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Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries

These recommendations give guidance on the safe handling of human remains that may contain Ebola virus and are for use by personnel who perform postmortem care in U.S. hospitals and mortuaries. In patients who die of Ebola virus infection, virus can be detected throughout the body. Ebola virus can be transmitted in postmortem care settings by laceration and puncture with contaminated instruments used during postmortem care, through direct handling of human remains without appropriate personal protective equipment, and through splashes of blood or other body fluids (e.g. urine, saliva, feces) to unprotected mucosa (e.g., eyes, nose, or mouth) which occur during postmortem care.
  • Only personnel trained in handling infected human remains, and wearing PPE, should touch, or move, any Ebola-infected remains.
  • Handling of human remains should be kept to a minimum.
  • Autopsies on patients who die of Ebola should be avoided. If an autopsy is necessary, the state health department and CDC should be consulted regarding additional precautions.

Definitions for Terms Used in this Guidance

Cremation: The act of reducing human remains to ash by intense heat.

Hermetically sealed casket: A casket that is airtight and secured against the escape of microorganisms. A casket will be considered hermetically sealed if accompanied by valid documentation that it has been hermetically sealed AND, on visual inspection, the seal appears not to have been broken.

Leakproof bag: A body bag that is puncture-resistant and sealed in a manner so as to contain all contents and prevent leakage of fluids during handling, transport, or shipping.

Personal protective equipment for postmortem care personnel

  • Personal protective equipment (PPE): Prior to contact with body, postmortem care personnel must wear PPE consisting of: surgical scrub suit, surgical cap, impervious gown with full sleeve coverage, eye protection (e.g., face shield, goggles), facemask, shoe covers, and double surgical gloves. Additional PPE (leg coverings, apron) might be required in certain situations (e.g., copious amounts of blood, vomit, feces, or other body fluids that can contaminate the environment).
  • Putting on, wearing, removing, and disposing of protective equipment: PPE should be in place BEFORE contact with the body, worn during the process of collection and placement in body bags, and should be removed immediately after and discarded as regulated medical waste. Use caution when removing PPE as to avoid contaminating the wearer. Hand hygiene (washing your hands thoroughly with soap and water or an alcohol based hand rub) should be performed immediately following the removal of PPE. If hands are visibly soiled, use soap and water.

Postmortem preparation

  • Preparation of the body: At the site of death, the body should be wrapped in a plastic shroud. Wrapping of the body should be done in a way that prevents contamination of the outside of the shroud. Change your gown or gloves if they become heavily contaminated with blood or body fluids. Leave any intravenous lines or endotracheal tubes that may be present in place. Avoid washing or cleaning the body. After wrapping, the body should be immediately placed in a leak-proof plastic bag not less than 150 μm thick and zippered closed The bagged body should then be placed in another leak-proof plastic bag not less than 150 μm thick and zippered closed before being transported to the morgue.
  • Surface decontamination: Prior to transport to the morgue, perform surface decontamination of the corpse-containing body bags by removing visible soil on outer bag surfaces with EPA-registered disinfectants which can kill a wide range of viruses. Follow the product’s label instructions. the visible soil has been removed, reapply the disinfectant to the entire bag surface and allow to air dry. Following the removal of the body, the patient room should be cleaned and disinfected. Reusable equipment should be cleaned and disinfected according to standard procedures. For more information on environmental infection control, please refer to “Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus” (http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html).
  • Individuals driving or riding in a vehicle carrying human remains: PPE is not required for individuals driving or riding in a vehicle carrying human remains, provided that drivers or riders will not be handling the remains of a suspected or confirmed case of Ebola, and the remains are safely contained and the body bag is disinfected as described above.

Mortuary Care

  • Do not perform embalming. The risks of occupational exposure to Ebola virus while embalming outweighs its advantages; therefore, bodies infected with Ebola virus should not be embalmed.
  • Do not open the body bags.
  • Do not remove remains from the body bags. Bagged bodies should be placed directly into a hermetically sealed casket.
  • Mortuary care personnel should wear PPE listed above (surgical scrub suit, surgical cap, impervious gown with full sleeve coverage, eye protection (e.g., face shield, goggles), facemask, shoe covers, and double surgical gloves) when handling the bagged remains.
  • In the event of leakage of fluids from the body bag, thoroughly clean and decontaminate areas of the environment with EPA-registered disinfectants which can kill a broad range of viruses in accordance with label instructions. Reusable equipment should be cleaned and disinfected according to standard procedures. For more information on environmental infection control, please refer to “Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus” (http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html).

Disposition of Remains

  • Remains should be cremated or buried promptly in a hermetically sealed casket.
  • Once the bagged body is placed in the sealed casket, no additional cleaning is needed unless leakage has occurred.
  • No PPE is needed when handling the cremated remains or the hermetically sealed closed casket.

Transportation of human remains

  • Transportation of remains that contain Ebola virus should be minimized to the extent possible.
  • All transportation, including local transport, for example, for mortuary care or burial, should be coordinated with relevant local and state authorities in advance.
  • Interstate transport should be coordinated with CDC by calling the Emergency Operations Center at 770-488-7100. The mode of transportation (i.e., airline or ground transport), must be considered carefully, taking into account distance and the most expeditious route. If shipping by air is needed, the remains must be labeled as dangerous goods in accordance with Department of Transportation regulations (49 Code of Federal Regulations 173.196).
  • Transportation of remains that contain Ebola virus outside the United States would need to comply with the regulations of the country of destination, and should be coordinated in advance with relevant authorities.

References

CDC. Medical Examiners, Coroners, and Biologic Terrorism A Guidebook for Surveillance and Case Management. MMWR 2004;53(RR08);1-27. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5308a1.htm)

Kentucky Fayette County Coroner Seeking Help in Finding Family of Victim

The Fayette County, Kentucky coroners office is asking for the help of the public on Wednesday, October 16th, to help find the family of Mario Rodriguez-Pena. He was hit by an SUV while walking on New Circle Road around 9:00 Tuesday night in Lexington, Kentucky. Rodriguez-Pena was taken to UK hospital with major injuries. He died later in the night at the age of 55. He was reportedly walking in the middle of the road, where there is no crosswalk. "At this point it appears the person was attempting to cross New Circle Road. We're not 100 percent certain on the direction from which side to the other. We just know that they were in the middle of the outer loop," said Lt. Chris Young with the Lexington Police Department. At this time, no charges have been filled against the driver.

" The Americans "

 This January the television show " The Americans " will air on FX.  Bagemandtagem has supplied the body bags you will see...

 

 

GBI - Medical Examiners Offive

 Taken from The GBI - Medical Examiners Page

 

Medical Examiner's Office

The Medical Examiner's Office of the Georgia Bureau of Investigation provides complete forensic pathology services to 153 of Georgia’s 159 counties in deaths which qualify as coroner cases under the Georgia Death Investigation Act. The Chief Medical Examiner for the State of Georgia oversees the GBI’s medical examiner (M.E.) program and also establishes policies and guidelines for all Georgia coroners and local medical examiners.

Autopsies are conducted by GBI medical examiners at the headquarters laboratory in Decatur and in the regional laboratories in Augusta, Macon, and Savannah. Staff at the headquarters medical examiner’s office consists of eight medical examiners, ten investigators, five forensic pathology assistants, two photographers, two secretaries, and three transcriptionists. One of the medical examiners at the headquarters lab specializes in pediatric pathology and the evaluation of fatal and non-fatal pediatric injury.

There are two medical examiners and two investigators in the Savannah Regional Office along with a transcriptionist and a forensic pathology assistant. The other regional labs mentioned above have a medical examiner, an investigator, a forensic pathology assistant, and a transcriptionist.

In addition to the forensic pathology responsibilities, the headquarters office also has a forensic anthropologist on staff for the recovery and examination of skeletal remains.

Death cases are reported to the Medical Examiner’s Office by coroners, deputy coroners, and law enforcement. The Medical Examiner’s Office determines if an examination will be performed. This office investigates deaths that fall under one or more of the following categories:

  • Those deaths that are apparently homicidal, suicidal, or occurring under suspicious or unknown circumstances
  • Resulting from the unlawful use of controlled substances or the use or abuse of chemicals or toxic agents.
  • Occurring while incarcerated or while in the custody of a law enforcement officer .
  • Apparently accidental or following an injury.
  • By disease, injury or toxic agent during or arising from employment.
  • While not under the care of a physician during the period immediately preceding the death.
  • Related to disease which might constitute a threat to the health of the general public.
  • In which human remains have been disposed of in an offensive manner.

Requests for examinations are received 24 hours a day, 7 days a week by the headquarters section of the M.E.’s Office. Cases accepted for examination are transported to the respective laboratory by transport services provided by the county where the death occurred or where the body was found.

In their examinations of the deceased, forensic pathologists aim to determine the cause and manner of death. Cause is why the person died or the medical reason for the death; that is, the injury or disease responsible for the death. Manner is how the person died or the circumstances that led to the cause of death.

The Georgia Death Investigation Act (O.C.G.A. 45-16-20) requires that the coroner or county medical examiner of the county where the body is found or the death occurs be notified and that a medical examiner's inquiry be made in all deaths that occur in this state that meet the following criteria:

  1. As a result of violence;
  2. By suicide or casualty;
  3. Suddenly when in apparent good health;
  4. When unattended by a physician; no person shall be deemed to have died unattended when the death occurred while the person was a patient of a hospice licensed under Article 9 of Chapter 7 of Title 31 of the Georgia Code.
  5. In any suspicious or unusual manner, with particular attention to those persons 16 years of age and under;
  6. After birth but before seven years of age if the death is unexpected or unexplained;
  7. As a result of an execution carried out pursuant to the imposition of the death penalty under Article 2 of Chapter 10 of Title 17;
  8. When an inmate of a state hospital or a state, county, or city penal institution; or
  9. After having been admitted to a hospital in an unconscious state and without regaining consciousness within 24 hours of admission.

There are five determinations for manner of death:

  1. Homicide - the death was caused by the actions of another person.

Note: Many people, including the media, confuse the terms homicide and murder. Murder is a criminal charge or the unlawful taking of a human life by another. After the medical examiner determines the manner of death to be a homicide, then law enforcement investigate that death to determine if there is probable cause to bring the criminal charge of murder against the person who caused the death. While all murders are homicides, not all homicides are murders. If a homeowner, fearful for his or her life, kills an intruder or a law enforcement officer kills someone in the line of duty, both are considered homicides but not necessarily murder.

  1. Natural - the death was from diseases or medical conditions such as cancer or heart attack.
  2. Accidental - an unintended death
  3. Suicide - a death that is intentionally self-inflicted
  4. Undetermined - there is little or no evidence to establish, with medical

Georgia Coroner Association Annual Meeting Macon Georgia

 The meeting of the Georgia Coroners Association was just held at the Macon Marriott City Center November 16th and 17th 2012. We would like to extend our gratiatude to the Association for welcoming us once again. It was great meeting the new Coroner Elects and as always we look forward to serving you with your supply needs.

We here at Bagemandtagem and our parent Company Vision Medical along with Chastain Professional Services ( meeting your transport needs) are excited about the upcoming year and the next meeting in Savannah.