Removing A Deceased Person
SAMPLE
17.1 Purpose
This unit covers steps for removing a deceased person from the place of death, or the coroner's office. In reality, removal of a body is the first step in the embalming process. The procedures are important in your process of the funeral service education.
17.2 Vocabulary List
Arterial Fluid - Embalming fluid injected into the circulatory system of the deceased, to disinfect, and preserve for viewing.
Aspiration - Removal of natural cavity fluids by piercing and suction.
Cavity Fluid - Embalming fluid induced into thoracic and abdominal cavities of the deceased to disinfect, and preserve for viewing.
Dilution - Reducing the concentration of a liquid by adding another liquid.
Dressing Table - Flat table on wheels with non-porous top, used for dressing, hairdressing and applying cosmetics to a dead human body. May also be used in a cooler, if applicable.
Embalming Room, ER, Operating Room, Preparation Room, Prep Room, Morgue - Refers to the area of funeral home designated embalming and preparation of the dead.
Embalming Machine - Tank and pump combination used for diluting fluids and injecting the solution through a rubber or plastic hose into a dead human body.
Embalming Table - Special operating table set up for embalming. Usably has an adjustable height and pitch to accommodate embalmer and conditions. Always have very positive drainage, and a non-porous surface.
First Call Car - Van, Station wagon, or hearse used to pick up human remains at home, institution or coroner's office.
Foley Catheter - A tube extending from the bladder to a storage bag for collecting urine in patients that are incontinent or immobile.
Formalins - Combination of formaldehyde in water or alcoholic solution.
Head Block - Device used to support head or arms during transport or preparation of a dead human body.
Index - The strength of embalming fluid used by some manufacturers.
Instruments - Operating tools of the embalmer.
Multilevel Cot - Adjustable cot, capable of being raised to various heights for the convenience of the user.
Purge - Post-mortem evacuation of any substance from any orifice of the dead body, as a result of pressure.
17.3 Removals
The three places from which a funeral director is usually asked to remove a diseased human body is:
- Hospital or nursing home
- Residence of deceased
- Coroner's office
If someone dies outside the home, but not in an institution, they are usually taken to the coroner's office. In small rural areas the coroner's office can actually be the funeral home, and the funeral director, also the coroner. Regardless from which facility you make the removal; you will need to take the following items with you:
- Hearse, station wagon or van
- A cot, preferably a 1 man designed with cover
- A strong helper
- At least 1 clean sheet
- A head rest or pillow
- Good directions, name, etc.
- Blank death certificates
- Infectious case kit-disaster pouch
You should always present a professional appearance when making a removal; a suit or company uniform is preferable. Remember that some states require a licensed employee to perform this task.
The diseased person will be wrapped in a clean sheet, and handled with respect and dignity. Be professional, you are a representative of your firm, and institute.
Hospital Removals - Removal is made with a release signed by the family. Hospitals can contact the funeral home directly, if they have a signed release. Hospitals are serious about this, so your chance of making a removal without a release are slim to none.
During normal working hours, the admissions office handles the release. In large city hospitals, sometime there is a mortician's office, staffed by licensed embalmers. Your job is easy in this situation, because they know your problems and are good at their jobs, but you will be usually dealing with the admitting clerk. Park the removal vehicle near the morgue, and walk to admitting. After signing for the diseased, you will be directed to the morgue (you do not show up at necessary). At the morgue, a security person, nurse, or someone responsible for insuring for insuring the right body leaves with the right funeral director will meet you.
Be sure to support the neck and head when transferring the deceased to the cot. You need to know if this is an infectious case (see handling infectious cases, this unit). The deceased should be wrapped at the hospital; you may be able to take the hospital, sheet, or trade sheets with the attendant. Once on the cot, make sure the head is propped up on a pillow or head block, to prevent a purge (nasty mess caused by gas build-up, pushing food, etc. through mouth).
The cot cover should be zippered closed, and the deceased wheeled to the first call car. People have different ideas about which end of the cot the head should be, I prefer feet first into the car. Your boss will have his own view on this process......follow it!
If a death occurs at night, you may make the removal from a room. Making a room removal is preferable to a morgue removal, because the height of your cot, and the deceased is in a bed that can be mechanically raised or lowered to the height of your cot, and the deceased pulled across rather than lifted. This is accomplished by placing the between the deceased and you, and pulling the sheet under the decedent toward you. Nurses are very helpful in moving people around. Remember, this nurse has a family too, and when there is a death in her family, she may make the decision about which funeral home to use, based on whom she deems most professional.
NURSING HOMES present another set of challenges for the novice removal team. You will almost, always be going to the patient's room, this is very sad during the day, when the other patients are watching you.... and they do. Once, we tilted the cot, and left the face exposed, as if the deceased were going to the hospital. Many residents talked to the deceased on our trip to the car. That trip seemed like a mile! Nursing homes are not nearly as particular about releasing a deceased to a funeral director, they do not want a body on hand one minute longer than necessary.
Take the time to talk to the residents when you visit a nursing home. They are frightened, and all know that someday they will be leaving the same way. It doesn't hurt to comfort a friend who has absolutely nothing better to do but take up your time. You must find the balance between being a good person, and making the boss angry.
RESIDENCE REMOVALS are a delicate matter. Ask yourself, “Is this a legal removal?” If there are any suspicious circumstances about the deceased, it must be reported (as blood dripping from a hole in the kidney area, pills all around the body). These are coroner cases and must be reported. If in doubt, have the funeral director get a release from the coroner. It is the responsibility of a licensed funeral director to determine if the removal is legal.
First, do not back into the house as soon as you arrive. Take some time to meet the family and assess the situation, which door is best, etc. When looking at the deceased, ask yourself these questions:
- Will my cot make the turns into the room?
- Are the sheets badly soiled?
- Does the deceased have any tubing, such as IV's or catheters?
- Do I have sufficient manpower to move this person?
- Should I ask the family to wait elsewhere?
Four hundred pound people die too! If you have only one helper and the deceased is up a flight of stairs, you better have a strong helper! Better yet, get several helpers, it's easy to get hurt with this type of removal.
If the sheets are badly soiled, or the clothing is not cleanable, ask the family if they want you to dispose of it for them (plastic bag). Many bedridden patients are incontinent, (they do not have control of their bowels or bladder). There may be a tube (catheter) leading from the pubic area to a bag on the lower side of the bed. You can cut the tube soon as you cut the tube, the air bubble that held the end in the bladder will deflate and then can be removed. Flush contents of the urine bag in the toilet, and place bag and tubing in a plastic bag.
Be very careful of furniture, with the cot, and watch slipping on area rugs, take it slow and easy. The family will appreciate this, you are their first contact for this funeral, so make a good impression.
CORONERS OFFICE REMOVALS are the most businesslike. The coroners' employees have seen it all, and this place is a breeding ground for gossip. Watch what you say about your firm. Releases are handled as in a hospital, they are very strict about releasing without proper documentation.
There is usually a property room at the coroner's office, where personal property is kept. You may check to see if you can bring home personal effects for the family, if the coroner's office is far away. They will not release money or valuables without a letter from the family.
GENERAL GUIDELINES - Always be sure your cot is locked down in the first call car. If there is a window, always open it for ventilation. Avoid stopping at the Seven-Eleven until this part of the job is over, people are very curious; the hearse certainly never belongs at McDonalds.
Upon arrival at the funeral home, take all paperwork to the office for processing. Try to unload within the garage or carport, if possible, to block the view of your work. The deceased will be taken to a dressing table, embalming table or cooler table. Do not leave the decedent in the cot unless instructed to do so.
If the transfer is to the embalming table, level the table first. Place the head at the end away from the drain. Completely undress the decedent and cover with a clean sheet. Again, make sure the head is supported with a head block. Position the arms with head blocks also. Arms should have the hands together at the waist (Christian) , or at the sides (Jewish).
If there is a toe tag, leave it there. This does not belong in the boss's desk unless you are going to look for new work soon! Same for wrist identification from the hospital, leave it on. If the embalmer wants it off, he can easily remove it.
At the funeral home, discard the nasties you have accumulated in your plastic bags. Make sure they are sealed, as nasties become nastier as time goes on. If you have saved the sheets, place them in the proper plastic also. Clean the cot mattress and bag with a sponge and antiseptic soap. A little spray of antiseptic is a good idea. Don't forget to put another head block and sheet in the cot for the next use. If you had any problems with the cot, or other equipment, write it down or tell someone. The equipment must function well on each trip. Don't forget to return the cot to the first call car or wherever it belongs. What's left??????????...come on...right!! Wash your hands with green (antiseptic) soap.
17.4 Preparation Overview
The process of embalming begins with spraying the body with a topical disinfectant. This is done primarily to protect the embalmer from infection. Several generations ago, the theory was that the germ died with the host, of course now we know that is not true. In a dead body, there is no immune system functioning to keep disease organisms in check. Bacteria, fungi, and viruses multiply rapidly after the death of the host.
Spraying of disinfectant is only a temporary measure. When the major embalming processes are completed, the micro-organism population of the body will be reduced by over 99%. This fact was demonstrated a few years ago in a project called the Snell Study, a research endeavor carried out by well-known independent labs. Results of this project were published in respected journals in the public health field, and field, and are facts known to all in funeral service. After spraying, the body is cleansed with germicidal soap, then out of respect, covered up to the shoulders with a sheet. Now the first and most important major steps in the embalming process can begin. It is called the arterial injection, and is not unlike an IV set-up. Initially, a small incision is made to allow access to a major artery such as the carotid, and a second, similar one is made over a vein. A small tube is inserted in the artery, and another in the vein. The arterial tube is connected by plastic or rubber tubing to a motorized injector. This machine holds the arterial chemical which will be injected, under pressure, into the circulatory system, from there to permeate out through all cells of the body. To avoid swelling, a part of the blood is the system is displaced and removed via the venous tube. All incisions are sutured closed when infection is completed.
After the arterial process, the embalmer moves on to the second set of procedures. In the abdominal and thoracic (or chest) cavities, there is often a build up of liquids and/or gases following death. In order to remove these and replace them with cavity preservative chemicals, a third small incision is made in the abdomen. Into this is placed a long tube and through this tube, liquid and gaseous wastes are aspirated, or suctioned off. Then, through the same tube, preservative chemicals are introduced, using simple gravity pressure.
When embalming is completed, the deceased will be dressed fully. The body is then placed into a casket, selected by family members, and necessary cosmetics are applied. Cosmetics are used sparingly, and in accordance with the family wishes. This procedure is not an attempt to disguise reality, but to reduce the paleness of death. Transferred to an appropriate chapel setting, the body can now be safely viewed, in an open casket...safely, that is, both from a public health and a psychological standpoint. Many times, the first viewing will be accorded family members privately. In most cases, that is formal funeral services held in a funeral home or church, and final committal services at the place of interment.
There are many misconceptions about embalming. I have never, in my 39 years around funeral service, seen a body sit up, nor have I heard anyone snore, but if as much as an arm falls down beside a body, in the middle of the night, it scares the heck out of you!
The old adage that “the dead cannot hurt you”, simply is not true anymore. With all the infectious diseases around, and especially AIDS, we must be careful of our own personal hygiene around the funeral home, especially in the embalming room. It is the responsibility of the licensed embalmer to make sure that sanitary working conditions prevail. Protect yourself, as well as others.
17.5 Disinfecting Instruments
The procedure described here is confined specifically to instruments and equipment, but it can be applied to walls, floors, and other areas of the operating room, as well. These procedures are also very important elements in effective decontamination control:
- Place all used instruments in clear, running, cold tap water until detritus and adhering biological matter is washed off.
- Drain the instruments briefly, using paper or disposable toweling.
- Submerge all instruments in a disinfecting solution. All scissors, hemostats, clamps, ect. , should be in the open position.
- Allow the instruments to remain in the disinfecting solution for a minimum of 20 minutes, preferably one hour or more.
- Remove the instruments and rinse in cold water leaving all cutting instruments open.
- Instruments may or may not be dried afterwards depending on the type of solution used. Some solutions are not to be dried as they leave a clear film on the instruments, which continue to fight bacteria as time goes on. The film not only keeps the instruments surgically clean but also safeguards delicate cutting edges against rusting.
- Mix fresh disinfecting solution regularly. It is not good to reuse any disinfecting solution. By following the simple procedures outlined here, the cleanliness of instruments and operating equipment will be guaranteed.
These are general disinfecting procedures and not applicable to all types of viral and fungal infections. If you know of a specific problem, consult with a licensed embalmer about the techniques.
UNIT-17-REMOVING THE DECEASED
UNIT QUIZ
INSTRUCTIONS - Read this lesson once, then read questions below. Read the lesson again and answer the questions. Circle the correct answer choice on this paper, and black out the appropriate box on your Quiz Answer response card.
- A tube extending from the bladder to a storage bag for collecting urine in patients who are incontinent, or immobile is called a:
- Bladder Tube
- Ray catheter
- Foley Catheter
- Ray Tube
- The only place from which a funeral director may not remove a deceased human body is:
- A Police Station
- A Coroner's Office
- Hospital or Nursing Home
- Residence of deceased
- Equipment for a residence removal can consist of:
- Pole stretcher for areas in which a cot won't fit
- Scissors to cut foley
- Large safety pins
- All the above
- Upon arrival to the funeral home, bring the deceased to:
- Dressing table
- Embalming table
- Cooler table
- Any of the above
- After the deceased is properly in the funeral home and equipment is in its' place, you must be sure to:
- Take a vacation
- Check on the next project
- Wash your hands with antiseptic soap
- Wait for one hour
- The Value of Viewing the Body consists of:
- Ascertaining the ability of the funeral home
- Keeping within state regulations
- Providing a temporary place for the deceased
- Helping the bereaved test the reality of the death
- In order to receive property at the Coroner's office you must have:
- Letter from the family
- Death Certificate from State
- Copy of deceased's will
- Just appear
- Only state where a licensed embalmer is not required on the premises when you work in the embalming room:
- California
- Montana
- Utah
- Colorado
- Reason that a small incision is made in the abdomen is:
- To identify the deceased
- It is standard procedure
- There is gas buildup after death
- None of the above
- If the deceased died under suspicious circumstances report it to:
- Sheriff's
- Family
- No one
- Coroner's Office
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