Mors 111 Lecture Notes Flashcards
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:
- Biological Chemistry
- Anatomy
- Pathology
- Microbiology
- Restorative Art
- Embalming Technique
Brief Summary of the Embalming Process
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.
Memory Picture
- Embalming is the process designed to retard tissue decomposition for a reasonable period of time, but not forever.
- At best the process will keep the remains intact for many years, but they will eventually turn to dust.
- It is our purpose to serve the living of our time, not to create museum specimens for the amazement of future generations.
- 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.
- 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.
What the Embalming Process Accomplishes
A deliberate deception for unfair or unlawful gain.
Fraud
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.
Airtight/Watertight Outside Enclosures
Will not accomplish protection against anaerobic bacteria that may cause embalmed remains to go into putrefaction.
Airtight/Watertight Outside Enclosures
- 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).
- It is the gas that is liberated from these fluids that cuases the chemical fixation of tissue cell protein.
- It is the process in which protein is altered so that it is no longer a suitable medium or food for bacterial growth.
How The Temporary Embalming Process is Accomplished
Tissue cell proteins.
Protoplasm
In this reaction, soluble albumins in the tissues (cell protoplasm) are converted into insoluble albuminoids or gels which cause the firmness of the tissues.
Protein Alteration
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).
Gases Liberated from Preservative Fluids
- The degree of tissue saturation.
- The degree of control of the bacterial growth.
Degree of Length of Preservation Depends on These Two Related Factors
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)
Embalming
- Cavity Embalming
- Hypodermic Embalming
- Surface Embalming
- Vascular Embalming
Four Classifications of Embalming
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.
Cavity Embalming
Injection of embalming chemicals directly into the tissues through the use of a syringe and needle or trocar, or a hypodermic trocar.
Hypodermic Embalming
Direct contact of internal or external body tissues with embalming chemicals.
- Phenol gels
- Wrap, spray- the gasses embalm
- Osmosis
Surface Embalming
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.
Vascular Embalming
- Em- In or about.
- Balm- Resinous substance, a balsamic agent.
Etymology of The Word Embalm
An aromatic gum resin obtained from certain trees and plants often used as a crude medicine.
Balm
Most states prior to 1984 F.T.C. Funeral Rule had no specific definition. Disposition of human remains reflected 19th century laws based on sanitation and moral codes (4).
Legal Definition of Embalming: Prior to 1984
- That a dead human body not endanger the health and well-being of the general public.
- That such a dead human body not cause a public nuisance.
- That there will not be seepage, leakage or the escape of noxious odors and gas while transporting a dead human body.
- 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.
Moral Codes
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
Embalming (Legal Term)
This is the same thing as the primary objectives of contemporary embalming.
Need for Embalming
- Education
- Immunization
- Occupational Hazards
- Ethical Standards
Embalmer Preparedness
- Associate degree of equivalent
- National Board Examination
- State Board Examination and Practical Embalming and State Regulations.
- Internship (apprenticeship) - 1,000 hours MD
Education
3 HBV shots mandatory.
Immunization
OSHA standard.
Occupational Hazards
All moral and legal considerations.
Ethical Standards
- Vascular
- Surface
- Hypodermic
- Cavity
Four Classifications of Embalming
- Vascular
- Cavity
Required Embalming
- Hypodermic
- Surface
Supplemental Embalming
- Limit admission
- Identify and secure the preparation room.
- Maintain dignity of the human remains.
- Instruct and maintain highest moral standards.
Professional Conduct: Procedure
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.
Limit Admission
- Eye bank
- Bone bank
- Tissue Bank
- Organ Removal
- Clergy
Note: OSHA Training may be required.
Those authorized by the family- P.R.D.
- Public officials
- Medical Examiner
- Police only in the course of their duty
Those authorized by law having police power
O.S.H.A. approved signs- HCHO Hazard - Carcinogen Danger - Spring-loaded key lock.
Identify and secure the preparation room
Funeral service professional has a custodial relationship and must protect the human remains.
Maintain Dignity of The Human Remains
An essential part of the funeral service.
Identification
- 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.
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.
- 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.
Identification makes sense professionally, practically, and legally.
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.
Identification Facilitates the process of grieving
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.
Identification serves as a preventive mental health measure for the bereaved.
- Relative
- Clergy
- Best friend
- These are people that can be a represenative.
Identification should be performed by the next of kin (PRD) or their desginated-in-writing represenative. (guideline)
- 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.
If identification is done by photograph (Guideline)
- Appropriate: Small chapel or slumber room.
- Never: Garage, flower room, storage room, preparation room, carport area.
Identification should take place at the funeral home in an appropriate room. (guideline)
- 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.
During the Arrangement Conference (in reference to identification: guideline)
- 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.
Prepare the person wholl will be making the identification before it occurs (guideline)
- 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.
Prepare a form on your letterhead (guideline)
Invite the person who made the identification to sit in your office and answer any question they may have.
If at all possible, after the identification has been performed. (guideline)
Offered by some funeral homes to the person making the identification.
A flower or small token (guideline)
- 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.
Attention Renendered prior to identification
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.
States
Inferior 1/3
Line of eye closure
- Crematory: 40oF
- Funeral Home: 44oF
- Must be within 48 hours
- All bodies within must be covered. The air flow will dehydrate them otherwise. (surface evaporation).
Refridgeration
Does not require embalming.
Law
- Verbal permission - Should be followed up as soon as possible with signed form.
- Design written permission form including restorative art permission- cover all liability.
Authorization to Embalm (Legal Considerations)
- Autopsy
- Organ, tissue donation, long bone, eye bank
- Major Restoration
- Removal of medical devices. I.E. pacemakers
- Cremation- refer to state law
- Shipping human remains- refer to state, national and international laws transporting human remains.
- Donation of body to science- Anatomy Board- possibility of funeral service with visitation, open casket, prior to donation.
Signed Authorization for procedure other than embalming (Legal Considerations).
- Dead human remains- refer to individual state laws for tagging guidelines, temporary and permanent identification.
- Procedures to inventory personal effects.
- Blood Sample
- Finger Prints
- Three Photographs
- Determine who has primary right of disposition= PRD, next of kin, or agent (lawyer) representing PRD, or documented domestic partner.
Identification Procedures
- 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
Blood Sample
- 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.
Finger Prints
- 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
Three Photographs
- Police
- Medical Examiner
- Coroner
Responsibility to report observations concerning situation consistent with presumed cause of death specifically any death surrounded by suspicion or unnatural causes.
Must the disposition of a human remains be carried out by a licensed funeral service practitioner- Mortician, Funeral Director, etc?
NO
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.
Licensed Funeral Director
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.
The person holding primary right of disposition
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).
Unlicensed Individual assisting the PRD acting, not in agency or under contract for consideration
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.
Medical Examiner, hospital, or other insititution (nursing home, hospice)
Requires 72 hours to designate the body as abandoned.
- Will become a ward of the state.
Maryland
Will be filed at the Department of Vital Records by the medical examiner, hospital, or other institution.
A certificate of death
Will accompany unclaimed remains to local anatomy board. ( in case of abandonment)
A burial and transit permit
Never to be made unless you are sure you have a contract with the PRD.
Funeral Arrangements
The body and its immediate environment are unsanitary.
After Death
- Protect the public
- Protect the operator
- Create a clean, sanitary body for transportation and funeralization.
- Protech the environment- EPA
Purpose of Sanitation and Disinfection
- Wear nitrile or latex gloves (possible double gloving)
- Protective clothing worn in preparation- PPE
- Use of disposable protective clothing
Personal Sanitation- to protect the operator
- Gown
- Shoe covers
- Mask
- Impermeable apron
- Goggles
- Head cover
- Face shield
- Coveralls
Types of PPE
- Meticulius hand washing
- Fingernails
- Wash throughly or shower
- Oral and nasal cavities
- Hair
Person Sanitation- Terminal Disinfection of the embalmer
- Bathing and external disinfection of body
- Disinfection of all external orifices of the body
- The use of internally disinfecting embalming chemicals
- Thorough diffusion to all tissues
- Closure of all external orifices
Environmental Sanitation- create a clean, sanitary body
- Vascular
- Cavity
- The use of internally disinfecting embalming chemicals
- Multi-site injection
- Adequate quantity of chemicals
- Thorough diffusion to all tissues
- Packing
- Suture
- Adhesives
- Closure of all external orifices
- Proper disposition of clothing
- Proper disposal of all waste materials from the embalming procedure.
- Strict complience with all local, state, and federal (OSHA) regulations.
- Types of Disinfection (3)
Environmental Sanitation
- Launder and return to family.
- Destory after proper authorization
Proper disposition of clothing
- Sharps
- Biohazardous waste
- Blood and body fluids
- Bandage and cotton
Proper disposal of all waste materials from the embalming procedure
- Primary Disinfection
- Concurrent Disinfection
- Terminal Disinfection
Types of Disinfection
Disinfection carried out prior to the embalming process.
Primary Disinfection
Disinfection practices carried out during the embalming process.
Concurrent Disinfection
Institution of disinfection and decontamination measures after the preparation of the remains.
Terminal Disinfection
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.
Individual State Board Regulations
- 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
Things that most state boards require for preparation room inspection check off list. (constant maintenance)
In 1683, discovered the existence of microorganisms. Considered the “father of microbiology”
Anthony Van Leewenhoek
In 1860, observed the association between microorganisms. disease and decomposition.
Louis Pasteur
- 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%
Commonly used disinfectants and microbicides
-40% HCHO by volume or 37% HCHO by weight, 5% solution is most commonly used for preservation
Formalin
