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Dead Bodies and Disasters:

Principles of Mortuary
Services

Amado Alejandro Baez MD MSc EMT-P


Brigham and Women’s Hospital / Harvard Medical
School
aabaez@partners.org
Senior Advisor National Directorate of Emergencies and
Disasters
"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
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.
Cadaver Recuperation Proces

Coordination and Communication

Temporary

Follow Up
Search
EVENT

deposit Release to Final


Localize and relatives Disposition
Transport Analysis *

Stages of the Process


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
Coordination &
Support
Body Communities, volunteers,
Recovery NGOs, police, military

Doctors, medical staff, forensic specialists,


Identification foreign embassies, INTERPOL, NGOs

Death Coroners, police


certification

Disposal Military, police, local authorities


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
Storage and Body Preservation
Storage Issues
 Without proper storage,
bodies may began to
decompose early depending
on environmental
temperature.
 Storage Options:
– Refrigeration
– Ice and Dry ice
– Temporary burial
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 morgue’s refrigeration capacity will
most likely be exceeded during a
disaster.
 Keep refrigerated trucks close to
holding site.
 Need for use of other preservative
measures:
Identification of
Bodies
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.
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
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
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.
Identification of bodies: Key Poin
 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.
“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 of
infectious hazards associated
with cadavers after a natural
disaster
 Bloodborne
 Gastrointestinal
– Rotavirus diarrhea
– Hepatitis B
– Campylobacter
– Hepatitis C enteritis
– HIV – Salmonellosis
– Enteric fevers
(typhoid and
 Respiratory paratyphoid)
– Tuberculosis – Escherichia coli
– Hepatitis A
– Shigellosis

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

Disposal of dead bodies in emergency
conditions
World Health Organization http://www.who.int
http://www.paho.org/english/dd/ped/ManejoCadaveres.htm
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/Study%20Pro
 Morgan O. Infectious disease risk of dead bodies
following natural disasters. Rev Panam Salud
2004;15(5):307-312.
 Pan American Health Organization. Management of Dead
Bodies in Disaster Situations. Washington DC: PAHO,
2004.