Cross-border disaster victim identification after the Struma Motorway bus fire: operational response and element-by-element comparison with the INTERPOL DVI Guide

Background Mass-fatality road incidents with severely burned victims require integration of scene recovery, post-mortem examination, ante-mortem information and reconciliation. In the Struma Motorway bus fire in Bulgaria on 23 November 2021, all victims were nationals of the neighbouring country. This report presents the findings from all 45 decedents, describes the local workflow assembled out of necessity, and compares it element by element with the INTERPOL Disaster Victim Identification (DVI) Guide. It is a retrospective review of the judicially mandated medico-legal investigation, based on the scene, autopsy, toxicology and DNA records, the ante-mortem material from North Macedonia and the identification outcomes. Carboxyhemoglobin and recovery position were transcribed from the annotated scene schematic, and 33 Guide elements were extracted before scoring and assigned one of five descriptors, from fulfilled to not fulfilled. Results The first search did not clear all compartments of the vehicle; when reconciliation showed one passenger unaccounted for, a repeat examination recovered the 45th decedent, a child, from a luggage hold. DNA profiles from all 45 sets of remains were compared with those of 34 relatives sampled in North Macedonia; DNA and dental analysis resolved a dizygotic twin pair and two sibling groups. All 45 victims were identified within 10 days. The certified cause of death was fatal thermal injury in all 45; a vital injury not attributable to heat was found in one. Carboxyhemoglobin was not detected in seven decedents and reached 49%, increasing from front to rear (zone medians 9%, 16%, 23%). Of 33 Guide elements, 17 were fulfilled by a documented local equivalent, 10 with partial documentation and 1 was not fulfilled; 2 were not applicable and 3 remain to be put in place. Conclusions Assembled in hours because no standing DVI team existed, the response identified all victims, with two documented shortfalls: an incomplete first search and a numbering convention that differed between two scene documents. Transferable elements are early cross-border collection of ante-mortem material, parallel post-mortem workstreams, reconciliation empowered to reopen a closed phase, and strict enforcement of the primary-identifier hierarchy. Foremost to prepare in advance is a trained national DVI team.