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Dead Bodies and Disasters: Principles of Mortuary Services

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Title: Dead Bodies and Disasters: Principles of Mortuary Services


1
Dead Bodies and Disasters Principles of Mortuary
Services
  • Amado Alejandro Baez MD MSc EMT-P
  • Brigham and Womens Hospital / Harvard Medical
    School
  • aabaez_at_partners.org
  • Senior Advisor National Directorate of
    Emergencies and Disasters
  • Dominican Republic State Secretary of Public
    Health and Social Assistance

2
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3
"We were working for the living, and now we are
working for the dead and the living," "It's
pretty tough, pulling out dead bodies." A
Louisiana State Medical officer referring to the
devastating aftermath of the August 2005
hurricane Katrina
4
Objectives
  • At the end of this lecture the participant will
    be able to
  • Understand the basic principles of the management
    of dead bodies in disasters.
  • Review important epidemiological issues related
    to mass dead bodies.
  • Understand principles of cadaver identification.
  • Review techniques of dead body disposal in
    disasters.

5
Cadaver Recuperation Process
Coordination and Communication
6
Equipment for mortuary services in major disasters
  • Stainless steel postmortem tables covered with
    plastic
  • Wheeled trolleys for transportation within the
    mortuary.
  • Plastic sheeting for the floor.
  • Heavy-duty black plastic sheeting for temporary
    screens.
  • Refuse bins and bags.
  • Cleaning materials mops, buckets, cloths, soap,
    towels.
  • Disinfectant and deodorizer.
  • Protective clothing and heavy-duty rubber gloves.
  • Translucent plastic body bags 0.1 mm thick and
    labels.
  • Wall charts to record progress or large poster
    boards if there are no walls.

7
Coordination Support
8
Body Recovery
  • Initial element in the cadaver management
    process.
  • Can be initially chaotic and extremely
    distressful.
  • Need to involve search and rescue groups.
  • Need for tagging bodies (name location etc..) to
    allow further identification.
  • Equipment can be diverse
  • Basic usually in the initial phase
  • Volunteers, wheel barrels
  • Advanced after improved resources
  • Trucks, planes buses

9
Storage and Body Preservation
10
Storage Issues
  • Without proper storage, bodies may began to
    decompose early depending on environmental
    temperature.
  • Storage Options
  • Refrigeration
  • Ice and Dry ice
  • Temporary burial

11
Body preservation measures
  • Body preservation measures are required on
    arrival.
  • Anticipate need for refrigerated holding areas.
  • Mobile or portable refrigeration units
    (refrigerated containers or trucks)
  • The morgues refrigeration capacity will most
    likely be exceeded during a disaster.
  • Keep refrigerated trucks close to holding site.
  • Need for use of other preservative measures
  • Calcium hydroxide, formol and zeolite

12
Identification of Bodies
13
Methods of Identification
  • Personal effects
  • Identity cards
  • Rings, necklaces
  • Telephone memory cards
  • Location of body.
  • Internet sites.
  • Message boards with photos of missing.
  • Red Cross.

14
Viewing and photographing
  • Should be arranged quickly.
  • Decomposition may be too advanced after 24-48hrs
  • Arranged locally when possible.
  • Logistically very difficult .
  • Distressing for relatives.
  • Photographs face body.
  • Soon after death
  • Possibly the best postmortem information
    available in mass fatality incident

15
Disaster Forensic Methods
  • Standard methods
  • Dental analysis
  • Limited by
  • Lack of comparison elements
  • Availability of resources
  • DNA techniques
  • Limited by costs and availability of expertise
    and resources

16
DNA analysis
  • Consideration of established techniques.
  • Choice of most informative and valid technique.
  • Application of analysis techniques for DNA
    according to necessity and availability of each
    sample.
  • Need for reference materials and conclusive
    samples.

17
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18
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19
Identification of bodies Key Points
  • Records of deaths kept to monitor mortality rates
    and the incidence of disease.
  • Displaying bodies for identification requires
    space
  • 1000 bodies require over 2000m2.
  • When possible avoid relatives viewing many
    bodies.
  • Separate location for identification and
    grieving.
  • Once identified, a death certificate should be
    issued and body tagged.
  • With violent deaths, record the cause of death
    for possible future investigation.

20
There is no evidence that, following a natural
disaster, dead bodies pose a risk of epidemics.
Epidemic-causing acute diseases are unlikely to
be more common among disaster victims than among
the general population, suggesting that the risk
to the general public is negligible
21
Categories and examples of infectious hazards
associated with cadavers after a natural disaster
  • Gastrointestinal
  • Rotavirus diarrhea
  • Campylobacter enteritis
  • Salmonellosis
  • Enteric fevers (typhoid and paratyphoid)
  • Escherichia coli
  • Hepatitis A
  • Shigellosis
  • Cholera
  • Bloodborne
  • Hepatitis B
  • Hepatitis C
  • HIV
  • Respiratory
  • Tuberculosis

22
Burial Services
  • Burial is the preferred method of body disposal.
  • Attention to ground conditions.
  • Groundwater drinking sources should be a least
    50m away
  • An area of at least 1500m2 per 10,000 population
    is required.
  • The burial site can be divided to accommodate
    different religious groups.
  • Burial depth should be at least 1.5m above the
    groundwater table, with at least a 1m covering of
    soil.
  • Burial in individual graves is preferred
  • If coffins are not available, corpses should be
    wrapped in plastic sheeting.

23
Burial
  • Preserve evidence.
  • Location of suitable grave sites difficult
  • Local communities
  • Environmental health concerns
  • Operational difficulties
  • Lack of suitable documentation
  • Single graves or trench graves?
  • Clearly marked, not a hole in the ground
  • Minimum burial depth, distance from water sources
    etc.

24
Cremation
  • There are no health advantages of cremation over
    burial.
  • Some communities may prefer it for religious or
    cultural reasons.
  • Factors against it
  • The amount of fuel required by a single
    cremation (approx 300kg wood)
  • Smoke pollution caused.

25
Suggestions for burial
  • Trench graves.
  • One layer of bodies
  • Location of each body clearly marked,
    corresponding with identification data
  • Grave construction
  • Water table at least 2.5m deep
  • Bodies buried at least 1.5m deep
  • 30m from springs watercourses
  • 250m from wells drinking water sources

26
  • Burials in common graves and mass cremations are
    rarely warranted and should be avoided.
  • Pan American Health Organization. Management of
    Dead Bodies in Disaster Situations. Washington
    DC PAHO, 2004.

27
Recommendations for managingthe dead following
natural disasters
  • Universal precautions for blood and body fluids.
  • Time for action is short.
  • Decomposition 24-72 hrs
  • Body recovery begins immediately
  • Avoiding cross-contamination of personal items.
  • Washing hands after handling bodies and before
    eating.
  • Disinfection of vehicles and equipment.
  • Use of body bags.
  • Hepatitis B and tetanus vaccination.
  • No special arrangements, such as disinfection
    with disposal of bodies.
  • New burial areas site at least 250 m away from
    drinking water sources, and with at least 0.7 m
    of distance above the saturated zone.

28
Important principles
  • Give priority to the living over the dead.
  • Dispel myths about health risks posed by corpses.
  • Identify and tag corpses.
  • Provide appropriate mortuary services.
  • Reject unceremonious and mass disposal of
    unidentified corpses.
  • Respond to the wishes of the family.
  • Respect cultural and religious observances.
  • Protect communities from the transmission of
    medical epidemics.

29
Disposal of dead bodies in emergency
conditions World Health Organization
http//www.who.int
30
http//www.paho.org/english/dd/ped/ManejoCadaveres
.htm
31
References
  • Harvey, P., Baghri, S. and Reed, R.A. (2002)
    Emergency Sanitation, Assessment and Programme
    Design. WEDC, Loughborough, UK.
  • Davis, J. and Lambert, R. (2002) Engineering in
    Emergencies a Practical Guide for Relief
    Workers, (2nd. Edn.) ITDG Publishing, London.
    Wisner, B. and Adams, J. (eds.) (2002)
    Environmental
  • Health in Emergencies and Disasters. WHO, Geneva.
    Pan American Health Organization (PAHO) (2003)
    Unseating the Myths Surrounding the Management
    of Cadavers, Disaster newsletter, No. 93,
    October 2003. PAHO, USA.
  • http//www.pitt.edu/super1/lecture/lec18941/index
    .htm
  • Oliver Morgan Egbert Sondorp Management of the
    dead following the South Asian tsunami
    disaster.January 2005. retrieved from the web at
    http//www.omorgan.info/download/projects/Study20
    Protocol2020Dead20bodies20after20the20Tsunam
    i.pdf
  • Morgan O. Infectious disease risk of dead bodies
    following natural disasters. Rev Panam Salud
    200415(5)307-312.
  • Pan American Health Organization. Management of
    Dead Bodies in Disaster Situations. Washington
    DC PAHO, 2004.
  • Yin R. Case Study Research. Design and Methods.
    London Sage Publications,2003.
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