysts, police, and humanitarian personnel (International Committee of the Red Cross, 2022 ; INTERPOL, 2023 ). Despite this multidisciplinary character, formal DVI systems remain unevenly developed across countries, especially in low- and middle-income settings where disaster burdens are high but forensic infrastructure is often limited (INTERPOL, 2023 ; Morgan et al., 2006 ). In these settings, available health professionals frequently assume functions adjacent to body recovery, temporary mortuary operations, documentation, family support, and continuity of care. Nurses are particularly relevant in this regard. As the largest professional group in the global health workforce, nurses are routinely deployed across the disaster cycle and commonly perform triage, clinical stabilization, coordination, documentation, psychosocial support, and community recovery functions (Fletcher et al., 2022 ; Veenema et al., 2016 ; World Health Organization, 2020 ). The potential relevance of nursing to DVI becomes even clearer when viewed through a forensic nursing lens. Forensic nursing integrates nursing science with forensic, legal, and justice processes. It includes competencies in injury documentation, evidence recognition and preservation, chain of custody, medicolegal death investigation, trauma-informed communication, and culturally sensitive engagement with families affected by violence or sudden death (International Association of Forensic Nurses & American Nurses Association, 2017; Lynch, 2011 ; Valentine et al., 2020 ). These competencies are conceptually and operationally transferable to DVI, particularly in post-mortem handling, ante-mortem information gathering, family liaison, and support during the return of remains. Yet international frameworks have not kept pace with this overlap. The INTERPOL DVI Guide (2023) does not assign explicit nursing roles within any DVI phase, and the ICN Core Competencies in Disaster Nursing (2022) does not address DVI, mass fatality management, or care of the dead as defined competency areas. This omission matters in practice. Historical and contemporary disasters suggest that nurses are already involved in identification-adjacent and mass fatality work, even when their roles are not formally defined. After the 2004 Indian Ocean tsunami, severe forensic capacity shortages in affected countries required a broad range of responders to support body recovery, documentation, and mortuary workflows (Morgan et al., 2006 During the COVID-19 pandemic, nurses and nursing assistants in New York were redeployed to decedent handling when morgue capacity was overwhelmed, despite limited preparation for the physical and psychological demands of this work (Lee et al., 2022 ). These examples suggest that the question is not whether nurses are relevant to DVI, but whether systems have adequately articulated, trained, and supported that relevance. The absence of a clearly defined role for nursing in DVI frameworks represents a missed opportunity to strengthen disaster response capacity, particularly in resource-limited contexts where nurses may be the most readily available health professionals. Several scholars have argued that forensic nursing can be better integrated into disaster preparedness and response (da Silva et al., 2023 ; Veenema et al., 2016 ), and increasing recognition has been given to the psychosocial dimensions of DVI, including how families are supported during identification, bereavement care, and the culturally appropriate handling of human remains, dimensions that align closely with core components of nursing care (Suwalowska et al., 2021 ). Despite this growing recognition, a comprehensive mapping of the scope and nature of the evidence on nursing roles and competencies related to DVI has not yet been conducted. A preliminary search of PubMed, PROSPERO, and the JBI Evidence Synthesis database identified no review specifically focused on nursing roles and competencies in DVI. The closest review, by da Silva et al. ( 2023 ), mapped forensic nursing competencies in disaster situations more broadly. However, it did not specifically examine DVI as a specialized forensic field or map nursing contributions across the four phases of INTERPOL DVI. Thus, an important evidence gap remains regarding how nursing is currently represented in the DVI literature, what competencies are described, and where policy, educational, and research deficits persist. Accordingly, this scoping review aimed to map the available evidence on the roles, competencies, and contributions of nursing professionals in disaster victim identification. Specifically, the review sought to identify how nursing roles are described across the DVI continuum, which competencies are reported or implied, and what gaps remain in frameworks, education, policy, and empirical research. By making these patterns visible, this review positions nursing not as an auxiliary presence in disaster response, but as a potentially underrecognized contributor to forensic preparedness and mass fatality management. METHODS Design This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews (Peters et al., 2020 ) and the methodological framework originally proposed by Arksey and O’Malley ( 2005 ) and further refined by Levac et al. ( 2010 ). The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist (Tricco et al., 2018 ). Review Question The review question was developed according to the Population, Concept, Context (PCC) framework recommended by JBI for scoping reviews (Peters et al., 2020 ). The review question was: What evidence is available on the roles and competencies of nursing professionals (Population) in disaster victim identification (Concept) across all disaster settings worldwide (Context)? Eligibility Criteria Population This review considered all nursing professionals, including registered nurses, forensic nurses, public health nurses, community health nurses, emergency nurses, disaster nurses, nurse practitioners, clinical nurse specialists, and nursing assistants involved in DVI-related tasks. No restrictions were imposed on age, sex, years of experience, level of education, or country of practice. Concept The core concepts of this review were the roles, competencies, knowledge, skills, training, and education of nursing professionals in disaster victim identification. These included activities spanning all four phases of the INTERPOL DVI process (INTERPOL, 2023 ): Phase 1 (Scene) — body recovery, scene management, and decontamination; Phase 2 (Post-mortem) — mortuary operations, forensic examination, evidence collection, documentation, photography, and DNA sample collection; Phase 3 (Ante-mortem) — data collection from families of missing persons, including family liaison and psychosocial support; and Phase 4 (Reconciliation) — matching post-mortem and ante-mortem data, notification to families, culturally and religiously appropriate return of remains, and ongoing bereavement care. Mass fatality management, dead body management, human remains identification, and forensic evidence collection and preservation in disaster contexts were also included. Context The review included all disaster settings worldwide with no geographic or temporal restrictions. Eligible contexts included natural disasters (earthquakes, tsunamis, floods, hurricanes, volcanic eruptions, wildfires), human-made disasters (terrorist attacks, armed conflicts, industrial accidents, and transportation incidents), pandemics involving mass fatalities, and chemical, biological, radiological, nuclear, and explosive (CBRNE) events. Settings included disaster sites, temporary mortuaries, field hospitals, family assistance centers, health facilities operating as body-collection sites, and community-based response operations. Both high-income and low- and middle-income country contexts were included. Types of Sources This scoping review considered primary studies using quantitative, qualitative, and mixed-methods approaches, including experimental, quasi-experimental, cross-sectional, cohort, case-control, before-and-after, time-series, and observational designs. Case reports and field reports were also included. Grey literature was considered, including organizational websites, protocols, procedures, guidelines, books, book chapters, legislation, letters, and organizational position documents. Systematic, scoping, and narrative reviews were excluded from the main analysis but were examined for reference tracking. Commentary, editorial, and opinion papers were excluded. Sources that did not explicitly reference nursing professionals or nursing roles were excluded at the full-text screening stage. All eligibility criteria are presented in Table 1 . Table 1 Eligibility Criteria Based on The PCC Framework Criteria Inclusion Exclusion Population All nursing professionals: registered nurses, forensic nurses, public health nurses, community health nurses, emergency nurses, disaster nurses, nurse practitioners, clinical nurse specialists, and nursing assistants involved in DVI tasks. Studies exclusively involving non-nursing professionals (physicians, forensic scientists, law enforcement) without explicit reference to nursing roles Concept Roles, competencies, knowledge, skills, training, education, and contributions related to disaster victim identification, mass fatality management, dead body management, human remains identification, mortuary operations, ante-mortem data collection, forensic evidence collection in disaster contexts, family support during identification, and cultural/ethical considerations in handling deceased disaster victims Studies focused exclusively on forensic science identification methods (DNA, odontology, anthropology, fingerprinting) without any reference to nursing or healthcare worker involvement; studies addressing only triage of living casualties without reference to management of the deceased Context All disaster settings globally (natural disasters, human-made disasters, pandemics, armed conflicts, CBRNE incidents) with no geographic or temporal restrictions Routine clinical forensic nursing (e.g., sexual assault examination, child abuse investigation) not related to disaster or mass fatality contexts Source types Primary studies (quantitative, qualitative, mixed methods); case reports, field reports; grey literature (guidelines, protocols, competency frameworks, professional standards, field manuals, training curricula) Conference abstracts without full text available; sources that do not explicitly reference nursing professionals Search Strategy The search strategy was constructed in three stages in accordance with JBI guidance (Peters et al., 2020 ). The first stage consisted of a limited preliminary search of PubMed to identify relevant articles, followed by analysis of the words in the titles and abstracts of retrieved studies and the index terms used to describe each article. This search served as a prototype for identifying the final term set for the full search strategy. In the second stage, the full search strategy, incorporating all identified keywords and index terms, was tailored for use across three electronic databases: MEDLINE (via PubMed), Web of Science (Core Collection), and Scopus. The search combined two concept blocks using the Boolean operator AND: (a) nursing professionals (using Medical Subject Headings [MeSH] and free-text terms for all nursing categories) and (b) disaster victim identification and related concepts (using controlled vocabulary and free-text terms for DVI, mass fatality management, dead body management, human remains identification, mortuary operations, mass casualty incidents, and forensic identification). Terms within each concept block were combined with the Boolean operator OR. No date or language limiters were applied at the search stage; language-based exclusion was applied only at the screening stage. Supplementary File 2 presents the full search strategies for each database. In the third stage, citation searching was conducted. Included studies were used as seed references in CitationChaser ( https://estech.shinyapps.io/citationchaser/ ) to identify additional relevant studies through both backward (reference-list screening) and forward (citation tracking) searches. Results from citation searching were exported and deduplicated against records already screened from the database searches to avoid duplicate screening. In addition, grey literature was searched through the following sources: the INTERPOL DVI resources repository, the World Health Organization (WHO) publications database, the International Committee of the Red Cross (ICRC) publications, the Pan American Health Organization (PAHO), the International Association of Forensic Nurses (IAFN), and the International Council of Nurses (ICN). The database searches were conducted in January 2026. Source Selection After the search, all identified citations were imported and deduplicated in Rayyan, a web-based systematic review screening tool (Ouzzani et al., 2016 ), for title and abstract screening. Three reviewers conducted the source selection process in two stages. In the first stage, two reviewers independently screened the titles and abstracts of all retrieved records for eligibility using Rayyan. Each record was tagged as “include,” “exclude,” or “maybe”. Records were moved to full-text review if either reviewer labeled them as “maybe”. To promote independent decision-making, the blinding feature in Rayyan was activated during screening, so that neither reviewer saw the other’s inclusion or exclusion decisions. Disagreements between the two reviewers during title and abstract screening were resolved through discussion; when consensus could not be reached, the third reviewer arbitrated the final decision. In the second stage, full texts of all potentially relevant sources were retrieved and evaluated in detail against the eligibility criteria by the same two reviewers. Sources were excluded at the full-text stage if they did not explicitly reference nursing professionals or nursing roles, even if they addressed mass fatality management or DVI-related topics involving health workers more broadly. Reasons for full-text exclusion were recorded and are reported in the PRISMA-ScR flow diagram (Fig. 1 ). Disagreements at full-text screening were resolved through discussion between the two reviewers, with the third reviewer consulted if consensus could not be reached. Prior to the formal commencement of screening, a pilot exercise was conducted in which all three reviewers independently, and in duplicate, screened a random sample of 20 titles and abstracts in Rayyan to calibrate the application of eligibility criteria and to ensure inter-rater consistency. Data Extraction Data were extracted from included sources using a standardized data-extraction instrument developed by the review team, based on the JBI data-extraction template for scoping reviews (Peters et al., 2020 ) and adapted to the specific objectives of this review. The following data were extracted from each included source: (a) source identification (authors, year, country of origin); (b) source characteristics (type of source/study design, population/participants); (c) concept-related data (disaster type; DVI phase[s] addressed, mapped to the INTERPOL framework; nursing roles identified; nursing competencies and training described; interdisciplinary collaboration); and (d) key findings and recommendations relevant to nursing roles in DVI. Data were extracted independently by two reviewers; disagreements were resolved through discussion, with the third reviewer consulted if consensus could not be reached. Data Analysis and Presentation of Results In accordance with JBI scoping-review methodology (Peters et al., 2020 ), the extracted data were analyzed using both numerical (descriptive) analysis and a qualitative thematic summary. The numerical analysis comprised counts and summary characteristics of included sources, including frequency and distribution by year of publication, country, source type (peer-reviewed or grey literature), and study design. Frequencies and percentages were derived for categorical variables. An inductive qualitative thematic analysis was conducted to identify, organize, and synthesize key themes emerging from the extracted data. Data extracted from the nursing roles, competencies, barriers, and gaps fields were independently coded by two reviewers and then grouped into higher-order themes through consensus discussion. Themes were refined through discussion between all three reviewers until consensus was reached. Consistent with JBI guidance (Peters et al., 2020 ), no formal critical appraisal of included sources was conducted, because scoping reviews aim to map the nature and extent of available evidence rather than to assess the quality of findings. Results are presented narratively, supplemented by tables and a figure. Table 2 summarises the characteristics of included sources, and Table 3 summarises the critical gaps identified in the evidence base. The source selection process is presented in a PRISMA-ScR flow diagram (Fig. 1 ). The full data extraction is provided in Supplementary File 1. Table 2 Characteristics of Included Sources (N = 6) Characteristic Category n (%) Source type Primary studies 2 (33.3) Grey literature 4 (66.7) Study design (primary, n = 2) Operational case study 1 (50.0) Observational case series 1 (50.0) Grey literature type (n = 4) Competency frameworks 2 (50.0) Professional standards document 1 (25.0) Textbook chapter 1 (25.0) Country / Region of origin USA 3 (50.0) Belgium (fieldwork in Thailand) 1 (16.7) International (ICN) 1 (16.7) USA with international scope (IAFN/ANA) 1 (16.7) Disaster type addressed Natural disaster (tsunami) 1 (16.7) Pandemic (COVID-19) 1 (16.7) All disaster types / multi-disaster 3 (50.0) Applicable to disaster contexts (not disaster-specific) 1 (16.7) DVI phases addressed All four phases 1 (16.7) Phase 2: Post-mortem 4 (66.7) Phase 3: Ante-mortem 1 (16.7) Not phase-specific 2 (33.3) Note. DVI-phase categories are not mutually exclusive; individual sources may address multiple phases. Country/Region percentages are calculated over N = 6 included sources. CBRNE = chemical, biological, radiological, nuclear, and explosive; DVI = disaster victim identification; IAFN/ANA = International Association of Forensic Nurses / American Nurses Association; ICN = International Council of Nurses. Table 3 Critical Gaps Identified in the Evidence Base Gap Category Description Supporting Sources Absence of DVI in international nursing competency frameworks The ICN Core Competencies in Disaster Nursing (2022) and the INCMCE (2003) framework do not include DVI, mass fatality management, dead body management, or forensic identification as competency domains for nurses. Despite the formal operational integration of forensic nurses into US mass fatality response structures (DMORT, FACT) described by Williams and Williams ( 2011 ), this operational reality has not been incorporated into international competency frameworks. IAFN & ANA (2017); ICN (2022); INCMCE (2003); Williams & Williams ( 2011 ) No DVI-specific training programs for nurses No DVI-specific training programme for nurses was identified in any included source. The IAFN/ANA (2017) standards cover forensic competencies transferable to DVI but are not specifically designed for DVI operations. IAFN & ANA (2017) Geographic concentration of evidence All included sources originated from high-income countries (USA, Belgium with fieldwork in Thailand) or from international organisations based in high-income countries (ICN, IAFN/ANA). No sources were identified from Africa, the Middle East, Latin America, or the Asia-Pacific region, regions that face disproportionately high disaster mortality and the greatest DVI capacity constraints. All included sources Scarcity of empirical evidence Only two peer-reviewed articles documented nursing involvement in mass fatality operations with empirical data. No experimental or quasi-experimental study has evaluated nursing interventions or training effectiveness in DVI. Beauthier et al. ( 2009 ); Lee et al. ( 2022 ) Lack of validated DVI nursing competency instruments No study has measured, validated, or evaluated DVI-specific competencies for nurses. No validated competency assessment instrument currently exists for nursing in DVI. IAFN & ANA (2017); ICN (2022); INCMCE (2003) Absence of nursing from the INTERPOL DVI framework The INTERPOL DVI Guide (2023) does not define specific nursing roles within any phase of the DVI process, despite the multidisciplinary nature of DVI operations and the documented operational integration of forensic nurses into DMORT and FACT structures within the US National Disaster Medical System. INTERPOL ( 2023 ); Williams & Williams ( 2011 ) RESULTS Search Results and Study Selection The systematic search across three electronic databases (PubMed, Web of Science, and Scopus) yielded 2,208 records. After removal of duplicates (n = 288), 1,920 records were screened by title and abstract. Following this screening, 1,891 records were excluded, and 29 reports were sought for full-text retrieval from the database searches. An additional 12 reports were identified through other methods, six through citation searching and six through grey-literature searching. All 41 reports were retrieved and assessed for eligibility. Following full-text assessment against the eligibility criteria, two reports from the database searches and four reports from other methods met the inclusion criteria, yielding a total of six sources. The study-selection process is illustrated in the PRISMA-ScR flow diagram (Fig. 1 ). Of the six included sources, two (33.3%) were primary studies and four (66.7%) were grey literature documents. Among the primary studies, one was an operational case study describing the deployment of a Belgian DVI team, including a nurse, to Thailand after the 2004 Indian Ocean Tsunami (Beauthier et al., 2009 ). One was an observational case series documenting the involvement of nurses and nursing assistants in decedent handling during the COVID-19 pandemic in New York (Lee et al., 2022 ). The grey literature comprised two competency frameworks (International Council of Nurses, 2022 ; International Nursing Coalition for Mass Casualty Education, 2003 ), one professional standards document (International Association of Forensic Nurses & American Nurses Association, 2017), and one textbook chapter that comprehensively addressed forensic nursing roles in multi-casualty scenes and mass fatality incidents (Williams & Williams, 2011 ). Table 2 summarises the characteristics of the included sources. Geographic and Temporal Distribution The two included primary studies were published in 2009 and 2022, respectively. The 2009 study reported on the 2004 Indian Ocean Tsunami response, and the 2022 study reported on the COVID-19 pandemic response. Grey literature sources were published between 2003 and 2022. In terms of geographic origin, the USA was the most represented country (n = 3; 50.0% of all sources, comprising the Lee et al. study, the INCMCE competency framework, and the Williams and Williams textbook chapter), followed by one Belgian source with fieldwork in Thailand (16.7%), one international source (ICN; 16.7%), and one source from the USA with international scope (IAFN/ANA; 16.7%). No sources originated from Africa, the Middle East, Latin America, or the Asia-Pacific region, indicating significant geographic gaps in the evidence base. Thematic Findings Thematic analysis of the included sources identified two main themes: (1) nursing roles and competencies relevant to DVI; and (2) gaps in frameworks, education, and policy. Figure 2 presents an evidence map of nursing roles and competencies across the four INTERPOL DVI phases, visualizing the distribution of documented roles, transferable competencies, strength of empirical evidence, and gaps in formal international recognition identified in this review. Theme 1: Nursing Roles and Competencies Relevant to DVI The two primary studies and the textbook chapter (Williams & Williams, 2011 ) together provided a more nuanced picture of nursing participation in mass fatality operations than had been previously established. Beauthier et al. ( 2009 ) documented a nurse as a formal member of the Belgian DVI team deployed to Khao Lak, Thailand, following the 2004 Indian Ocean Tsunami. The Belgian team composition, detailed in the study, included one paramedical member (a nurse), a physician, and a psychologist. The Belgian DVI team was reported to be one of the few teams internationally to include a physician, a nurse, a psychologist, and a stress-management team as regular members (Beauthier et al., 2009 ). The nurse’s documented role involved attending to team members’ medical needs, including the emergency treatment of a US volunteer who experienced heat stroke and of a Belgian team member with a leg wound. Although the nurse’s role was to provide medical support to the DVI team rather than to participate directly in forensic identification tasks, the formal integration of a nurse into the DVI team’s structure represents an important organizational precedent. Lee et al. ( 2022 ) documented the involvement of registered nurses (RNs) and nursing assistants (NAs) in decedent handling during the COVID-19 pandemic in a New York healthcare system. The study described a mass fatality event sustained over months, during which hospital morgues became overwhelmed and temporary body collection points (BCPs) were established. Nurses placed decedents into body bags on medical units and transferred them onto transport stretchers for conveyance to the morgue. Workers’ compensation data confirmed that nursing assistants accounted for 22 claims (35.5% of all decedent-handling injuries) and registered nurses accounted for 5 claims (8.0%). Staff assuming new decedent-handling roles were reported to be unaccustomed to the physical and mental demands of this work. Subsequent handling in morgues and BCPs was primarily performed by security personnel, morgue attendants, and transporters. The textbook chapter by Williams and Williams ( 2011 ), published in a major international forensic nursing reference text and authored by a forensic nurse with personal DMORT deployment experience, provided the most comprehensive articulation of forensic nursing roles in DVI identified in this review. The authors stated that the roles of the forensic nurse in mass fatality contexts include identifying the dead, recognizing medicolegal issues, providing information and education, delivering direct patient care, and conducting disaster research (Williams & Williams, 2011 ). The chapter described the formal integration of forensic nurses into two operational structures within the US National Disaster Medical System (NDMS): the Disaster Mortuary Operational Response Team (DMORT), in which forensic nurses work alongside forensic pathologists, anthropologists, odontologists, fingerprint experts, and funeral directors in the establishment of mobile morgue operations, forensic examination, DNA acquisition, remains identification, search and recovery, and ante-mortem and post-mortem data collection, and in the operation of family assistance centres; and the Family Assistance Care Team (FACT), mandated by the Aviation Disaster Family Assistance Act of 1996, in which forensic nurses conduct structured ante-mortem interviews with families using an 8-page Victim Identification Profile (VIP) covering physical characteristics, scars, implants, tattoos, occupational history, and sources of medical and dental records, and collect DNA reference swabs from next of kin. The chapter also described specific historical forensic nursing deployments, including the 9/11 World Trade Center response, Hurricane Katrina, Hurricane Andrew, the 1993 Hardin Cemetery flood, the 2002 Noble, Georgia incident, the 2003 Station Nightclub fire, and the 2004 Southeast Asia tsunami. The grey literature sources provided comprehensive competency frameworks relevant to nursing in DVI contexts, though none specifically addressed DVI operations. The IAFN/ANA Scope and Standards of Practice (2017) established 19 professional standards with competencies covering medicolegal death investigation, forensic evidence collection and preservation, chain of custody, documentation, family advocacy, and disaster response. These competencies are directly transferable to DVI contexts, particularly to the post-mortem phase (body examination and evidence handling) and to the ante-mortem phase (family interviewing and psychosocial support). The ICN Core Competencies in Disaster Nursing (2022) provided a comprehensive framework across eight domains: preparation and planning, communication, incident management systems, safety and security, assessment, intervention, recovery, and law and ethics. However, the ICN framework did not include DVI, mass fatality management, or dead-body handling as competency areas. Similarly, the INCMCE (2003) framework set out 64 competencies for registered nurses responding to mass casualty incidents across the domains of critical thinking, assessment, technical skills, and communication. However, it made no provisions for mortuary operations or body identification. Theme 2: Gaps in Frameworks, Education, and Policy The analysis identified several critical gaps that limit nursing participation in DVI. The most significant gap was the absence of a formal role definition for nurses within international DVI frameworks. Although Williams and Williams ( 2011 ) demonstrated that forensic nurses are operationally embedded in US mass fatality response structures such as DMORT and FACT, this national-level integration has not been mirrored in global competency frameworks. The ICN Core Competencies in Disaster Nursing (2022) and the INCMCE (2003) framework do not include DVI, mass fatality management, dead body management, or forensic identification as competency domains for nurses. The IAFN/ANA (2017) standards provided the most relevant competency guidance, covering forensic evidence collection, medicolegal death investigation, and disaster response, but were not specifically tailored for DVI operations. The INTERPOL DVI Guide (2023), the international standard for DVI operations, does not define specific nursing roles within any phase of the DVI process. Psychological preparedness represented another critical gap. Lee et al. ( 2022 ) confirmed that nurses redeployed to decedent handling during COVID-19 were unaccustomed to the physical and mental demands of mortuary work. Although Williams and Williams ( 2011 ) described Critical Incident Stress Management (CISM) training as part of forensic nursing competency for disaster response, no DVI-specific psychological support program for nurses was identified in the included sources, despite the documented psychological demands of mass fatality work (Adamovic et al., 2023 ). Geographic concentration of evidence represented a further gap. No sources were identified from Africa, the Middle East, Latin America, or the Asia-Pacific region, despite these regions experiencing disproportionately high disaster mortality and limited forensic capacity (INTERPOL, 2023 ). The evidence base remained predominantly descriptive: no experimental or quasi-experimental studies evaluating nursing interventions or the effectiveness of DVI training were identified, and no validated instrument existed to assess DVI-specific competencies among nursing professionals. Table 3 summarises the critical gaps identified. DISCUSSION This scoping review mapped the available evidence on the roles, competencies, and contributions of nursing professionals in disaster victim identification (DVI). The principal finding is the marked scarcity of literature explicitly addressing nursing within the DVI domain. Despite a broad search strategy across major databases, citation tracking, and structured grey-literature retrieval, only six eligible sources were identified, of which only two were peer-reviewed empirical reports. This limited evidence base is not merely a bibliographic observation; rather, it reflects the persistent structural invisibility of nursing within a field traditionally dominated by forensic pathology, odontology, anthropology, fingerprint science, and DNA-based identification systems (INTERPOL, 2023 ; Beauthier et al., 2009 ; Lee et al., 2022 ). A central finding of this review is the disconnect between operational participation and formal recognition. Available evidence indicates that nurses have participated in mass fatality operations in both emergency and organized forensic settings. For example, Williams and Williams ( 2011 ) described the longstanding integration of forensic nurses within the United States Disaster Mortuary Operational Response Team (DMORT) and Family Assistance Care Team (FACT), where nurses contributed to scene support, mortuary workflows, ante-mortem family interviewing, specimen handling, and family assistance functions. However, this operational reality is not reflected in leading international frameworks. The current INTERPOL DVI Guide does not explicitly define nursing roles across the four DVI phases, and major disaster nursing competency frameworks similarly provide limited attention to mass fatality management or identification processes (INTERPOL, 2023 ; International Council of Nurses, 2022 ). This mismatch suggests that the principal barrier is not a lack of capability, but a lack of formal role articulation, competency standardization, and policy diffusion across jurisdictions. These findings extend prior work by da Silva et al. ( 2023 ), who identified shared forensic nursing competencies across disaster contexts but did not specifically examine DVI as a distinct medico-legal operational field. Once DVI is considered separately from broader disaster response, the evidence becomes notably sparse. Nevertheless, the available sources consistently indicate that nurses possess competencies highly relevant to DVI. These include structured documentation, chain-of-custody awareness, specimen support, communication with distressed families, trauma-informed interviewing, culturally sensitive care, ethical decision-making, and multidisciplinary coordination (International Association of Forensic Nurses & American Nurses Association, 2017; Valentine et al., 2020 ). Such competencies position nursing as a profession uniquely capable of bridging technical forensic requirements with the humanitarian and psychosocial dimensions of identification processes. The divide between disaster nursing and forensic nursing appears central to the current evidence gap. Mainstream disaster nursing frameworks have largely focused on triage, emergency treatment, shelter management, public health continuity, and recovery of living populations (International Council of Nurses, 2022 ; Veenema et al., 2016 ). In contrast, forensic nursing has evolved stronger competencies in evidence preservation, medicolegal documentation, death investigation, and trauma-informed care related to violence or sudden death (Lynch, 2011 ; Drake et al., 2020 ). DVI lies at the intersection of these two fields, yet has not been fully integrated into either the educational or policy domains. As a consequence, disaster nursing curricula may omit competencies related to management of the deceased, while forensic nursing curricula may not systematically address large-scale disaster systems and surge operations. This fragmentation likely contributes to the ad hoc deployment patterns observed during major incidents. The implications are particularly significant for low- and middle-income countries (LMICs), where forensic specialists are often limited, and nurses may represent the largest immediately deployable regulated health workforce. Following the 2004 Indian Ocean tsunami, affected countries experienced substantial shortages in forensic identification capacity, delaying body management and victim identification processes (Morgan et al., 2006 ). Similar constraints have been reported in other resource-limited disaster settings where infrastructure, trained personnel, and interoperable identification systems are insufficient (International Committee of the Red Cross, 2022 ). In such contexts, excluding nurses from DVI preparedness planning may represent a missed opportunity at the systems level. Context-adapted nursing roles in temporary mortuary documentation, ante-mortem data collection, family liaison, specimen logistics, and culturally appropriate return-of-remains processes could strengthen national response capacity without requiring immediate expansion of highly specialized forensic staffing. Comparison with other forensic disciplines is also instructive. Forensic odontology, anthropology, and, more recently, postmortem imaging have achieved clearer institutional positioning within DVI systems through dedicated methods, recognized training pathways, and sustained evidence demonstrating utility in identification outcomes (INTERPOL, 2023 ). Nursing, despite its substantially larger workforce and broader relational competencies, has not undergone comparable international formalization in DVI. This may partly reflect the historical framing of nurses as supportive responders rather than technical contributors within medico-legal operations. Generating empirical evidence on nursing contributions to operational efficiency, family experience, documentation quality, and interagency coordination will be essential if this perception is to change. Psychological preparedness emerged as another underdeveloped area. Lee et al. ( 2022 ) documented that nurses and nursing assistants redeployed to decedent handling during the COVID-19 pandemic were often unaccustomed to the physical and emotional demands of mortuary work. Earlier literature on mortuary and forensic personnel similarly reported associations between repeated exposure to mass death and stress reactions, fatigue, sleep disturbance, and emotional burden (McCarroll et al., 1993 ). Contemporary forensic practitioners involved in DVI operations have also described psychological strain, cumulative stress, and organizational pressures (Adamovic et al., 2023 ). If nursing roles in DVI are to be expanded, competency development should include psychological preparation, reflective debriefing, peer-support systems, and clear role expectations before deployment. The cultural and ethical dimensions of DVI further underscore the relevance of nursing expertise. Identification processes frequently involve intense grief, uncertainty, and culturally specific expectations regarding dignity, viewing of remains, burial timing, and communication with authorities. Mishandling these processes can undermine family trust and the legitimacy of disaster response. Ethical analyses of dead-body management during epidemics and disasters have emphasized the importance of balancing public health imperatives with cultural and family rights (Suwalowska et al., 2021 ). Nursing’s longstanding emphasis on person- and family-centered care, communication, advocacy, and culturally responsive practice makes it especially relevant in ante-mortem interviewing, family assistance centers, death notification support, and return-of-remains pathways. The current evidence base appears to remain at a pre-empirical stage. Most included sources were descriptive or grey literature, and no interventional studies evaluating DVI-specific nursing education, competency development, or deployment models were identified. No validated instrument measuring DVI competencies among nurses was found. This pattern is consistent with broader observations that disaster nursing research has historically concentrated on preparedness and self-reported competencies, with less emphasis on tested interventions or systems outcomes (Hugelius, 2021 ). Advancing the field will require movement from descriptive acknowledgment toward measurable implementation science. Strengths and Limitations This review has several strengths. It was conducted in accordance with JBI methodology and reported in accordance with PRISMA-ScR, with dual independent screening, pilot calibration, comprehensive citation chasing, and a grey-literature strategy spanning six organizational repositories. The analytic framework was explicitly mapped to the four INTERPOL DVI phases, providing a structure for comparison across heterogeneous sources. Several limitations should be acknowledged. First, the small number of included sources (N = 6) reflects the nascent stage of evidence on nursing roles in DVI; this is itself a finding of the review, but it limits the breadth of conclusions that can be drawn. Second, the strict eligibility criterion requiring explicit reference to nursing professionals resulted in the exclusion of several sources that addressed mass fatality management involving health workers more broadly, without specifically identifying nursing. At the same time, this strengthened the precision and verifiability of findings, but it may have excluded relevant contextual evidence. Third, the included peer-reviewed articles originate predominantly from high-income countries, limiting applicability to LMIC contexts where DVI capacity needs are greatest. Fourth, no conclusions can be drawn about the effectiveness of nursing contributions to DVI outcomes, as no experimental or quasi-experimental studies evaluating nursing interventions or training programs for DVI were identified. Fifth, the inclusion of one textbook chapter as a primary source of operational information, although methodologically justified under our grey-literature inclusion criteria, reflects the unusual state of the evidence base and should be interpreted with appropriate caution regarding generalisability beyond the US context. Finally, the CINAHL database was not searched (owing to institutional access constraints), and the review protocol was not prospectively registered; both decisions are acknowledged as methodological limitations, although the broad grey-literature search, citation chasing, and PRISMA-ScR-compliant reporting partially mitigate these constraints. Implications for Practice, Education, Policy, and Research The findings support the formal inclusion of nursing professionals in DVI team roles, particularly in areas where existing nursing competencies are directly transferable, such as ante-mortem data collection, family liaison, therapeutic communication, specimen sampling, and culturally competent care. The DMORT and FACT structures described by Williams and Williams ( 2011 ) provide an operational template that could be contextually adapted for national DVI systems in other jurisdictions, particularly in disaster-prone LMICs. At both undergraduate and postgraduate levels, nursing curricula should include DVI and mass fatality management content to bridge the current divide between disaster nursing and forensic nursing education. Simulated training exercises on body handling, forensic documentation, chain of custody, ante-mortem data collection using structured instruments such as the VIP, and psychological preparation for mortuary work environments should be incorporated into such programs. International organizations such as INTERPOL, the ICN, and the WHO should review their respective policy documents to ensure that nursing roles across all four DVI phases are officially recognized and defined. The operational integration of forensic nurses into DMORT and FACT structures within the US National Disaster Medical System (Williams & Williams, 2011 ) provides concrete precedent that could inform international standard-setting. Regional bodies such as the Association of Southeast Asian Nations (ASEAN) and the WHO Regional Office for South-East Asia (SEARO) are well placed to lead context-sensitive adaptation of DVI nursing competencies for disaster-prone LMICs. National disaster management authorities, especially in disaster-prone developing nations, should ensure that nurses are included in DVI preparedness planning and that clear deployment pathways exist. In terms of research, there is a pressing need for primary empirical investigation, including qualitative exploration of the lived experiences of nurses involved in DVI operations, quantitative assessment of DVI-specific competencies among nursing staff, and intervention studies evaluating the effectiveness of DVI training programs for this workforce. The development of a validated, DVI-specific nursing competency assessment instrument would provide a basis for both designing educational programs and evaluating nursing practice. CONCLUSION This scoping review demonstrates that nursing roles in disaster victim identification remain underdocumented, underconceptualized, and underrecognized in the published literature. Only six eligible sources were identified, and only two provided peer-reviewed empirical evidence. Nevertheless, the available evidence consistently indicates that nurses possess competencies directly relevant to DVI, including structured documentation, evidence-aware practice, family liaison, communication, specimen support, culturally sensitive care, and multidisciplinary coordination. A key conclusion is the persistent disconnect between operational feasibility and formal recognition. Nurses have been integrated into selected mass fatality response structures, most notably within the United States DMORT and FACT systems. Yet, this integration is not mirrored in international DVI standards or mainstream disaster nursing frameworks. This gap represents both a scientific blind spot and a policy vulnerability. Strengthening future mass fatality preparedness will require explicit recognition of nursing roles within forensic disaster systems, the development of DVI-specific education and competency pathways, and the generation of rigorous empirical evidence across diverse contexts, particularly in LMICs, where workforce flexibility is essential. Making nursing visible within the DVI field is not simply a disciplinary concern; it is a practical step toward more comprehensive, humane, and resilient disaster victim identification systems. Abbreviations ADFAA Aviation Disaster Family Assistance Act ANA American Nurses Association ATF Alcohol, Tobacco, and Firearms BCP Body Collection Point CBRNE Chemical, Biological, Radiological, Nuclear, and Explosive CDC Centers for Disease Control and Prevention CISM Critical Incident Stress Management DMAT Disaster Medical Assistance Team DMORT Disaster Mortuary Operational Response Team DPMU Disaster Portable Mobile Unit DVI Disaster Victim Identification EMAC Emergency Management Assistance Compact ESF Emergency Support Function FACT Family Assistance Care Team FBI Federal Bureau of Investigation FEMA Federal Emergency Management Agency FNE Forensic Nurse Examiner HHS Health and Human Services HIC High—Income Country HIPAA Health Insurance Portability and Accountability Act IAFN International Association of Forensic Nurses ICN International Council of Nurses ICRC International Committee of the Red Cross INCMCE International Nursing Coalition for Mass Casualty Education INTERPOL International Criminal Police Organization JBI Joanna Briggs Institute LMIC Low—and Middle—Income Countries MCI Mass Casualty Incident MFI Mass Fatality Incident NA Nursing Assistant NDMS National Disaster Medical System NTSB National Transportation Safety Board PAHO Pan American Health Organization PCC Population, Concept, Context PMCT Postmortem Computed Tomography PRISMA ScR—Preferred Reporting Items for Systematic Reviews and Meta—Analyses Extension for Scoping Reviews RN Registered Nurse VIP Victim Identification Profile WHO World Health Organization Declarations Clinical trial number Not applicable. Human Ethics and Consent to Participate Not applicable. Consent for publication Not applicable. Funding This study was not received any external funding. References Adamovic, N., Howes, L. M., White, R., & Julian, R. (2023). Understanding the challenges of disaster victim identification: perspectives of Australian forensic practitioners. Forensic Sciences Research, 8(2), 107–115. https://doi.org/10.1093/fsr/owad020 Arksey, H., & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616 Beauthier, J.-P., De Valck, E., Lefevre, P., & De Winne, J. (2009). Mass Disaster Victim Identification: The Tsunami Experience. The Open Forensic Science Journal, 2(1), 54–62. https://doi.org/10.2174/1874402800902010054 Centre for Research on the Epidemiology of Disasters. (2025). 2024 Disasters in Numbers. https://files.emdat.be/reports/2024_EMDAT_report.pdf da Silva, T. A. S. M., Haberland, D. F., Kneodler, T. da S., Duarte, A. C. da S., Williams, J., & Oliveira, A. B. de. (2023). Forensic Nursing competencies in disasters situations: scoping review. Revista Da Escola de Enfermagem Da USP, 57. https://doi.org/10.1590/1980-220x-reeusp-2022-0486en Drake, S. A., & Burton, C. (2022). Trauma-Informed Approaches to Medicolegal Death Investigation: A Forensic Nursing Perspective. Journal of Forensic Nursing, 18(2), 85–90. https://doi.org/10.1097/JFN.0000000000000359 Drake, S. A., Tabor, P., Hamilton, H., & Cannon, A. (2020). Nurses and Medicolegal Death Investigation. Journal of Forensic Nursing, 16(4), 207–214. https://doi.org/10.1097/JFN.0000000000000310 Fletcher, K. A., Reddin, K., & Tait, D. (2022). The history of disaster nursing: from Nightingale to nursing in the 21st century. Journal of Research in Nursing, 27(3), 257–272. https://doi.org/10.1177/17449871211058854 Hugelius, K. (2021). Disaster nursing research: A scoping review of the nature, content, and trends of studies published during 2011–2020. International Emergency Nursing, 59, 101107. https://doi.org/10.1016/j.ienj.2021.101107 International Association of Forensic Nurses, & American Nurses Association. (2017). Forensic Nursing: Scope and Standards of Practice (2nd ed.). American Nurses Association. International Committee of the Red Cross. (2022). The Forensic Human Identification Process: an Integrated Approach. https://library.icrc.org/library/docs/DOC/icrc-4590-002.pdf International Council of Nurses. (2022). ICN core competencies in disaster nursing. https://www.icn.ch/sites/default/files/2023-04/ICN_2022_Disaster-Comp-Report_EN_WEB.pdf International Nursing Coalition for Mass Casualty Education. (2003). Educational Competencies for Registered Nurses Responding to Mass Casualty Incidents. https://www.aacnnursing.org/Portals/0/PDFs/Teaching-Resources/INCMCECompetencies.pdf INTERPOL. (2023). Disaster victim identification guide. https://www.interpol.int/content/download/589/file/DVI_DVI%20Guide%202023.pdf Lee, T., Roy, A., Power, P., Sembajwe, G., & Dropkin, J. (2022). Ergonomic exposures and control measures associated with mass fatality decedent handling in morgues and body collection points in a New York healthcare system during COVID-19: A case series. International Journal of Industrial Ergonomics, 88, 103260. https://doi.org/10.1016/j.ergon.2022.103260 Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: advancing the methodology. Implementation Science, 5(1), 69. https://doi.org/10.1186/1748-5908-5-69 Lynch, V. A. (2011). Forensic nursing science: Global strategies in health and justice. Egyptian Journal of Forensic Sciences, 1(2), 69–76. https://doi.org/10.1016/j.ejfs.2011.04.001 McCarroll, J. E., Ursano, R. J., Fullerton, C. S., & Lundy, A. (1993). Traumatic Stress of a Wartime Mortuary. The Journal of Nervous and Mental Disease, 181(9), 545–551. https://doi.org/10.1097/00005053-199309000-00003 Morgan, O. W., Sribanditmongkol, P., Perera, C., Sulasmi, Y., Van Alphen, D., & Sondorp, E. (2006). Mass Fatality Management following the South Asian Tsunami Disaster: Case Studies in Thailand, Indonesia, and Sri Lanka. PLoS Medicine, 3(6), e195. https://doi.org/10.1371/journal.pmed.0030195 National Academy of Medicine, National Academies of Sciences, Engineering, and Medicine, & Committee on the Future of Nursing 2020–2030. (2021). The Future of Nursing 2020-2030. National Academies Press. https://doi.org/10.17226/25982 Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan—a web and mobile app for systematic reviews. Systematic Reviews, 5(1), 210. https://doi.org/10.1186/s13643-016-0384-4 Peters, M. D. J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A. C., & Khalil, H. (2020). Chapter 11: Scoping reviews (2020 version). In E. Aromataris & Z. Munn (Eds.), JBI Manual for Evidence Synthesis. JBI. https://doi.org/10.46658/JBIMES-20-12 Suwalowska, H., Amara, F., Roberts, N., & Kingori, P. (2021). Ethical and sociocultural challenges in managing dead bodies during epidemics and natural disasters. BMJ Global Health, 6(11), e006345. https://doi.org/10.1136/bmjgh-2021-006345 Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., … Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850 United Nations Office for Disaster Risk Reduction. (2022). Global assessment report on disaster risk reduction 2022: Our world at risk: Transforming governance for a resilient future. https://www.undrr.org/gar/gar2022-our-world-risk-gar Valentine, J. L., Sekula, L. K., & Lynch, V. (2020). Evolution of Forensic Nursing Theory—Introduction of the Constructed Theory of Forensic Nursing Care: A Middle-Range Theory. Journal of Forensic Nursing, 16(4), 188–198. https://doi.org/10.1097/JFN.0000000000000287 Veenema, T. G., Griffin, A., Gable, A. R., MacIntyre, L., Simons, R. N., Couig, M. P., Walsh, J. J., Lavin, R. P., Dobalian, A., & Larson, E. (2016). Nurses as Leaders in Disaster Preparedness and Response—A Call to Action. Journal of Nursing Scholarship, 48(2), 187–200. https://doi.org/10.1111/jnu.12198 Williams, J., & Williams, D. (2011). Multi-Casualty Scenes. In V. A. Lynch & J. B. Duval (Eds.), Forensic Nursing Science (2nd ed., pp. 627–652). Mosby/Elsevier. World Health Organization. (2020). State of the World’s Nursing 2020: Investing in Education, Jobs, and Leadership. https://www.who.int/publications/i/item/9789240003279 Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1.DataExtraction.docx Supplementaryfile2.FullSearchStrategy.docx PRISMAScRChecklist.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 07 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers invited by journal 28 Apr, 2026 Editor assigned by journal 28 Apr, 2026 Submission checks completed at journal 28 Apr, 2026 First submitted to journal 26 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9536048","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":633823460,"identity":"e5c85b15-62af-43b8-b76b-28ce7aec5d11","order_by":0,"name":"I Made Moh. 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Climate-related hazards, rapid urbanization, population growth, protracted conflict, and technological risks have increased both the frequency and operational complexity of events that may result in multiple fatalities. (Centre for Research on the Epidemiology of Disasters, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; United Nations Office for Disaster Risk Reduction, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In 2024 alone, 393 natural hazard-related disasters were recorded worldwide, causing 16,753 deaths and affecting more than 167.2\u0026nbsp;million people (Centre for Research on the Epidemiology of Disasters, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In such contexts, the management and identification of the dead are not peripheral activities but critical components of disaster response, public accountability, and family rights.\u003c/p\u003e \u003cp\u003eDisaster victim identification (DVI) is the structured process used to establish the identity of individuals who die in disasters through scientifically robust, legally defensible, and ethically sensitive procedures. Beyond its technical function, DVI has humanitarian importance because identification enables death certification, supports criminal or civil investigations where relevant, facilitates repatriation and burial, and provides families with certainty after traumatic loss (Adamovic et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Morgan et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). The INTERPOL DVI Guide is widely recognized as the international reference standard for this work and organizes DVI into four phases: scene, post-mortem, ante-mortem, and reconciliation (INTERPOL, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Each phase requires coordinated contributions from multiple professional groups, including forensic pathologists, odontologists, anthropologists, fingerprint specialists, DNA analysts, police, and humanitarian personnel (International Committee of the Red Cross, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; INTERPOL, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite this multidisciplinary character, formal DVI systems remain unevenly developed across countries, especially in low- and middle-income settings where disaster burdens are high but forensic infrastructure is often limited (INTERPOL, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Morgan et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). In these settings, available health professionals frequently assume functions adjacent to body recovery, temporary mortuary operations, documentation, family support, and continuity of care. Nurses are particularly relevant in this regard. As the largest professional group in the global health workforce, nurses are routinely deployed across the disaster cycle and commonly perform triage, clinical stabilization, coordination, documentation, psychosocial support, and community recovery functions (Fletcher et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Veenema et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; World Health Organization, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe potential relevance of nursing to DVI becomes even clearer when viewed through a forensic nursing lens. Forensic nursing integrates nursing science with forensic, legal, and justice processes. It includes competencies in injury documentation, evidence recognition and preservation, chain of custody, medicolegal death investigation, trauma-informed communication, and culturally sensitive engagement with families affected by violence or sudden death (International Association of Forensic Nurses \u0026amp; American Nurses Association, 2017; Lynch, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Valentine et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These competencies are conceptually and operationally transferable to DVI, particularly in post-mortem handling, ante-mortem information gathering, family liaison, and support during the return of remains. Yet international frameworks have not kept pace with this overlap. The INTERPOL DVI Guide (2023) does not assign explicit nursing roles within any DVI phase, and the ICN Core Competencies in Disaster Nursing (2022) does not address DVI, mass fatality management, or care of the dead as defined competency areas.\u003c/p\u003e \u003cp\u003eThis omission matters in practice. Historical and contemporary disasters suggest that nurses are already involved in identification-adjacent and mass fatality work, even when their roles are not formally defined. After the 2004 Indian Ocean tsunami, severe forensic capacity shortages in affected countries required a broad range of responders to support body recovery, documentation, and mortuary workflows (Morgan et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2006\u003c/span\u003e During the COVID-19 pandemic, nurses and nursing assistants in New York were redeployed to decedent handling when morgue capacity was overwhelmed, despite limited preparation for the physical and psychological demands of this work (Lee et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These examples suggest that the question is not whether nurses are relevant to DVI, but whether systems have adequately articulated, trained, and supported that relevance.\u003c/p\u003e \u003cp\u003eThe absence of a clearly defined role for nursing in DVI frameworks represents a missed opportunity to strengthen disaster response capacity, particularly in resource-limited contexts where nurses may be the most readily available health professionals. Several scholars have argued that forensic nursing can be better integrated into disaster preparedness and response (da Silva et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Veenema et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), and increasing recognition has been given to the psychosocial dimensions of DVI, including how families are supported during identification, bereavement care, and the culturally appropriate handling of human remains, dimensions that align closely with core components of nursing care (Suwalowska et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Despite this growing recognition, a comprehensive mapping of the scope and nature of the evidence on nursing roles and competencies related to DVI has not yet been conducted.\u003c/p\u003e \u003cp\u003eA preliminary search of PubMed, PROSPERO, and the JBI Evidence Synthesis database identified no review specifically focused on nursing roles and competencies in DVI. The closest review, by da Silva et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), mapped forensic nursing competencies in disaster situations more broadly. However, it did not specifically examine DVI as a specialized forensic field or map nursing contributions across the four phases of INTERPOL DVI. Thus, an important evidence gap remains regarding how nursing is currently represented in the DVI literature, what competencies are described, and where policy, educational, and research deficits persist.\u003c/p\u003e \u003cp\u003e Accordingly, this scoping review aimed to map the available evidence on the roles, competencies, and contributions of nursing professionals in disaster victim identification. Specifically, the review sought to identify how nursing roles are described across the DVI continuum, which competencies are reported or implied, and what gaps remain in frameworks, education, policy, and empirical research. By making these patterns visible, this review positions nursing not as an auxiliary presence in disaster response, but as a potentially underrecognized contributor to forensic preparedness and mass fatality management.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews (Peters et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and the methodological framework originally proposed by Arksey and O\u0026rsquo;Malley (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) and further refined by Levac et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist (Tricco et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eReview Question\u003c/h3\u003e\n\u003cp\u003eThe review question was developed according to the Population, Concept, Context (PCC) framework recommended by JBI for scoping reviews (Peters et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The review question was: What evidence is available on the roles and competencies of nursing professionals (Population) in disaster victim identification (Concept) across all disaster settings worldwide (Context)?\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003eThis review considered all nursing professionals, including registered nurses, forensic nurses, public health nurses, community health nurses, emergency nurses, disaster nurses, nurse practitioners, clinical nurse specialists, and nursing assistants involved in DVI-related tasks. No restrictions were imposed on age, sex, years of experience, level of education, or country of practice.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eConcept\u003c/h3\u003e\n\u003cp\u003eThe core concepts of this review were the roles, competencies, knowledge, skills, training, and education of nursing professionals in disaster victim identification. These included activities spanning all four phases of the INTERPOL DVI process (INTERPOL, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e): Phase 1 (Scene) \u0026mdash; body recovery, scene management, and decontamination; Phase 2 (Post-mortem) \u0026mdash; mortuary operations, forensic examination, evidence collection, documentation, photography, and DNA sample collection; Phase 3 (Ante-mortem) \u0026mdash; data collection from families of missing persons, including family liaison and psychosocial support; and Phase 4 (Reconciliation) \u0026mdash; matching post-mortem and ante-mortem data, notification to families, culturally and religiously appropriate return of remains, and ongoing bereavement care. Mass fatality management, dead body management, human remains identification, and forensic evidence collection and preservation in disaster contexts were also included.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eContext\u003c/h2\u003e \u003cp\u003eThe review included all disaster settings worldwide with no geographic or temporal restrictions. Eligible contexts included natural disasters (earthquakes, tsunamis, floods, hurricanes, volcanic eruptions, wildfires), human-made disasters (terrorist attacks, armed conflicts, industrial accidents, and transportation incidents), pandemics involving mass fatalities, and chemical, biological, radiological, nuclear, and explosive (CBRNE) events. Settings included disaster sites, temporary mortuaries, field hospitals, family assistance centers, health facilities operating as body-collection sites, and community-based response operations. Both high-income and low- and middle-income country contexts were included.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTypes of Sources\u003c/h3\u003e\n\u003cp\u003eThis scoping review considered primary studies using quantitative, qualitative, and mixed-methods approaches, including experimental, quasi-experimental, cross-sectional, cohort, case-control, before-and-after, time-series, and observational designs. Case reports and field reports were also included. Grey literature was considered, including organizational websites, protocols, procedures, guidelines, books, book chapters, legislation, letters, and organizational position documents. Systematic, scoping, and narrative reviews were excluded from the main analysis but were examined for reference tracking. Commentary, editorial, and opinion papers were excluded. Sources that did not explicitly reference nursing professionals or nursing roles were excluded at the full-text screening stage. All eligibility criteria are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEligibility Criteria Based on The PCC Framework\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInclusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExclusion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePopulation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll nursing professionals: registered nurses, forensic nurses, public health nurses, community health nurses, emergency nurses, disaster nurses, nurse practitioners, clinical nurse specialists, and nursing assistants involved in DVI tasks.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudies exclusively involving non-nursing professionals (physicians, forensic scientists, law enforcement) without explicit reference to nursing roles\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConcept\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoles, competencies, knowledge, skills, training, education, and contributions related to disaster victim identification, mass fatality management, dead body management, human remains identification, mortuary operations, ante-mortem data collection, forensic evidence collection in disaster contexts, family support during identification, and cultural/ethical considerations in handling deceased disaster victims\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudies focused exclusively on forensic science identification methods (DNA, odontology, anthropology, fingerprinting) without any reference to nursing or healthcare worker involvement; studies addressing only triage of living casualties without reference to management of the deceased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContext\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll disaster settings globally (natural disasters, human-made disasters, pandemics, armed conflicts, CBRNE incidents) with no geographic or temporal restrictions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRoutine clinical forensic nursing (e.g., sexual assault examination, child abuse investigation) not related to disaster or mass fatality contexts\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSource types\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary studies (quantitative, qualitative, mixed methods); case reports, field reports; grey literature (guidelines, protocols, competency frameworks, professional standards, field manuals, training curricula)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConference abstracts without full text available; sources that do not explicitly reference nursing professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e\u003cTable is about here\u003e\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSearch Strategy\u003c/h2\u003e \u003cp\u003eThe search strategy was constructed in three stages in accordance with JBI guidance (Peters et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The first stage consisted of a limited preliminary search of PubMed to identify relevant articles, followed by analysis of the words in the titles and abstracts of retrieved studies and the index terms used to describe each article. This search served as a prototype for identifying the final term set for the full search strategy.\u003c/p\u003e \u003cp\u003eIn the second stage, the full search strategy, incorporating all identified keywords and index terms, was tailored for use across three electronic databases: MEDLINE (via PubMed), Web of Science (Core Collection), and Scopus. The search combined two concept blocks using the Boolean operator AND: (a) nursing professionals (using Medical Subject Headings [MeSH] and free-text terms for all nursing categories) and (b) disaster victim identification and related concepts (using controlled vocabulary and free-text terms for DVI, mass fatality management, dead body management, human remains identification, mortuary operations, mass casualty incidents, and forensic identification). Terms within each concept block were combined with the Boolean operator OR. No date or language limiters were applied at the search stage; language-based exclusion was applied only at the screening stage. Supplementary File 2 presents the full search strategies for each database.\u003c/p\u003e \u003cp\u003eIn the third stage, citation searching was conducted. Included studies were used as seed references in CitationChaser (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://estech.shinyapps.io/citationchaser/\u003c/span\u003e\u003cspan address=\"https://estech.shinyapps.io/citationchaser/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) to identify additional relevant studies through both backward (reference-list screening) and forward (citation tracking) searches. Results from citation searching were exported and deduplicated against records already screened from the database searches to avoid duplicate screening. In addition, grey literature was searched through the following sources: the INTERPOL DVI resources repository, the World Health Organization (WHO) publications database, the International Committee of the Red Cross (ICRC) publications, the Pan American Health Organization (PAHO), the International Association of Forensic Nurses (IAFN), and the International Council of Nurses (ICN). The database searches were conducted in January 2026.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSource Selection\u003c/h2\u003e \u003cp\u003eAfter the search, all identified citations were imported and deduplicated in Rayyan, a web-based systematic review screening tool (Ouzzani et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), for title and abstract screening. Three reviewers conducted the source selection process in two stages. In the first stage, two reviewers independently screened the titles and abstracts of all retrieved records for eligibility using Rayyan. Each record was tagged as \u0026ldquo;include,\u0026rdquo; \u0026ldquo;exclude,\u0026rdquo; or \u0026ldquo;maybe\u0026rdquo;. Records were moved to full-text review if either reviewer labeled them as \u0026ldquo;maybe\u0026rdquo;. To promote independent decision-making, the blinding feature in Rayyan was activated during screening, so that neither reviewer saw the other\u0026rsquo;s inclusion or exclusion decisions. Disagreements between the two reviewers during title and abstract screening were resolved through discussion; when consensus could not be reached, the third reviewer arbitrated the final decision.\u003c/p\u003e \u003cp\u003eIn the second stage, full texts of all potentially relevant sources were retrieved and evaluated in detail against the eligibility criteria by the same two reviewers. Sources were excluded at the full-text stage if they did not explicitly reference nursing professionals or nursing roles, even if they addressed mass fatality management or DVI-related topics involving health workers more broadly. Reasons for full-text exclusion were recorded and are reported in the PRISMA-ScR flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Disagreements at full-text screening were resolved through discussion between the two reviewers, with the third reviewer consulted if consensus could not be reached. Prior to the formal commencement of screening, a pilot exercise was conducted in which all three reviewers independently, and in duplicate, screened a random sample of 20 titles and abstracts in Rayyan to calibrate the application of eligibility criteria and to ensure inter-rater consistency.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData Extraction\u003c/h2\u003e \u003cp\u003eData were extracted from included sources using a standardized data-extraction instrument developed by the review team, based on the JBI data-extraction template for scoping reviews (Peters et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and adapted to the specific objectives of this review. The following data were extracted from each included source: (a) source identification (authors, year, country of origin); (b) source characteristics (type of source/study design, population/participants); (c) concept-related data (disaster type; DVI phase[s] addressed, mapped to the INTERPOL framework; nursing roles identified; nursing competencies and training described; interdisciplinary collaboration); and (d) key findings and recommendations relevant to nursing roles in DVI. Data were extracted independently by two reviewers; disagreements were resolved through discussion, with the third reviewer consulted if consensus could not be reached.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis and Presentation of Results\u003c/h2\u003e \u003cp\u003eIn accordance with JBI scoping-review methodology (Peters et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), the extracted data were analyzed using both numerical (descriptive) analysis and a qualitative thematic summary. The numerical analysis comprised counts and summary characteristics of included sources, including frequency and distribution by year of publication, country, source type (peer-reviewed or grey literature), and study design. Frequencies and percentages were derived for categorical variables. An inductive qualitative thematic analysis was conducted to identify, organize, and synthesize key themes emerging from the extracted data. Data extracted from the nursing roles, competencies, barriers, and gaps fields were independently coded by two reviewers and then grouped into higher-order themes through consensus discussion. Themes were refined through discussion between all three reviewers until consensus was reached. Consistent with JBI guidance (Peters et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), no formal critical appraisal of included sources was conducted, because scoping reviews aim to map the nature and extent of available evidence rather than to assess the quality of findings. Results are presented narratively, supplemented by tables and a figure. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises the characteristics of included sources, and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarises the critical gaps identified in the evidence base. The source selection process is presented in a PRISMA-ScR flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The full data extraction is provided in Supplementary File 1.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Included Sources (N\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSource type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrey literature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eStudy design (primary, n\u0026thinsp;=\u0026thinsp;2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperational case study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObservational case series\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eGrey literature type (n\u0026thinsp;=\u0026thinsp;4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompetency frameworks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional standards document\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTextbook chapter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eCountry / Region of origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelgium (fieldwork in Thailand)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational (ICN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA with international scope (IAFN/ANA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eDisaster type addressed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNatural disaster (tsunami)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePandemic (COVID-19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll disaster types / multi-disaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApplicable to disaster contexts (not disaster-specific)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eDVI phases addressed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll four phases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhase 2: Post-mortem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhase 3: Ante-mortem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot phase-specific\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote. DVI-phase categories are not mutually exclusive; individual sources may address multiple phases. Country/Region percentages are calculated over N\u0026thinsp;=\u0026thinsp;6 included sources. CBRNE\u0026thinsp;=\u0026thinsp;chemical, biological, radiological, nuclear, and explosive; DVI\u0026thinsp;=\u0026thinsp;disaster victim identification; IAFN/ANA\u0026thinsp;=\u0026thinsp;International Association of Forensic Nurses / American Nurses Association; ICN\u0026thinsp;=\u0026thinsp;International Council of Nurses.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCritical Gaps Identified in the Evidence Base\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGap Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupporting Sources\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbsence of DVI in international nursing competency frameworks\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe ICN Core Competencies in Disaster Nursing (2022) and the INCMCE (2003) framework do not include DVI, mass fatality management, dead body management, or forensic identification as competency domains for nurses. Despite the formal operational integration of forensic nurses into US mass fatality response structures (DMORT, FACT) described by Williams and Williams (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), this operational reality has not been incorporated into international competency frameworks.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIAFN \u0026amp; ANA (2017); ICN (2022); INCMCE (2003); Williams \u0026amp; Williams (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo DVI-specific training programs for nurses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo DVI-specific training programme for nurses was identified in any included source. The IAFN/ANA (2017) standards cover forensic competencies transferable to DVI but are not specifically designed for DVI operations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIAFN \u0026amp; ANA (2017)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeographic concentration of evidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll included sources originated from high-income countries (USA, Belgium with fieldwork in Thailand) or from international organisations based in high-income countries (ICN, IAFN/ANA). No sources were identified from Africa, the Middle East, Latin America, or the Asia-Pacific region, regions that face disproportionately high disaster mortality and the greatest DVI capacity constraints.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll included sources\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScarcity of empirical evidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly two peer-reviewed articles documented nursing involvement in mass fatality operations with empirical data. No experimental or quasi-experimental study has evaluated nursing interventions or training effectiveness in DVI.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBeauthier et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2009\u003c/span\u003e); Lee et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLack of validated DVI nursing competency instruments\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo study has measured, validated, or evaluated DVI-specific competencies for nurses. No validated competency assessment instrument currently exists for nursing in DVI.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIAFN \u0026amp; ANA (2017); ICN (2022); INCMCE (2003)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbsence of nursing from the INTERPOL DVI framework\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe INTERPOL DVI Guide (2023) does not define specific nursing roles within any phase of the DVI process, despite the multidisciplinary nature of DVI operations and the documented operational integration of forensic nurses into DMORT and FACT structures within the US National Disaster Medical System.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eINTERPOL (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e); Williams \u0026amp; Williams (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSearch Results and Study Selection\u003c/h2\u003e \u003cp\u003eThe systematic search across three electronic databases (PubMed, Web of Science, and Scopus) yielded 2,208 records. After removal of duplicates (n\u0026thinsp;=\u0026thinsp;288), 1,920 records were screened by title and abstract. Following this screening, 1,891 records were excluded, and 29 reports were sought for full-text retrieval from the database searches. An additional 12 reports were identified through other methods, six through citation searching and six through grey-literature searching. All 41 reports were retrieved and assessed for eligibility. Following full-text assessment against the eligibility criteria, two reports from the database searches and four reports from other methods met the inclusion criteria, yielding a total of six sources. The study-selection process is illustrated in the PRISMA-ScR flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e\u0026lt;Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e is about here\u0026gt;\u003c/h2\u003e \u003cp\u003eOf the six included sources, two (33.3%) were primary studies and four (66.7%) were grey literature documents. Among the primary studies, one was an operational case study describing the deployment of a Belgian DVI team, including a nurse, to Thailand after the 2004 Indian Ocean Tsunami (Beauthier et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). One was an observational case series documenting the involvement of nurses and nursing assistants in decedent handling during the COVID-19 pandemic in New York (Lee et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The grey literature comprised two competency frameworks (International Council of Nurses, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; International Nursing Coalition for Mass Casualty Education, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2003\u003c/span\u003e), one professional standards document (International Association of Forensic Nurses \u0026amp; American Nurses Association, 2017), and one textbook chapter that comprehensively addressed forensic nursing roles in multi-casualty scenes and mass fatality incidents (Williams \u0026amp; Williams, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises the characteristics of the included sources.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e\u0026lt;Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e is about here\u0026gt;\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003eGeographic and Temporal Distribution\u003c/h2\u003e \u003cp\u003eThe two included primary studies were published in 2009 and 2022, respectively. The 2009 study reported on the 2004 Indian Ocean Tsunami response, and the 2022 study reported on the COVID-19 pandemic response. Grey literature sources were published between 2003 and 2022. In terms of geographic origin, the USA was the most represented country (n\u0026thinsp;=\u0026thinsp;3; 50.0% of all sources, comprising the Lee et al. study, the INCMCE competency framework, and the Williams and Williams textbook chapter), followed by one Belgian source with fieldwork in Thailand (16.7%), one international source (ICN; 16.7%), and one source from the USA with international scope (IAFN/ANA; 16.7%). No sources originated from Africa, the Middle East, Latin America, or the Asia-Pacific region, indicating significant geographic gaps in the evidence base.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eThematic Findings\u003c/h2\u003e \u003cp\u003eThematic analysis of the included sources identified two main themes: (1) nursing roles and competencies relevant to DVI; and (2) gaps in frameworks, education, and policy. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents an evidence map of nursing roles and competencies across the four INTERPOL DVI phases, visualizing the distribution of documented roles, transferable competencies, strength of empirical evidence, and gaps in formal international recognition identified in this review.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e\u0026lt;Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e is about here\u0026gt;\u003c/h2\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003eTheme 1: Nursing Roles and Competencies Relevant to DVI\u003c/h2\u003e \u003cp\u003eThe two primary studies and the textbook chapter (Williams \u0026amp; Williams, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) together provided a more nuanced picture of nursing participation in mass fatality operations than had been previously established. Beauthier et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) documented a nurse as a formal member of the Belgian DVI team deployed to Khao Lak, Thailand, following the 2004 Indian Ocean Tsunami. The Belgian team composition, detailed in the study, included one paramedical member (a nurse), a physician, and a psychologist. The Belgian DVI team was reported to be one of the few teams internationally to include a physician, a nurse, a psychologist, and a stress-management team as regular members (Beauthier et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). The nurse\u0026rsquo;s documented role involved attending to team members\u0026rsquo; medical needs, including the emergency treatment of a US volunteer who experienced heat stroke and of a Belgian team member with a leg wound. Although the nurse\u0026rsquo;s role was to provide medical support to the DVI team rather than to participate directly in forensic identification tasks, the formal integration of a nurse into the DVI team\u0026rsquo;s structure represents an important organizational precedent.\u003c/p\u003e \u003cp\u003eLee et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) documented the involvement of registered nurses (RNs) and nursing assistants (NAs) in decedent handling during the COVID-19 pandemic in a New York healthcare system. The study described a mass fatality event sustained over months, during which hospital morgues became overwhelmed and temporary body collection points (BCPs) were established. Nurses placed decedents into body bags on medical units and transferred them onto transport stretchers for conveyance to the morgue. Workers\u0026rsquo; compensation data confirmed that nursing assistants accounted for 22 claims (35.5% of all decedent-handling injuries) and registered nurses accounted for 5 claims (8.0%). Staff assuming new decedent-handling roles were reported to be unaccustomed to the physical and mental demands of this work. Subsequent handling in morgues and BCPs was primarily performed by security personnel, morgue attendants, and transporters.\u003c/p\u003e \u003cp\u003eThe textbook chapter by Williams and Williams (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), published in a major international forensic nursing reference text and authored by a forensic nurse with personal DMORT deployment experience, provided the most comprehensive articulation of forensic nursing roles in DVI identified in this review. The authors stated that the roles of the forensic nurse in mass fatality contexts include identifying the dead, recognizing medicolegal issues, providing information and education, delivering direct patient care, and conducting disaster research (Williams \u0026amp; Williams, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). The chapter described the formal integration of forensic nurses into two operational structures within the US National Disaster Medical System (NDMS): the Disaster Mortuary Operational Response Team (DMORT), in which forensic nurses work alongside forensic pathologists, anthropologists, odontologists, fingerprint experts, and funeral directors in the establishment of mobile morgue operations, forensic examination, DNA acquisition, remains identification, search and recovery, and ante-mortem and post-mortem data collection, and in the operation of family assistance centres; and the Family Assistance Care Team (FACT), mandated by the Aviation Disaster Family Assistance Act of 1996, in which forensic nurses conduct structured ante-mortem interviews with families using an 8-page Victim Identification Profile (VIP) covering physical characteristics, scars, implants, tattoos, occupational history, and sources of medical and dental records, and collect DNA reference swabs from next of kin. The chapter also described specific historical forensic nursing deployments, including the 9/11 World Trade Center response, Hurricane Katrina, Hurricane Andrew, the 1993 Hardin Cemetery flood, the 2002 Noble, Georgia incident, the 2003 Station Nightclub fire, and the 2004 Southeast Asia tsunami.\u003c/p\u003e \u003cp\u003eThe grey literature sources provided comprehensive competency frameworks relevant to nursing in DVI contexts, though none specifically addressed DVI operations. The IAFN/ANA Scope and Standards of Practice (2017) established 19 professional standards with competencies covering medicolegal death investigation, forensic evidence collection and preservation, chain of custody, documentation, family advocacy, and disaster response. These competencies are directly transferable to DVI contexts, particularly to the post-mortem phase (body examination and evidence handling) and to the ante-mortem phase (family interviewing and psychosocial support). The ICN Core Competencies in Disaster Nursing (2022) provided a comprehensive framework across eight domains: preparation and planning, communication, incident management systems, safety and security, assessment, intervention, recovery, and law and ethics. However, the ICN framework did not include DVI, mass fatality management, or dead-body handling as competency areas. Similarly, the INCMCE (2003) framework set out 64 competencies for registered nurses responding to mass casualty incidents across the domains of critical thinking, assessment, technical skills, and communication. However, it made no provisions for mortuary operations or body identification.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eTheme 2: Gaps in Frameworks, Education, and Policy\u003c/h2\u003e \u003cp\u003eThe analysis identified several critical gaps that limit nursing participation in DVI. The most significant gap was the absence of a formal role definition for nurses within international DVI frameworks. Although Williams and Williams (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) demonstrated that forensic nurses are operationally embedded in US mass fatality response structures such as DMORT and FACT, this national-level integration has not been mirrored in global competency frameworks. The ICN Core Competencies in Disaster Nursing (2022) and the INCMCE (2003) framework do not include DVI, mass fatality management, dead body management, or forensic identification as competency domains for nurses. The IAFN/ANA (2017) standards provided the most relevant competency guidance, covering forensic evidence collection, medicolegal death investigation, and disaster response, but were not specifically tailored for DVI operations. The INTERPOL DVI Guide (2023), the international standard for DVI operations, does not define specific nursing roles within any phase of the DVI process.\u003c/p\u003e \u003cp\u003ePsychological preparedness represented another critical gap. Lee et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) confirmed that nurses redeployed to decedent handling during COVID-19 were unaccustomed to the physical and mental demands of mortuary work. Although Williams and Williams (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) described Critical Incident Stress Management (CISM) training as part of forensic nursing competency for disaster response, no DVI-specific psychological support program for nurses was identified in the included sources, despite the documented psychological demands of mass fatality work (Adamovic et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Geographic concentration of evidence represented a further gap. No sources were identified from Africa, the Middle East, Latin America, or the Asia-Pacific region, despite these regions experiencing disproportionately high disaster mortality and limited forensic capacity (INTERPOL, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The evidence base remained predominantly descriptive: no experimental or quasi-experimental studies evaluating nursing interventions or the effectiveness of DVI training were identified, and no validated instrument existed to assess DVI-specific competencies among nursing professionals. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarises the critical gaps identified.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e\u0026lt;Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e is about here\u0026gt;\u003c/h2\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e This scoping review mapped the available evidence on the roles, competencies, and contributions of nursing professionals in disaster victim identification (DVI). The principal finding is the marked scarcity of literature explicitly addressing nursing within the DVI domain. Despite a broad search strategy across major databases, citation tracking, and structured grey-literature retrieval, only six eligible sources were identified, of which only two were peer-reviewed empirical reports. This limited evidence base is not merely a bibliographic observation; rather, it reflects the persistent structural invisibility of nursing within a field traditionally dominated by forensic pathology, odontology, anthropology, fingerprint science, and DNA-based identification systems (INTERPOL, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Beauthier et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Lee et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA central finding of this review is the disconnect between operational participation and formal recognition. Available evidence indicates that nurses have participated in mass fatality operations in both emergency and organized forensic settings. For example, Williams and Williams (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) described the longstanding integration of forensic nurses within the United States Disaster Mortuary Operational Response Team (DMORT) and Family Assistance Care Team (FACT), where nurses contributed to scene support, mortuary workflows, ante-mortem family interviewing, specimen handling, and family assistance functions. However, this operational reality is not reflected in leading international frameworks. The current INTERPOL DVI Guide does not explicitly define nursing roles across the four DVI phases, and major disaster nursing competency frameworks similarly provide limited attention to mass fatality management or identification processes (INTERPOL, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; International Council of Nurses, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This mismatch suggests that the principal barrier is not a lack of capability, but a lack of formal role articulation, competency standardization, and policy diffusion across jurisdictions.\u003c/p\u003e \u003cp\u003eThese findings extend prior work by da Silva et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), who identified shared forensic nursing competencies across disaster contexts but did not specifically examine DVI as a distinct medico-legal operational field. Once DVI is considered separately from broader disaster response, the evidence becomes notably sparse. Nevertheless, the available sources consistently indicate that nurses possess competencies highly relevant to DVI. These include structured documentation, chain-of-custody awareness, specimen support, communication with distressed families, trauma-informed interviewing, culturally sensitive care, ethical decision-making, and multidisciplinary coordination (International Association of Forensic Nurses \u0026amp; American Nurses Association, 2017; Valentine et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Such competencies position nursing as a profession uniquely capable of bridging technical forensic requirements with the humanitarian and psychosocial dimensions of identification processes.\u003c/p\u003e \u003cp\u003eThe divide between disaster nursing and forensic nursing appears central to the current evidence gap. Mainstream disaster nursing frameworks have largely focused on triage, emergency treatment, shelter management, public health continuity, and recovery of living populations (International Council of Nurses, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Veenema et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In contrast, forensic nursing has evolved stronger competencies in evidence preservation, medicolegal documentation, death investigation, and trauma-informed care related to violence or sudden death (Lynch, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Drake et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). DVI lies at the intersection of these two fields, yet has not been fully integrated into either the educational or policy domains. As a consequence, disaster nursing curricula may omit competencies related to management of the deceased, while forensic nursing curricula may not systematically address large-scale disaster systems and surge operations. This fragmentation likely contributes to the ad hoc deployment patterns observed during major incidents.\u003c/p\u003e \u003cp\u003eThe implications are particularly significant for low- and middle-income countries (LMICs), where forensic specialists are often limited, and nurses may represent the largest immediately deployable regulated health workforce. Following the 2004 Indian Ocean tsunami, affected countries experienced substantial shortages in forensic identification capacity, delaying body management and victim identification processes (Morgan et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Similar constraints have been reported in other resource-limited disaster settings where infrastructure, trained personnel, and interoperable identification systems are insufficient (International Committee of the Red Cross, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In such contexts, excluding nurses from DVI preparedness planning may represent a missed opportunity at the systems level. Context-adapted nursing roles in temporary mortuary documentation, ante-mortem data collection, family liaison, specimen logistics, and culturally appropriate return-of-remains processes could strengthen national response capacity without requiring immediate expansion of highly specialized forensic staffing.\u003c/p\u003e \u003cp\u003eComparison with other forensic disciplines is also instructive. Forensic odontology, anthropology, and, more recently, postmortem imaging have achieved clearer institutional positioning within DVI systems through dedicated methods, recognized training pathways, and sustained evidence demonstrating utility in identification outcomes (INTERPOL, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Nursing, despite its substantially larger workforce and broader relational competencies, has not undergone comparable international formalization in DVI. This may partly reflect the historical framing of nurses as supportive responders rather than technical contributors within medico-legal operations. Generating empirical evidence on nursing contributions to operational efficiency, family experience, documentation quality, and interagency coordination will be essential if this perception is to change.\u003c/p\u003e \u003cp\u003ePsychological preparedness emerged as another underdeveloped area. Lee et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) documented that nurses and nursing assistants redeployed to decedent handling during the COVID-19 pandemic were often unaccustomed to the physical and emotional demands of mortuary work. Earlier literature on mortuary and forensic personnel similarly reported associations between repeated exposure to mass death and stress reactions, fatigue, sleep disturbance, and emotional burden (McCarroll et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). Contemporary forensic practitioners involved in DVI operations have also described psychological strain, cumulative stress, and organizational pressures (Adamovic et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). If nursing roles in DVI are to be expanded, competency development should include psychological preparation, reflective debriefing, peer-support systems, and clear role expectations before deployment.\u003c/p\u003e \u003cp\u003eThe cultural and ethical dimensions of DVI further underscore the relevance of nursing expertise. Identification processes frequently involve intense grief, uncertainty, and culturally specific expectations regarding dignity, viewing of remains, burial timing, and communication with authorities. Mishandling these processes can undermine family trust and the legitimacy of disaster response. Ethical analyses of dead-body management during epidemics and disasters have emphasized the importance of balancing public health imperatives with cultural and family rights (Suwalowska et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Nursing\u0026rsquo;s longstanding emphasis on person- and family-centered care, communication, advocacy, and culturally responsive practice makes it especially relevant in ante-mortem interviewing, family assistance centers, death notification support, and return-of-remains pathways.\u003c/p\u003e \u003cp\u003eThe current evidence base appears to remain at a pre-empirical stage. Most included sources were descriptive or grey literature, and no interventional studies evaluating DVI-specific nursing education, competency development, or deployment models were identified. No validated instrument measuring DVI competencies among nurses was found. This pattern is consistent with broader observations that disaster nursing research has historically concentrated on preparedness and self-reported competencies, with less emphasis on tested interventions or systems outcomes (Hugelius, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Advancing the field will require movement from descriptive acknowledgment toward measurable implementation science.\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis review has several strengths. It was conducted in accordance with JBI methodology and reported in accordance with PRISMA-ScR, with dual independent screening, pilot calibration, comprehensive citation chasing, and a grey-literature strategy spanning six organizational repositories. The analytic framework was explicitly mapped to the four INTERPOL DVI phases, providing a structure for comparison across heterogeneous sources.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. First, the small number of included sources (N\u0026thinsp;=\u0026thinsp;6) reflects the nascent stage of evidence on nursing roles in DVI; this is itself a finding of the review, but it limits the breadth of conclusions that can be drawn. Second, the strict eligibility criterion requiring explicit reference to nursing professionals resulted in the exclusion of several sources that addressed mass fatality management involving health workers more broadly, without specifically identifying nursing. At the same time, this strengthened the precision and verifiability of findings, but it may have excluded relevant contextual evidence. Third, the included peer-reviewed articles originate predominantly from high-income countries, limiting applicability to LMIC contexts where DVI capacity needs are greatest. Fourth, no conclusions can be drawn about the effectiveness of nursing contributions to DVI outcomes, as no experimental or quasi-experimental studies evaluating nursing interventions or training programs for DVI were identified. Fifth, the inclusion of one textbook chapter as a primary source of operational information, although methodologically justified under our grey-literature inclusion criteria, reflects the unusual state of the evidence base and should be interpreted with appropriate caution regarding generalisability beyond the US context. Finally, the CINAHL database was not searched (owing to institutional access constraints), and the review protocol was not prospectively registered; both decisions are acknowledged as methodological limitations, although the broad grey-literature search, citation chasing, and PRISMA-ScR-compliant reporting partially mitigate these constraints.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice, Education, Policy, and Research\u003c/h2\u003e \u003cp\u003eThe findings support the formal inclusion of nursing professionals in DVI team roles, particularly in areas where existing nursing competencies are directly transferable, such as ante-mortem data collection, family liaison, therapeutic communication, specimen sampling, and culturally competent care. The DMORT and FACT structures described by Williams and Williams (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) provide an operational template that could be contextually adapted for national DVI systems in other jurisdictions, particularly in disaster-prone LMICs. At both undergraduate and postgraduate levels, nursing curricula should include DVI and mass fatality management content to bridge the current divide between disaster nursing and forensic nursing education. Simulated training exercises on body handling, forensic documentation, chain of custody, ante-mortem data collection using structured instruments such as the VIP, and psychological preparation for mortuary work environments should be incorporated into such programs.\u003c/p\u003e \u003cp\u003eInternational organizations such as INTERPOL, the ICN, and the WHO should review their respective policy documents to ensure that nursing roles across all four DVI phases are officially recognized and defined. The operational integration of forensic nurses into DMORT and FACT structures within the US National Disaster Medical System (Williams \u0026amp; Williams, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) provides concrete precedent that could inform international standard-setting. Regional bodies such as the Association of Southeast Asian Nations (ASEAN) and the WHO Regional Office for South-East Asia (SEARO) are well placed to lead context-sensitive adaptation of DVI nursing competencies for disaster-prone LMICs. National disaster management authorities, especially in disaster-prone developing nations, should ensure that nurses are included in DVI preparedness planning and that clear deployment pathways exist. In terms of research, there is a pressing need for primary empirical investigation, including qualitative exploration of the lived experiences of nurses involved in DVI operations, quantitative assessment of DVI-specific competencies among nursing staff, and intervention studies evaluating the effectiveness of DVI training programs for this workforce. The development of a validated, DVI-specific nursing competency assessment instrument would provide a basis for both designing educational programs and evaluating nursing practice.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis scoping review demonstrates that nursing roles in disaster victim identification remain underdocumented, underconceptualized, and underrecognized in the published literature. Only six eligible sources were identified, and only two provided peer-reviewed empirical evidence. Nevertheless, the available evidence consistently indicates that nurses possess competencies directly relevant to DVI, including structured documentation, evidence-aware practice, family liaison, communication, specimen support, culturally sensitive care, and multidisciplinary coordination.\u003c/p\u003e \u003cp\u003eA key conclusion is the persistent disconnect between operational feasibility and formal recognition. Nurses have been integrated into selected mass fatality response structures, most notably within the United States DMORT and FACT systems. Yet, this integration is not mirrored in international DVI standards or mainstream disaster nursing frameworks. This gap represents both a scientific blind spot and a policy vulnerability.\u003c/p\u003e \u003cp\u003eStrengthening future mass fatality preparedness will require explicit recognition of nursing roles within forensic disaster systems, the development of DVI-specific education and competency pathways, and the generation of rigorous empirical evidence across diverse contexts, particularly in LMICs, where workforce flexibility is essential. Making nursing visible within the DVI field is not simply a disciplinary concern; it is a practical step toward more comprehensive, humane, and resilient disaster victim identification systems.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADFAA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAviation Disaster Family Assistance Act\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Nurses Association\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eATF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlcohol, Tobacco, and Firearms\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBCP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Collection Point\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBRNE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChemical, Biological, Radiological, Nuclear, and Explosive\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCDC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCenters for Disease Control and Prevention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCISM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCritical Incident Stress Management\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDMAT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisaster Medical Assistance Team\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDMORT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisaster Mortuary Operational Response Team\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDPMU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisaster Portable Mobile Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisaster Victim Identification\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMAC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency Management Assistance Compact\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency Support Function\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFACT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFamily Assistance Care Team\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFederal Bureau of Investigation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFEMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFederal Emergency Management Agency\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFNE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eForensic Nurse Examiner\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth and Human Services\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh\u0026mdash;Income Country\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIPAA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Insurance Portability and Accountability Act\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIAFN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Association of Forensic Nurses\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Council of Nurses\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Committee of the Red Cross\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eINCMCE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Nursing Coalition for Mass Casualty Education\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eINTERPOL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Criminal Police Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJoanna Briggs Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow\u0026mdash;and Middle\u0026mdash;Income Countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMass Casualty Incident\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMFI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMass Fatality Incident\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNursing Assistant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNDMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Disaster Medical System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNTSB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Transportation Safety Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePAHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePan American Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePopulation, Concept, Context\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePMCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePostmortem Computed Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRISMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e ScR\u0026mdash;Preferred Reporting Items for Systematic Reviews and Meta\u0026mdash;Analyses Extension for Scoping Reviews\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRegistered Nurse\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVIP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVictim Identification Profile\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not received any external funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAdamovic, N., Howes, L. M., White, R., \u0026amp; Julian, R. (2023). Understanding the challenges of disaster victim identification: perspectives of Australian forensic practitioners. Forensic Sciences Research, 8(2), 107\u0026ndash;115. https://doi.org/10.1093/fsr/owad020\u003c/li\u003e\n \u003cli\u003eArksey, H., \u0026amp; O\u0026rsquo;Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19\u0026ndash;32. https://doi.org/10.1080/1364557032000119616\u003c/li\u003e\n \u003cli\u003eBeauthier, J.-P., De Valck, E., Lefevre, P., \u0026amp; De Winne, J. (2009). Mass Disaster Victim Identification: The Tsunami Experience. The Open Forensic Science Journal, 2(1), 54\u0026ndash;62. https://doi.org/10.2174/1874402800902010054\u003c/li\u003e\n \u003cli\u003eCentre for Research on the Epidemiology of Disasters. (2025). 2024 Disasters in Numbers. https://files.emdat.be/reports/2024_EMDAT_report.pdf\u003c/li\u003e\n \u003cli\u003eda Silva, T. A. S. M., Haberland, D. F., Kneodler, T. da S., Duarte, A. C. da S., Williams, J., \u0026amp; Oliveira, A. B. de. (2023). Forensic Nursing competencies in disasters situations: scoping review. Revista Da Escola de Enfermagem Da USP, 57. https://doi.org/10.1590/1980-220x-reeusp-2022-0486en\u003c/li\u003e\n \u003cli\u003eDrake, S. A., \u0026amp; Burton, C. (2022). Trauma-Informed Approaches to Medicolegal Death Investigation: A Forensic Nursing Perspective. Journal of Forensic Nursing, 18(2), 85\u0026ndash;90. https://doi.org/10.1097/JFN.0000000000000359\u003c/li\u003e\n \u003cli\u003eDrake, S. A., Tabor, P., Hamilton, H., \u0026amp; Cannon, A. (2020). Nurses and Medicolegal Death Investigation. Journal of Forensic Nursing, 16(4), 207\u0026ndash;214. https://doi.org/10.1097/JFN.0000000000000310\u003c/li\u003e\n \u003cli\u003eFletcher, K. A., Reddin, K., \u0026amp; Tait, D. (2022). The history of disaster nursing: from Nightingale to nursing in the 21st century. Journal of Research in Nursing, 27(3), 257\u0026ndash;272. https://doi.org/10.1177/17449871211058854\u003c/li\u003e\n \u003cli\u003eHugelius, K. (2021). Disaster nursing research: A scoping review of the nature, content, and trends of studies published during 2011\u0026ndash;2020. International Emergency Nursing, 59, 101107. https://doi.org/10.1016/j.ienj.2021.101107\u003c/li\u003e\n \u003cli\u003eInternational Association of Forensic Nurses, \u0026amp; American Nurses Association. (2017). Forensic Nursing: Scope and Standards of Practice (2nd ed.). American Nurses Association.\u003c/li\u003e\n \u003cli\u003eInternational Committee of the Red Cross. (2022). The Forensic Human Identification Process: an Integrated Approach. https://library.icrc.org/library/docs/DOC/icrc-4590-002.pdf\u003c/li\u003e\n \u003cli\u003eInternational Council of Nurses. (2022). ICN core competencies in disaster nursing. https://www.icn.ch/sites/default/files/2023-04/ICN_2022_Disaster-Comp-Report_EN_WEB.pdf\u003c/li\u003e\n \u003cli\u003eInternational Nursing Coalition for Mass Casualty Education. (2003). Educational Competencies for Registered Nurses Responding to Mass Casualty Incidents. https://www.aacnnursing.org/Portals/0/PDFs/Teaching-Resources/INCMCECompetencies.pdf\u003c/li\u003e\n \u003cli\u003eINTERPOL. (2023). Disaster victim identification guide. https://www.interpol.int/content/download/589/file/DVI_DVI%20Guide%202023.pdf\u003c/li\u003e\n \u003cli\u003eLee, T., Roy, A., Power, P., Sembajwe, G., \u0026amp; Dropkin, J. (2022). Ergonomic exposures and control measures associated with mass fatality decedent handling in morgues and body collection points in a New York healthcare system during COVID-19: A case series. International Journal of Industrial Ergonomics, 88, 103260. https://doi.org/10.1016/j.ergon.2022.103260\u003c/li\u003e\n \u003cli\u003eLevac, D., Colquhoun, H., \u0026amp; O\u0026rsquo;Brien, K. K. (2010). Scoping studies: advancing the methodology. Implementation Science, 5(1), 69. https://doi.org/10.1186/1748-5908-5-69\u003c/li\u003e\n \u003cli\u003eLynch, V. A. (2011). Forensic nursing science: Global strategies in health and justice. Egyptian Journal of Forensic Sciences, 1(2), 69\u0026ndash;76. https://doi.org/10.1016/j.ejfs.2011.04.001\u003c/li\u003e\n \u003cli\u003eMcCarroll, J. E., Ursano, R. J., Fullerton, C. S., \u0026amp; Lundy, A. (1993). Traumatic Stress of a Wartime Mortuary. The Journal of Nervous and Mental Disease, 181(9), 545\u0026ndash;551. https://doi.org/10.1097/00005053-199309000-00003\u003c/li\u003e\n \u003cli\u003eMorgan, O. W., Sribanditmongkol, P., Perera, C., Sulasmi, Y., Van Alphen, D., \u0026amp; Sondorp, E. (2006). Mass Fatality Management following the South Asian Tsunami Disaster: Case Studies in Thailand, Indonesia, and Sri Lanka. PLoS Medicine, 3(6), e195. https://doi.org/10.1371/journal.pmed.0030195\u003c/li\u003e\n \u003cli\u003eNational Academy of Medicine, National Academies of Sciences, Engineering, and Medicine, \u0026amp; Committee on the Future of Nursing 2020\u0026ndash;2030. (2021). The Future of Nursing 2020-2030. National Academies Press. https://doi.org/10.17226/25982\u003c/li\u003e\n \u003cli\u003eOuzzani, M., Hammady, H., Fedorowicz, Z., \u0026amp; Elmagarmid, A. (2016). Rayyan\u0026mdash;a web and mobile app for systematic reviews. Systematic Reviews, 5(1), 210. https://doi.org/10.1186/s13643-016-0384-4\u003c/li\u003e\n \u003cli\u003ePeters, M. D. J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A. C., \u0026amp; Khalil, H. (2020). Chapter 11: Scoping reviews (2020 version). In E. Aromataris \u0026amp; Z. Munn (Eds.), JBI Manual for Evidence Synthesis. JBI. https://doi.org/10.46658/JBIMES-20-12\u003c/li\u003e\n \u003cli\u003eSuwalowska, H., Amara, F., Roberts, N., \u0026amp; Kingori, P. (2021). Ethical and sociocultural challenges in managing dead bodies during epidemics and natural disasters. BMJ Global Health, 6(11), e006345. https://doi.org/10.1136/bmjgh-2021-006345\u003c/li\u003e\n \u003cli\u003eTricco, A. C., Lillie, E., Zarin, W., O\u0026rsquo;Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., \u0026hellip; Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), 467\u0026ndash;473. https://doi.org/10.7326/M18-0850\u003c/li\u003e\n \u003cli\u003eUnited Nations Office for Disaster Risk Reduction. (2022). Global assessment report on disaster risk reduction 2022: Our world at risk: Transforming governance for a resilient future. https://www.undrr.org/gar/gar2022-our-world-risk-gar\u003c/li\u003e\n \u003cli\u003eValentine, J. L., Sekula, L. K., \u0026amp; Lynch, V. (2020). Evolution of Forensic Nursing Theory\u0026mdash;Introduction of the Constructed Theory of Forensic Nursing Care: A Middle-Range Theory. Journal of Forensic Nursing, 16(4), 188\u0026ndash;198. https://doi.org/10.1097/JFN.0000000000000287\u003c/li\u003e\n \u003cli\u003eVeenema, T. G., Griffin, A., Gable, A. R., MacIntyre, L., Simons, R. N., Couig, M. P., Walsh, J. J., Lavin, R. P., Dobalian, A., \u0026amp; Larson, E. (2016). Nurses as Leaders in Disaster Preparedness and Response\u0026mdash;A Call to Action. Journal of Nursing Scholarship, 48(2), 187\u0026ndash;200. https://doi.org/10.1111/jnu.12198\u003c/li\u003e\n \u003cli\u003eWilliams, J., \u0026amp; Williams, D. (2011). Multi-Casualty Scenes. In V. A. Lynch \u0026amp; J. B. Duval (Eds.), Forensic Nursing Science (2nd ed., pp. 627\u0026ndash;652). Mosby/Elsevier.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2020). State of the World\u0026rsquo;s Nursing 2020: Investing in Education, Jobs, and Leadership. https://www.who.int/publications/i/item/9789240003279\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"egyptian-journal-of-forensic-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejfs","sideBox":"Learn more about [Egyptian Journal of Forensic Sciences](http://ejfs.springeropen.com)","snPcode":"41935","submissionUrl":"https://submission.springernature.com/new-submission/41935/3?","title":"Egyptian Journal of Forensic Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"disaster victim identification, forensic nursing, disaster nursing, nursing competencies, forensic preparedness","lastPublishedDoi":"10.21203/rs.3.rs-9536048/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9536048/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Disaster victim identification (DVI) is a critical component of forensic and humanitarian disaster response. Although nurses constitute the largest segment of the global health workforce and are frequently mobilized during disasters, their roles in DVI and mass fatality management remain poorly defined in international standards and disaster nursing frameworks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain body:\u003c/strong\u003e This scoping review aimed to map the available evidence on the roles, competencies, and contributions of nursing professionals in DVI. The review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guideline. Searches of MEDLINE (via PubMed), Web of Science (Core Collection), and Scopus were conducted, supplemented by citation chasing, a grey-literature search across six organizational repositories, and targeted handsearching of forensic nursing reference texts. Three reviewers independently screened records and extracted data. Six sources met the inclusion criteria: two peer-reviewed primary studies and four grey-literature sources, including two nursing competency frameworks, one professional standards document, and one forensic nursing textbook chapter. The primary studies documented nursing participation in mass fatality operations in two distinct contexts: a nurse formally integrated into a Belgian DVI team during the 2004 Indian Ocean Tsunami response, and nurses and nursing assistants redeployed to decedent handling during the COVID-19 pandemic in New York. The most comprehensive operational account was a forensic nursing textbook chapter describing nursing roles across all four INTERPOL DVI phases and their formal integration into the US Disaster Mortuary Operational Response Team and Family Assistance Care Team. Across sources, two themes were identified: (1) nursing roles and transferable competencies relevant to DVI, including evidence handling, documentation, family liaison, specimen collection, and culturally sensitive care; and (2) persistent gaps in policy, education, and formal role recognition. Notably, neither the INTERPOL DVI Guide (2023) nor the ICN Core Competencies in Disaster Nursing (2022) formally defines nursing roles in DVI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The evidence base on nursing in DVI is extremely limited, but the available literature indicates that nurses possess competencies directly relevant to forensic identification and mass fatality response. Formal integration exists in selected national forensic response structures, yet this is not reflected in international DVI standards. Recognizing nursing within DVI frameworks, developing DVI-specific education, and generating empirical evidence are necessary to strengthen global forensic preparedness, particularly in low- and middle-income settings.\u003c/p\u003e","manuscriptTitle":"Nursing Roles and Competencies in Disaster Victim Identification: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 14:41:09","doi":"10.21203/rs.3.rs-9536048/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-07T17:53:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188077793906861415967266051834005692285","date":"2026-05-04T04:16:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177041147317481999874159501631992814274","date":"2026-04-30T08:30:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-28T12:56:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-28T07:12:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-28T06:49:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Egyptian Journal of Forensic Sciences","date":"2026-04-27T03:51:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"egyptian-journal-of-forensic-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejfs","sideBox":"Learn more about [Egyptian Journal of Forensic Sciences](http://ejfs.springeropen.com)","snPcode":"41935","submissionUrl":"https://submission.springernature.com/new-submission/41935/3?","title":"Egyptian Journal of Forensic Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2a62ce52-6c7d-48f5-805e-a336ba43dc2e","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-07T17:53:13+00:00","index":16,"fulltext":""},{"type":"reviewerAgreed","content":"188077793906861415967266051834005692285","date":"2026-05-04T04:16:24+00:00","index":15,"fulltext":""},{"type":"reviewerAgreed","content":"177041147317481999874159501631992814274","date":"2026-04-30T08:30:39+00:00","index":14,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T14:41:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 14:41:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9536048","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9536048","identity":"rs-9536048","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}