Dead bodies and disasters

Dead Bodies and Disasters:Dead Bodies and Disasters:
Principles of MortuaryPrinciples of Mortuary
ServicesServices
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"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

ObjectivesObjectives
At the end of this lecture the participant will beAt the end of this lecture the participant will be
able to:able to:
 Understand the basic principles of theUnderstand the basic principles of the
management of dead bodies in disasters.management of dead bodies in disasters.
 Review important epidemiological issuesReview important epidemiological issues
related to mass dead bodies.related to mass dead bodies.
 Understand principles of cadaverUnderstand principles of cadaver
identification.identification.
 Review techniques of dead body disposal inReview techniques of dead body disposal in
disasters.disasters.

Cadaver Recuperation ProcessCadaver Recuperation Process
Search
Localize
Transport
Temporary
deposit
and
Analysis *
Final
Disposition
Release to
relatives
EVENT
FollowUp
Coordination and Communication
Stages of the Process

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

Coordination & SupportCoordination & Support
Body
Recovery
Communities, volunteers,
NGOs, police, military
Identification
Doctors, medical staff, forensic specialists,
foreign embassies, INTERPOL, NGOs
Death
certification
Coroners, police
Disposal Military, police, local authorities

Body RecoveryBody Recovery
 Initial element in the cadaverInitial element in the cadaver
management process.management process.
 Can be initially chaotic and extremelyCan be initially chaotic and extremely
distressful.distressful.
 Need to involve search and rescueNeed to involve search and rescue
groups.groups.
 Need for tagging bodies (name locationNeed for tagging bodies (name location
etc..) to allow further identification.etc..) to allow further identification.
 Equipment can be diverseEquipment can be diverse
– Basic usually in the initial phaseBasic usually in the initial phase
 Volunteers, wheel barrelsVolunteers, wheel barrels
– Advanced after improved resourcesAdvanced after improved resources
 Trucks, planes busesTrucks, planes buses

Storage and Body Preservation

Storage IssuesStorage Issues
 Without proper storage, bodiesWithout proper storage, bodies
may began to decompose earlymay began to decompose early
depending on environmentaldepending on environmental
temperature.temperature.
 Storage Options:Storage Options:
– RefrigerationRefrigeration
– Ice and Dry iceIce and Dry ice
– Temporary burialTemporary burial

Body preservation measuresBody preservation measures
 Body preservation measures are required onBody preservation measures are required on
arrival.arrival.
 Anticipate need for refrigerated holding areas.Anticipate need for refrigerated holding areas.
– Mobile or portable refrigeration units (refrigeratedMobile or portable refrigeration units (refrigerated
containers or trucks)containers or trucks)
 The morgue’s refrigeration capacity will mostThe morgue’s refrigeration capacity will most
likely be exceeded during a disaster.likely be exceeded during a disaster.
 Keep refrigerated trucks close to holding site.Keep refrigerated trucks close to holding site.
 Need for use of other preservative measures:Need for use of other preservative measures:
 Calcium hydroxide, formol and zeoliteCalcium hydroxide, formol and zeolite

Identification of BodiesIdentification of Bodies

Methods of IdentificationMethods of Identification
 Personal effects:Personal effects:
– Identity cardsIdentity cards
– Rings, necklacesRings, necklaces
– Telephone memory cardsTelephone memory cards
 Location of body.Location of body.
 Internet sites.Internet sites.
 Message boards with photos of missing.Message boards with photos of missing.
 Red Cross.Red Cross.

Viewing andViewing and
photographingphotographing
 Should be arranged quickly.Should be arranged quickly.
– Decomposition may be too advanced after 24-Decomposition may be too advanced after 24-
48hrs48hrs
 Arranged locally when possible.Arranged locally when possible.
 Logistically very difficult .Logistically very difficult .
 Distressing for relatives.Distressing for relatives.
 Photographs – face & body.Photographs – face & body.
– Soon after deathSoon after death
– Possibly the best postmortem informationPossibly the best postmortem information
available in mass fatality incidentavailable in mass fatality incident

Disaster Forensic MethodsDisaster Forensic Methods
 Standard methodsStandard methods
 Dental analysisDental analysis
– Limited by:Limited by:
 Lack of comparison elementsLack of comparison elements
 Availability of resourcesAvailability of resources
 DNA techniquesDNA techniques
– Limited by costs and availability ofLimited by costs and availability of
expertise and resourcesexpertise and resources

DNA analysisDNA analysis
 Consideration of establishedConsideration of established
techniques.techniques.
 Choice of most informative andChoice of most informative and
valid technique.valid technique.
 Application of analysisApplication of analysis
techniques for DNA according totechniques for DNA according to
necessity and availability ofnecessity and availability of
each sample.each sample.
 Need for reference materialsNeed for reference materials
and conclusive samples.and conclusive samples.The Nurses and attendants staff we provide for your

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

“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”

Categories and examples ofCategories and examples of
infectious hazards associated withinfectious hazards associated with
cadavers after a natural disastercadavers after a natural disaster
 BloodborneBloodborne
– Hepatitis BHepatitis B
– Hepatitis CHepatitis C
– HIVHIV
 RespiratoryRespiratory
– TuberculosisTuberculosis
 GastrointestinalGastrointestinal
– Rotavirus diarrheaRotavirus diarrhea
– Campylobacter enteritisCampylobacter enteritis
– SalmonellosisSalmonellosis
– Enteric fevers (typhoidEnteric fevers (typhoid
and paratyphoid)and paratyphoid)
– Escherichia coliEscherichia coli
– Hepatitis AHepatitis A
– ShigellosisShigellosis
– CholeraCholera

Burial ServicesBurial Services
 Burial is the preferredBurial is the preferred
method of bodymethod of body
disposal.disposal.
 Attention to groundAttention to ground
conditions.conditions.
– Groundwater drinkingGroundwater drinking
sources should be asources should be a
least 50m awayleast 50m away
 An area of at leastAn area of at least
1500m2 per 10,0001500m2 per 10,000
population is required.population is required.
 The burial site can beThe burial site can be
divided to accommodatedivided to accommodate
different religiousdifferent religious
groups.groups.
 Burial depth shouldBurial depth should
be at least 1.5mbe at least 1.5m
above theabove the
groundwater table,groundwater table,
with at least a 1mwith at least a 1m
covering of soil.covering of soil.
 Burial in individualBurial in individual
graves is preferredgraves is preferred
 If coffins are notIf coffins are not
available, corpsesavailable, corpses
should be wrappedshould be wrapped
in plastic sheeting.in plastic sheeting.

BurialBurial
 Preserve evidence.Preserve evidence.
 Location of suitable grave sitesLocation of suitable grave sites
difficultdifficult
– Local communitiesLocal communities
– Environmental health concernsEnvironmental health concerns
 Operational difficultiesOperational difficulties
– Lack of suitable documentationLack of suitable documentation
– Single graves or trench graves?Single graves or trench graves?
– Clearly marked, not a ‘hole in theClearly marked, not a ‘hole in the
ground’ground’
– Minimum burial depth, distance fromMinimum burial depth, distance from
water sources etc.water sources etc.

CremationCremation
 There are no health advantages ofThere are no health advantages of
cremation over burial.cremation over burial.
 Some communities may prefer itSome communities may prefer it
for religious or cultural reasons.for religious or cultural reasons.
 Factors against it:Factors against it:
– The amount of fuel required by aThe amount of fuel required by a
single cremation (approx 300kg wood)single cremation (approx 300kg wood)
– Smoke pollution caused.Smoke pollution caused.

Suggestions for burialSuggestions for burial
 Trench graves.Trench graves.
 One layer of bodiesOne layer of bodies
 Location of each body clearlyLocation of each body clearly
marked, corresponding withmarked, corresponding with
identification dataidentification data
 Grave constructionGrave construction
– Water table at least 2.5m deepWater table at least 2.5m deep
– Bodies buried at least 1.5m deepBodies buried at least 1.5m deep
– 30m from springs & watercourses30m from springs & watercourses
– 250m from wells & drinking water250m from wells & drinking water
sourcessourcesThe Nurses and attendants staff we provide for your

 Burials in common graves andBurials in common graves and
mass cremations are rarelymass cremations are rarely
warranted and should bewarranted and should be
avoided.avoided.
Pan American Health Organization. Management of Dead Bodies inPan American Health Organization. Management of Dead Bodies in
Disaster Situations. Washington DC: PAHO, 2004.Disaster Situations. Washington DC: PAHO, 2004.

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

Important principlesImportant principles
 Give priority to the living over the dead.Give priority to the living over the dead.
 Dispel myths about health risks posed byDispel myths about health risks posed by
corpses.corpses.
 Identify and tag corpses.Identify and tag corpses.
 Provide appropriate mortuary services.Provide appropriate mortuary services.
 Reject unceremonious and mass disposalReject unceremonious and mass disposal
of unidentified corpses.of unidentified corpses.
 Respond to the wishes of the family.Respond to the wishes of the family.
 Respect cultural and religiousRespect cultural and religious
observances.observances.
 Protect communities from theProtect communities from the
transmission of medical epidemics.transmission of medical epidemics.The Nurses and attendants staff we provide for your

Disposal of dead bodies in emergency conditions
World Health Organization http://www.who.int

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Dead bodies and disasters

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