Mors 111 Lecture Notes

Question 1

Embalming is an art form. It is not a science. It is based on an inborn ability and the development of that ability which is based on the scientific knowledge one is given in the fiends of:

1. Biological Chemistry
2. Anatomy
3. Pathology
4. Microbiology
5. Restorative Art
6. Embalming Technique

Answer 1

Brief Summary of the Embalming Process

Question 2

The embalmer is the creator of illusions, hopefully pleasant ones, which banish the traces of death and grief and present the deceased in an attitude of normal restful sleep.

Answer 2

Memory Picture

Question 3

1. Embalming is the process designed to retard tissue decomposition for a reasonable period of time, but not forever.
2. At best the process will keep the remains intact for many years, but they will eventually turn to dust.
3. It is our purpose to serve the living of our time, not to create museum specimens for the amazement of future generations.
4. The process will accomplish the clean process of oxidation and dissolutions of the remains into dust by eliminating the putrefactive or rotting stage, and so will cremation.
5. Embalming preservation is only temporary. For a mortician to tell a family that embalming will guarantee preservation until judgement day or eternity is a fraud. For a mortician to tell a family that embalmed remains in an airtight, waterless glass, iron, concrete, etc. casket, vault or crypt will last forever is also a fraud.

Answer 3

What the Embalming Process Accomplishes

Question 4

A deliberate deception for unfair or unlawful gain.

Answer 4

Fraud

Question 5

Will accomplish protection of the remains against moisture and air which carry aerobic bacteria that cause decay. Aerobic bacteria thrive in the presence of oxygen.

Answer 5

Airtight/Watertight Outside Enclosures

Question 6

Will not accomplish protection against anaerobic bacteria that may cause embalmed remains to go into putrefaction.

Answer 6

Airtight/Watertight Outside Enclosures

Question 7

1. Accomplished through saturation of the body tissues with preservative fluids which act as a vector or carrier of gases (HCHO, CH₂O, formaldehyde) that enter tissue cell proteins (protoplasm).
2. It is the gas that is liberated from these fluids that cuases the chemical fixation of tissue cell protein.
3. It is the process in which protein is altered so that it is no longer a suitable medium or food for bacterial growth.

Answer 7

How The Temporary Embalming Process is Accomplished

Question 8

Tissue cell proteins.

Answer 8

Protoplasm

Question 9

In this reaction, soluble albumins in the tissues (cell protoplasm) are converted into insoluble albuminoids or gels which cause the firmness of the tissues.

Answer 9

Protein Alteration

Question 10

These gases will kill or alter bacteria.

• I.E., Anaerobic bacteria, many of which are encapsulated rod-shaped organisms, may go into a spore state until tissue returns to pH of 8 (suitable for growth).

Answer 10

Gases Liberated from Preservative Fluids

Question 11

1. The degree of tissue saturation.
2. The degree of control of the bacterial growth.

Answer 11

Degree of Length of Preservation Depends on These Two Related Factors

Question 12

Process of chemically treating the dead human body to reduce the presence and growth of microorganisms, to temporarily inhibit organic decomposition, and to restore an acceptable physical appearance. (Non-legal Definition)

Answer 12

Embalming

Question 13

1. Cavity Embalming
2. Hypodermic Embalming
3. Surface Embalming
4. Vascular Embalming

Answer 13

Four Classifications of Embalming

Question 14

Direct treatment other than vascular (arterial) embalming of the contents of the body cavities and the lumina of the hollow viscera; usually accomplished by aspiration and then injection of chemicals using a trocar.

Answer 14

Cavity Embalming

Question 15

Injection of embalming chemicals directly into the tissues through the use of a syringe and needle or trocar, or a hypodermic trocar.

Answer 15

Hypodermic Embalming

Question 16

Direct contact of internal or external body tissues with embalming chemicals.

• Phenol gels
• Wrap, spray- the gasses embalm
• Osmosis

Answer 16

Surface Embalming

Question 17

The use of the vascular systems of the body for preservation, disinfection, and restoration. Usually accomplished through injection of embalming solutions into the arteries and drainage from the veins.

Answer 17

Vascular Embalming

Question 18

• Em- In or about.
• Balm- Resinous substance, a balsamic agent.

Answer 18

Etymology of The Word Embalm

Question 19

An aromatic gum resin obtained from certain trees and plants often used as a crude medicine.

Answer 19

Balm

Question 20

Most states prior to 1984 F.T.C. Funeral Rule had no specific definition. Disposition of human remains reflected 19^th century laws based on sanitation and moral codes (4).

Answer 20

Legal Definition of Embalming: Prior to 1984

Question 21

1. That a dead human body not endanger the health and well-being of the general public.
2. That such a dead human body not cause a public nuisance.
3. That there will not be seepage, leakage or the escape of noxious odors and gas while transporting a dead human body.
4. That such a dead human body be transported and disposed of in a morally dignified manner according tothe wishes of the person holding the primary right of disposition on that dead human body.

Answer 21

Moral Codes

Question 22

Chemically injecting disinfectant into the blood vascular system followed by direct treatment of the entire viscera contained in the body cavities.

• Most States After The 1984 F.T.C. Funeral Rule

Answer 22

Embalming (Legal Term)

Question 23

This is the same thing as the primary objectives of contemporary embalming.

Answer 23

Need for Embalming

Question 24

• Education
• Immunization
• Occupational Hazards
• Ethical Standards

Answer 24

Embalmer Preparedness

Question 25

1. Associate degree of equivalent 2. National Board Examination 3. State Board Examination and Practical Embalming and State Regulations. 4. Internship (apprenticeship) - 1,000 hours MD

Answer 25

Education

Question 26

3 HBV shots mandatory.

Answer 26

Immunization

Question 27

OSHA standard.

Answer 27

Occupational Hazards

Question 28

All moral and legal considerations.

Answer 28

Ethical Standards

Question 29

1. Vascular 2. Surface 3. Hypodermic 4. Cavity

Answer 29

Four Classifications of Embalming

Question 30

1. Vascular 2. Cavity

Answer 30

Required Embalming

Question 31

1. Hypodermic 2. Surface

Answer 31

Supplemental Embalming

Question 32

1. Limit admission 2. Identify and secure the preparation room. 3. Maintain dignity of the human remains. 4. Instruct and maintain highest moral standards.

Answer 32

Professional Conduct: Procedure

Question 33

Keep preparation room private during the embalming process. Use spring-loaded lock on preparation room door opened only with a key. When key is removed, the lock resets. Limited to: * Licensed funeral service professionals and registered trainees- apprentices; also hairdresser. * Those authroized by the family - P.R.D. * Those authorized by law having police power.

Answer 33

Limit Admission

Question 34

* Eye bank * Bone bank * Tissue Bank * Organ Removal * Clergy Note: OSHA Training may be required.

Answer 34

Those authorized by the family- P.R.D.

Question 35

* Public officials * Medical Examiner * Police only in the course of their duty

Answer 35

Those authorized by law having police power

Question 36

O.S.H.A. approved signs- HCHO Hazard - Carcinogen Danger - Spring-loaded key lock.

Answer 36

Identify and secure the preparation room

Question 37

Funeral service professional has a custodial relationship and must protect the human remains.

Answer 37

Maintain Dignity of The Human Remains

Question 38

An essential part of the funeral service.

Answer 38

Identification

Question 39

* Regardless of what services are requested, we must perform certain legal functions. Everything we do in caring for a decedent and in serving a family has legal implications and carries liability. * We cannot treat even minimal service requests casually. (take them more seriously) * No matter how simple of complex the service, we must perform all duties in an ethical, professional manner. * Abbreviated services of any type carry a higher risk of misidentification than traditional (full) services.

Answer 39

Requests for both cremation and burial without formal ritual are becoming common in funeral homes throughout the country. As these increase, so does the decision not to view the body. These are some challenges that poses.

Question 40

* Certifies that this is the right person beyond any doubt. * Underscores the professional responsibilities we assume in providing disposition. * Stresses the irreversibility of the cremation process. * Facilitates the process of grieving. * Serves as a preventive mental health measure for the bereaved.

Answer 40

Identification makes sense professionally, practically, and legally.

Question 41

The majority of memories are visual. Seeing the person dead is a powerful confrontation that undercuts the normal tendency to deny that a death has occurred. * If at least one person in the family certifies personally to the death, it becomes easier for others to accept the finality of death and to proceed with the mourning. * The "Missing person" phenomenon teaches us that the absence of positive identification can complicate bereavement.

Answer 41

Identification Facilitates the process of grieving

Question 42

By establishing a basis for certifying the death has occurred and for setting in motion the supportive and therapeutic benefits of whatever ethnic, social and spiritual services follow the death.

Answer 42

Identification serves as a preventive mental health measure for the bereaved.

Question 43

* Relative * Clergy * Best friend * These are people that can be a represenative.

Answer 43

Identification should be performed by the next of kin (PRD) or their desginated-in-writing represenative. (guideline)

Question 44

* The funeral home should take the photograph after obtaining written permission to do so. * If the family brings in their own photograph, it must be recent enough for valid comparison and must be retained in the decedent's file. * The person making the identification should sign the back of the photograph, noting the date and time the identification occurred.

Answer 44

If identification is done by photograph (Guideline)

Question 45

* Appropriate: Small chapel or slumber room. * **_Never_**: Garage, flower room, storage room, preparation room, carport area.

Answer 45

Identification should take place at the funeral home in an appropriate room. (guideline)

Question 46

* Families should be informed that identification viewing is not the same as formal viewing. * It is a very limited time act, usually taking from serveral seconds to several minutes. * Frank discussion reduces the possibility of misunderstanding about its purpose.

Answer 46

During the Arrangement Conference (in reference to identification: guideline)

Question 47

* Inform them where it will take place, what they will see, and how the deceased is covered. * Disclose that the body may not be embalmed, dressed in normal attire or clean-shaven. * If there was a postmortem examination or there are any manifestations of trauma or disfigurement, mention this as well as any relevant details.

Answer 47

Prepare the person wholl will be making the identification before it occurs (guideline)

Question 48

* Stating the name of the deceased, date of death and the name and relationship of the person with the primary right of disposition. * If the next of kin designates another person to make the identification, it must be done in writing, noting the relationship of the person designated by the next of kin. * Once the identification is complete, have the person making the identification sign the form and indicate the date and time it occurred.

Answer 48

Prepare a form on your letterhead (guideline)

Question 49

Invite the person who made the identification to sit in your office and answer any question they may have.

Answer 49

If at all possible, after the identification has been performed. (guideline)

Question 50

Offered by some funeral homes to the person making the identification.

Answer 50

A flower or small token (guideline)

Question 51

* Check the body for valueables (This Should be done at the place of death). * Remove medical devices such as catheters or intravenous equipment (do not remove intravenous equipment prior to embalming). * Wash, comb or brush the hair. * Wipe the face clean, close the eyelids and deodorize the surface of the body. * Cover the body with a clean apron and rewrap it. * Refridgerate the body.

Answer 51

Attention Renendered prior to identification

Question 52

May have laws or statutes governing what may or may not be done to a body for the purpose of providing attention prior to identification.

Answer 52

States

Question 53

Inferior 1/3

Answer 53

Line of eye closure

Question 54

* Crematory: 40^oF * Funeral Home: 44^oF * Must be within 48 hours * All bodies within must be covered. The air flow will dehydrate them otherwise. (surface evaporation).

Answer 54

Refridgeration

Question 55

Does not require embalming.

Answer 55

Law

Question 56

1. Verbal permission - Should be followed up as soon as possible with signed form. 2. Design written permission form including restorative art permission- cover all liability.

Answer 56

Authorization to Embalm (Legal Considerations)

Question 57

1. Autopsy 2. Organ, tissue donation, long bone, eye bank 3. Major Restoration 4. Removal of medical devices. I.E. pacemakers 5. Cremation- refer to state law 6. Shipping human remains- refer to state, national and international laws transporting human remains. 7. Donation of body to science- Anatomy Board- possibility of funeral service with visitation, open casket, prior to donation.

Answer 57

Signed Authorization for procedure other than embalming (Legal Considerations).

Question 58

1. Dead human remains- refer to individual state laws for tagging guidelines, temporary and permanent identification. 2. Procedures to inventory personal effects. 3. Blood Sample 4. Finger Prints 5. Three Photographs 6. Determine who has primary right of disposition= PRD, next of kin, or agent (lawyer) representing PRD, or documented domestic partner.

Answer 58

Identification Procedures

Question 59

* With proper authorization- police power * Wash out embalming fluid bottle, lable, print name, source of drainage, right internal jugular vein. * With drainage tube, draw blood * Do not turn on embalming machine because sample will be contaminated- DNA

Answer 59

Blood Sample

Question 60

* With proper authorization- police power * Most state police have a kit in their car * If mortician is authorized to take prints, use two sheets of clean white paper. * Ink from wrist to finger tips-entire handprint * Print deceased's name on both papers- left and right hand. * Be sure ink dries before folding and putting prints in envelope.

Answer 60

Finger Prints

Question 61

* With proper authorization- police power * Use polaroid camera * Do not close mouth or eyes * Do not pose features * Show teeth if possible * Done prior to embalming * Full front, left profile and right profile

Answer 61

Three Photographs

Question 62

1. Police 2. Medical Examiner 3. Coroner

Answer 62

Responsibility to report observations concerning situation consistent with presumed cause of death specifically any death surrounded by suspicion or unnatural causes.

Question 63

Must the disposition of a human remains be carried out by a licensed funeral service practitioner- Mortician, Funeral Director, etc?

Answer 63

**_NO_**

Question 64

Disposition may be carried out by this person if contracted in agency for consideration by the person holding primary right of disposition of the deceased.

Answer 64

Licensed Funeral Director

Question 65

May dispose of their own loved one themselves, as long as they obey all state laws related to disposition and file all documents pertinent to the disposition of their own loved one. * Responsible for transportation- no seepage, leakage or danger in handing the deceased (heavy duty pouch). * Medical examiner and Registrar of health in that political subdivision must be informed of their intentions in writing. * Legal counsel is usually required.

Answer 65

The person holding primary right of disposition

Question 66

May dispose of a human remains as long as they obey all state laws related to disposition and file all documents pertinent to the disposition. * Cannot charge for or advertise their service * Operate, often, on a _donation for service basis_. * This is expected to change in the future with the rise of direct disposition licensure (Memorial Society).

Answer 66

Unlicensed Individual assisting the PRD acting, not in agency or under contract for consideration

Question 67

May dispose of a human remains when so designated to by the person holding primary right of disposition, PRD, after 72 hours from the time of death when the PRD fails to come forth and claim the remains. * In most states, the ME and Registrar of health must be immediately informed, when, after 72 hours the body is designated or given up as _abandoned_.

Answer 67

Medical Examiner, hospital, or other insititution (nursing home, hospice)

Question 68

Requires 72 hours to designate the body as abandoned. * Will become a ward of the state.

Answer 68

Maryland

Question 69

Will be filed at the Department of Vital Records by the medical examiner, hospital, or other institution.

Answer 69

A certificate of death

Question 70

Will accompany unclaimed remains to local anatomy board. ( in case of abandonment)

Answer 70

A burial and transit permit

Question 71

Never to be made unless you are sure you have a contract with the PRD.

Answer 71

Funeral Arrangements

Question 72

The body and its immediate environment are unsanitary.

Answer 72

After Death

Question 73

1. Protect the public 2. Protect the operator 3. Create a clean, sanitary body for transportation and funeralization. 4. Protech the environment- EPA

Answer 73

Purpose of Sanitation and Disinfection

Question 74

1. Wear nitrile or latex gloves (possible double gloving) 2. Protective clothing worn in preparation- PPE 3. Use of disposable protective clothing

Answer 74

Personal Sanitation- to protect the operator

Question 75

* Gown * Shoe covers * Mask * Impermeable apron * Goggles * Head cover * Face shield * Coveralls

Answer 75

Types of PPE

Question 76

1. Meticulius hand washing 2. Fingernails 3. Wash throughly or shower 4. Oral and nasal cavities 5. Hair

Answer 76

Person Sanitation- Terminal Disinfection of the embalmer

Question 77

1. Bathing and external disinfection of body 2. Disinfection of all external orifices of the body 3. The use of internally disinfecting embalming chemicals 4. Thorough diffusion to all tissues 5. Closure of all external orifices

Answer 77

Environmental Sanitation- create a clean, sanitary body

Question 78

* Vascular * Cavity

Answer 78

3. The use of internally disinfecting embalming chemicals

Question 79

* Multi-site injection * Adequate quantity of chemicals

Answer 79

4. Thorough diffusion to all tissues

Question 80

* Packing * Suture * Adhesives

Answer 80

5. Closure of all external orifices

Question 81

1. Proper disposition of clothing 2. Proper disposal of all waste materials from the embalming procedure. 3. Strict complience with all local, state, and federal (OSHA) regulations. 4. Types of Disinfection (3)

Answer 81

Environmental Sanitation

Question 82

* Launder and return to family. * Destory after proper authorization

Answer 82

Proper disposition of clothing

Question 83

* Sharps * Biohazardous waste * Blood and body fluids * Bandage and cotton

Answer 83

Proper disposal of all waste materials from the embalming procedure

Question 84

* Primary Disinfection * Concurrent Disinfection * Terminal Disinfection

Answer 84

Types of Disinfection

Question 85

Disinfection carried out prior to the embalming process.

Answer 85

Primary Disinfection

Question 86

Disinfection practices carried out during the embalming process.

Answer 86

Concurrent Disinfection

Question 87

Institution of disinfection and decontamination measures after the preparation of the remains.

Answer 87

Terminal Disinfection

Question 88

Refer to here for preparation room inspection check off list. Most of these require as a minimum standard of sanitation and disinfection that certain things require constant maintenance.

Answer 88

Individual State Board Regulations

Question 89

* Wash down: * Ceilings * Walls * Doors * Floors * Windows * Clean all drains * Clean table (top,base,stand,under) * Instruments and equipment * Cabinets * Ventilation fan * Light fixtures taken down and cleaned * Trash can

Answer 89

Things that most state boards require for preparation room inspection check off list. (constant maintenance)

Question 90

In 1683, discovered the existence of microorganisms. Considered the "father of microbiology"

Answer 90

Anthony Van Leewenhoek

Question 91

In 1860, observed the association between microorganisms. disease and decomposition.

Answer 91

Louis Pasteur

Question 92

* Phenol (carbolic acid) -2-5% * Cresol (raw phenol)- 2-5% * Lysol (cresol, linseed soap) - 2-5% * Formalin * Chlorine gas- 1-5% parts/million * Chlorinated lime- depends on strength * Sodium Hypochlorite (chlorox bleach) 60-70% solution * Ethyl Alcohol- 60-70% solution * Bichloride of mercury- 1/1000 to 1/2000 oil to 0.2% * Gluteraldehyde- 0.2% * Stabilized hydrogen peroxide- 6-10% * Idiophores - 75-200 p.p.m. * Iodine- 0.5% and alcohol 70% * Quaternary ammonium compounds Q.U.A.T.S. - 0.1-0.2%

Answer 92

Commonly used disinfectants and microbicides

Question 93

-40% HCHO by volume or 37% HCHO by weight, 5% solution is most commonly used for preservation

Answer 93

Formalin