In a message dated 4/3/03 3:03:20 PM Eastern Standard Time, Mass FDA writes:
TO: MFDA MEMBERS
FROM: RICHARD C. DEWHIRST, ETC.
SUBJECT: Severe Acute Respiratory Syndrome (SARS)
DATE: April 2, 2003
We've received a request for information about postmortem procedures for patients deceased as a result of Severe Acute Respiratory Syndrome.
The following information was provided to us by Curt Rostad, OSHA Trainer and a frequent speaker at MFDA sessions:
SARS is an airborne virus.
The embalming protocol is simple: UNIVERSAL PRECAUTIONS.
Face mask, eye shields, gown, gloves, and shoecovers
Special attention should be paid to covering the nose and mouth of the body
especially during removal, lifting and repositioning. Nasal and oral
treatment with an embalming chemical is absolutely essential.
Special care should be taken not to create airborne contaminates. This
includes taking steps to insure no splashing or spraying of liquids that could
become aerosols. (No splashing of drainage or aspirator contents in the
utility sink.)
All other common sense/good embalming practices simply become more obvious:
Use drain tubes and drain hoses, avoid practices that could lead to needle stick injury, etc.
In short, DO WHAT ALL THAT OSHA TRAINING HAS BEEN TELLING YOU TO DO.
For those with website access, additional information is available on the CDC website:
PDF format: http://www.cdc.gov/ncidod/sars/pdf/sarsautopsy.pdf
HTML format: http://www.cdc.gov/ncidod/sars/autopsy.htm
=================== MORE =============================
Thursday, April 3, 2003 13:46:52 EDT Anonymous writes:
Please find information regarding guidelines for handling human remains that
have died from (SARS), Severe Acute Respiratory Syndrome. The Centers for
Disease Control and Prevention (CDC) and the World Health Organization have
received reports of patients with severe acute respiratory syndrome (SARS)
from Canada, China, Hong Kong Special Administrative Region of China,
Indonesia, Philippines, Singapore, Thailand, and Vietnam. This information
is an educational resource and will be helpful to our membership in the
event that they handle a death of this type. I have also include a break
down of the suspected cases in the USA . Please feel free to forward this
information to anyone it may assist.
Thanks and God Bless America,
Tommy
Thomas H. Ralph
FFDA Emergency Management Committee
RESOURCES:
Safe Handling of Human Remains of SARS Patients: Interim Domestic Guidance
(March 25, 2003, 1:30 PM EST)
Guidance on safe handling of human remains of (SARS) patients
PDF format: http://www.cdc.gov/ncidod/sars/pdf/sarsautopsy.pdf
HTML format: http://www.cdc.gov/ncidod/sars/autopsy.htm
SUSPECTED UNITED STATES CASES:
Severe Acute Respiratory Syndrome
Report of Suspected Cases Under Investigation
in the United States
This information in this table will be updated Monday through Friday.
These data were reported to the World Health Organization on March 30, 2003.
Numbers of suspected cases are expected to fluctuate as additional
information becomes available.
State Suspected cases under investigation*
Alabama 1
California 14
Connecticut 1
Georgia 1
Hawaii 3
Illinois 2
Kansas 1
Maine 2
Massachusetts 2
Michigan 2
Missouri 2
Mississippi 1
Minnesota 3
New Hampshire 1
New Jersey 2
New Mexico 1
North Carolina 2
New York 10
Ohio 1
Pennsylvania 3
Rhode Island 1
Texas 3
Utah 4
Virginia 3
Washington 1
Wisconsin 2
Total Suspected Cases Under Investigation69
*Case definition <http://www.cdc.gov/ncidod/sars/casedefinition.htm>
(http://www.cdc.gov/ncidod/sars/casedefinition.htm)
For more information, visit this CDC SARS web site
<http://www.cdc.gov/ncidod/sars/>.
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April 3, 2003: NFDA Membership Update
Dear Members:
IN addition to the inform on the attached memorandum, NFDA members may contact OSHA Consultant Jay Burnside @1-800-NFD-AOSH or visit the NFDA "MEMBERS ONLY" website at:
http://www.nfda.org/page.php?pID=378
In a message dated 1/12/03 10:30:18 AM, DennisCMcGeeJr writes:
Embalming Case Study:
Restoration of the head
By: Dennis C. McGee, Jr., CFSP
The Facts:
On Saturday, December 28, 2002, at approximately 2:30 am the gentleman in this case was traveling eastbound on a motorcycle on a major roadway and apparently was unable to negotiate a turn to the right in the road. At a high rate of speed he crashed into a guard rail in the median of the road. The medical personnel arrived and he was pronounced dead at the scene. Investigators at the accident assured that this gentleman was indeed wearing a helmet. The remains were removed by the investigator to the county medical examiners office and scheduled for an autopsy. On Sunday, December 29, 2002, the on duty investigator contacted the funeral home and assured us his case would be reviewed that day and would start at 2 pm. At approximately 3:30 pm the funeral home was contacted and informed that only a "view" would be done, the remains were prepared for removal and released to the funeral home.
The Findings: Case Analysis
Upon arrival at the funeral home the deceased was brought into the preparation room and removed from the pouch. He was put onto the preparation table and was observed to have the following: A medial laceration from the left inner canthus up through the forehead extending through to the occipital region and ending approximately at the "bump of knowledge." There was a compound femur fracture of the right leg as well as a compound fracture of the right patella. It appeared that both shoulders were dislocated, which posed a problem for positioning. Additionally, there was a laceration around the circumference of the left forearm. The remains, as a whole, were probably covered from 70 to 90% in "road rash" abrasions.
Initial Procedures:
The remains were positioned with blocks, washed down and features set. The most significant damage was the laceration through the head, superior to the eyes. Other than the damage to the head it appeared that no circulatory damage was done. In order to control and effectively embalm the head a restricted cervical injection technique using both the right and left common carotid arteries was performed. A solution of 16 oz. per Gallon of a 23 index humectant fluid was diluted into two gallons water yielding a 2.75% solution. An ounce of dye and 8 oz. of a tissue gas chemical were also used per gallon. The tissue gas chemical was used due to a "hissing" sound when making the incisions for arterial injection. A total of 4 gallons of solution were used on this case during arterial injection. Intermittent drainage, through the use of a drain tube, took place at the right internal jugular vein. After injection the remains were aspirated as usual, the injection sites were sutured and 32 oz. of cavity was injected into the thoracic, abdominal and abdominopelvic cavities.
Through the left anterior nare an intradermal suture was used to begin closing the laceration through the head. A model for normal anatomy was based off of a foam wig head and inserted into the cranium. This helped realign both the frontal and temporal bones on the left side as well as match up the superciliary arches bilaterally. Absorbent cotton was used and placed into the cranium via forceps to fill out any depressions in the skin the foam insert was unable to correct. The suture was continued and completely closed the laceration. The laceration was still obvious so a second suture was done over top of the existing. This time, a double strand of translucent dental floss was used. This helped close the laceration more securely and discreetly. Finishing out the initial restoration, his lips were glued, and finally, the head was built up with tissue fill in order to round out the head reflecting normal anatomy.
Restorative Procedures:
The next day the gentleman was dressed and prepared for further restoration. A layer of incision seal was applied to all of the suture sites, preparing the head for wax application. A liquid opaque cosmetic was applied to lay a base and cover the suture site. A wound filler wax was applied and smoothed with drywash. After covering the suture a second layer of wound filler wax was applied and smoothed in order to give it a more natural looking appearance, concealing the ligature. The two wax layers were coated with a pore closer then a suntan opaque and cream cosmetic were applied over the wax and sealant. The suture now looked more natural but still required more modeling from the wax. A third layer of lip wax was applied and completely smoothed out concealing the suture. The third layer of wax, again, was covered with pore closer then cosmetized with a suntan opaque cosmetic. A natural appearance was achieved.
Conclusion:
Too many times cases such as these go unrestored and leave families with no final memory picture of peaceful repose, diminishing the value of the funeral experience. Instances such as these are why we are licensed; why there are restorative art classes in our mortuary schools and why families call on funeral service. Families need to see there loved ones to help confirm the reality of that death. Through teamwork, planning and careful decision-making we were able to help this family say good-bye and see him one last time. The funeral drew approximately 500 people during 2 visitation hours and another 100 the next day at the funeral services. The case was cremated and returned to the family in a marble urn.
In a message dated 11/2/01 4:18:57 PM, CRostad@aol.com writes: John
A couple quick reminders for the weekly update:
1. DON'T WASTE YOUR MONEY--Frequently we see ads on various ways to fulfill the requirements for mandatory employee annual OSHA training including books, tapes, and Internet sites. Please be advised that you are wasting your money and not fulfilling the clear intent of the law. OSHA requires that the training be interactive. That is, an instructor must be available at the time of training to answer questions. Books and tapes can not meet that requirement. Unless the Internet site has a live instructor on the other end to take instant message type questions, that does not meet the requirement either.
Also beware of nurses, hospitals, or other similar training providers who provide OSHA training that is generally limited to Bloodborne Pathogens training. The training must address the risks faced by funeral service professionals, not generic training on the nature of bloodborne pathogens or the risks faced by health care workers.
In addition, funeral service professionals must also receive annual training on the Formaldehyde Standard, which most of these other trainers do not address and know nothing about.
2. CJD INFORMATION: For the latest information on Creutzfeldt-Jakob Disease and new preparation guidelines see the Wyoming Funeral Directors Association Website at www.wyfda.org. Click on "members" (no password needed) and click on Creutzfeldt-jacob Disease. It's FREE.
Curtis Rostad, CFSP
Wyoming Funeral Directors Assn.
John -
I hope this information will be useful to you for your website.
Regards,
Fay Spano
"Bio/Chemical Hazards: The New Battle Ground"
Are you prepared for the possibility of treating individuals with diseases such as Anthrax or other bio or chemical hazards?
Receive an update on the current situations facing the country and the funeral industry. Find out recommendations you can follow should you have an incident in your community.
A two hour telephone-based learning session is presented by NFDA's Compliance Consultant, James F. Burnside, III, Professional Compliance, Inc., Baltimore, MD; Stephen Kemp of Stinson Funeral Home, Detroit, MI; and David J. Weber, David J. Weber Funeral Homes, Baltimore, MD
-Friday, November 9th, 1 - 3 p.m. Central Standard Time
-$95 FEE covers long distance fees & connection, materials, CEU processing for one.
-ADDITIONAL participating licensed funeral directors at the site may obtain CEUs for $35 per individual.
-The session is approved for .2 CEUs by APFSP and most state boards.
Contact a NFDA member services representative at 800-228-6332, or visit the NFDA website at www.nfda.org to register.
Fay Spano
Public Relations Manager
National Funeral Directors Assoc.
13625 Bishop's Drive
Brookfield, WI 53005
262-814-1549
fspano@nfda.org
In a message dated 10/18/01 6:07:21 PM, CRostad@aol.com writes:
John,
I've had requests for info on anthrax and embalming.
An article follows:
ANTHRAX-NO HYPEÉJUST FACTS
Curtis D. Rostad, CFSP
Anthrax is caused by the bacteria, bacillus anthracis. It is a spore-forming bacterium that in its natural state is commonly found in the soil of agricultural areas and is best known as an animal disease. It was formerly known as "wool sorter's disease" because it was commonly seen in workers exposed to wool and sheep skins infected with the disease producing agent. It is commonly found in Asia and Africa, but is also common in rural soils of Texas, Oklahoma, and the Mississippi Valley.
The bacterium has been around for a long time and in fact was used by German bacteriologist Robert Koch in 1877, when he discovered the basic principles of infectious diseases.
The bacterium causes three distinct forms of the disease we call anthrax.
The cutaneous, or skin form of the disease is the least serious. It occurs when the agent penetrates the skin through a cut or from skin contact with the spores on tissues or hides of infected animals. 95% of all anthrax cases reported are cutaneous.
The lesion that results is an itchy red bump that looks much like an insect bite. Within 1-2 days, it develops into a vesicle and then a painless ulcer. Its unique characteristic is a black necrotic area that develops in the center of the lesion. Headaches, muscle aches and general flu-like symptoms commonly develop. Swollen lymph glands are also common.
Antibiotic treatment is very successful and death is rare. Even left totally untreated, the fatality rate is about 20%.
The second form of anthrax is gastrointestinal. It results from eating undercooked meat from an infected animal.
The symptoms are nausea, vomiting, fever, abdominal pain, severe diarrhea and vomiting of blood. Again, antibiotic treatment is very successful in treating the disease, especially when diagnosed early. Without any treatment, the disease is 25-60% fatal.
The third form of anthrax, respiratory, is the most serious. It results from the inhalation of the anthrax spores.
It causes flu-like symptoms including fever, cough, difficulty in breathing, and general malaise. Left untreated, the patient develops septicemia, goes into shock, coma and eventually dies. Unless diagnosed quickly and treated with an aggressive course of antibiotics, the fatality rate is about 90%.
While anthrax is often referred to as a potential weapon for a bio-terrorist, it does have its problems.
In order to cause respiratory infection, the spores first must be inhaled in a large enough number to actually cause infection. It takes at least 8,000 to 30,000 spores to cause an infection. In fact in one study, goat workers inhaling 500 spores per hour during their 8-hour shift did not contract the disease.
To be an effective weapon them, the spores must remain airborne long enough and in sufficient concentration to allow potential victims to inhale large numbers of the spores.
A standard ventilation system filter in a home or office will routinely remove about 97% of the spores on the first pass through the system, making residual infection unlikely. The more efficient HEPA type filters will remove 99.9% of the spores on the first pass through.
Secondly, the spores must be inhaled deep into the lungs to cause infection.
The bacterium is approximately 1 micron in size (a human hair is 25-50 microns in width). In its natural state the spores clump together. Once these clumps become 5 microns or more in size, they are usually trapped in the upper respiratory system and can not infiltrate the lungs where they can cause the disease.
Making "weapons grade" anthrax requires a sophisticated laboratory where the spores may be genetically altered and refined so they will remain separated and smaller than 5 microns. They are then placed in a powder to increase the time they can remain airborne and to prevent the spores from clumping again before they can be inhaled.
There are about 4 dozen labs worldwide that store anthrax cultures where terrorists could obtain b.anthracis. Many of these countries are not friendly to the U.S., most notably, Iran, Iraq, China, and several states of the former Soviet Union.
With this information, we can put some of the news reports into perspective. One person who "tested positive" for anthrax, indeed had a single spore on his cheek. He was technically "infected", but far from being in any danger.
The unsettling part of the current news reports is that the anthrax we are dealing with certainly appears to be professionally prepared. It is unlikely it comes from a "natural" source and is being sent by an amateur or other "terrorist wannabe."
The real danger from anthrax does not lie in a contaminated envelope, however. A terrorist with an airplane could indeed infect an entire city with a mist of anthrax which would be undetected until symptoms developed and the fatality rate would make the World Trade Center disaster seem like a minor incident. Worse yet would be the use of small pox as a bio-terrorist weapon, which is highly transmissible. Possible scenarios there could exceed any horror movie Hollywood has ever thought of.
Enough of those unpleasant thoughtsÉ and back to the situation at hand.
For the embalmer, anthrax is not the worst disease they could be presented with.
We can assume that most casualties will be of the respiratory type. Anthrax is not considered transmissible. That is, there is no concern of contracting anthrax from an infected person either from normal casual contact or by inhalation.
Nevertheless, an embalmer making the removal of an anthrax patient should use universal precautions and standard barrier isolation. Since anthrax is opportunistic (is especially infectious) to persons who already have respiratory infections, removal personnel should be suspicious of transmissible respiratory infections and should utilize a face mask on the deceased as well as on themselves.
Gloves should be used on all removals, and in the event of an anthrax patient where cutaneous anthrax may be present, gloves become critical and contact with the lesions should be avoided.
Standard embalming with universal precautions should not present a particular risk to the embalmer. Formaldehyde kills b. anthracis, but since it is a spore-forming bacterium, the spore is not killed on contact with embalming fluid. The spores may survive for minutes or even hours.
Aspiration of the lungs should be done in such manner to minimize any chance of creating an aerosol. Again, this should already be common practice, but in the case of anthrax, this becomes even more important. Do not assume that arterial embalming has destroyed the spores by the time aspiration is done since formaldehyde contact in the lungs is limited and because of the time it takes for the spores to be destroyed. Instruments should be autoclaved or disposed of.
Any lesions should be treated with a topical embalming product and covered to avoid any possible contact.
Many disinfectants can be used for general cleaning and disinfection purposes. Sodium hypochlorite (Clorox) is an effective disinfectant.
There are no additional health concerns with cremation of a body infected with anthrax.
Finally, however, it should also be noted that articles in the Journal of the American Medical Association and in The Control of Communicable Disease Manual discourage embalming because embalming creates "other concerns." They do not say what those concerns might be.
But I think I know what those concerns are. A careful professional embalmer can safely prepare an anthrax case, but an embalmer that routinely takes shortcuts, fails to understand and utilize the concept of "universal precautions" or is simply careless, should think twice before attempting preparation of the anthrax case or any other case for that matter.
© Copyright 2001, Management Associates, All Rights Reserved Mail to Curtis D. Rostad, CFSP
In a message dated 10/16/01 9:32:09 AM, RMayer writes:
<< John - I have heard that the body , dead from anthrax , in Florida was taken directly from the coroner's office to the crematory. The most shaken persons were the removal people. I understand from Melissa Johnson , in Chicago, that in their area any death from anthrax will be treated by no autopsy being performed and immediate cremation.
This got me to thinking how many funeral homes use removal services - in many states there is no licensing requirements for these services ; perhaps in some states removals need to be made with a licensed funeraldirector/embalmer. Should some minimum training be necessary for removal services?
What would be the protocol for dealing with an "anthrax" death in your location?
Who is incharge when dealing with a death say from anthrax - federal government/ Local health department? state health department/ coroner?
What precautions should be taken for the handling and transport of a body dead from pulmonary anthrax?
What temperature kills the anthrax spore? What chemicals and time of their exposure are necessary to kill the vegetative anthrax bacterium and the spore form of anthrax.
When I was in mortuary school , 1962, all we learned about Anthrax was that it was one of 4 spore formers - along with Cl. botulinum ; Cl. perfringens; teatnus.
I feel funeral service is better prepared than we ever were to handle bodies dead from infectious and/or coontagious diseases - I guess if there has been any benefit from OSHA we have the necessary equiptment in place in most funeral homes.
What , if any, immunizations should the embalmer / funeral director/ removal service personell have with reguard to infectious and/or contagious diseases?
Just some thoughts. Bob Mayer, Pittsburgh
In a message dated 10/19/01 5:53:23 PM, noreply@nfda.org writes:
NFDA ENews Alert
October 19, 2001
Volume 2, Issue 22
IN THIS ISSUE...
OSHA CONSULTANT REASSURES FUNERAL DIRECTORS ON ANTHRAX CASES
Jay Burnside, NFDA's Occupational Safety and Health Administration consultant, has recently received several calls from funeral directors concerned about embalming and handling remains that are infected with anthrax.
Anthrax is a communicable bacteria that requires direct contact with the bacteria or spores to be transmissible. However, embalmers properly and completely following Universal Precaution procedures and concurrent and terminal disinfecting procedures, have only a minuscule chance of contracting any contagious or infectious disease. While one person has recently died as a result of anthrax, there is no indication that additional infections will result in a large number of fatalities.
NFDA is completely prepared to assist its members and state associations, as well as any government agency, in the event of a biological or chemical incident.
If you have questions about handling an anthrax case or any case involving another communicable disease, call NFDA's 24-hour OSHA hotline at 800-633-2674 to discuss equipment and procedures that may be necessary. Experts are available to discuss equipment and procedures that will help ensure your safety.
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Consider these steps for your life.
1. Work like you don't need the money.
2. Love like you've never been hurt.
3. Dance like you do when nobody's watching.
C YA
John
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