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Management of the Deceased

Adapted from Guidelines for Handling Decedents Contaminated with Radioactive Materials (PDF - 1.40 MB), Video Watch video (HHS/CDC, April 2007)

Deceased Persons with Exposure to Radiation but No Contamination


  • No radiation-specific precautions are needed.
  • Use standard autopsy procedures.

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Survey Equipment Used to Check Bodies for Contamination


  • Directional probes are preferred when checking bodies for contamination
  • Use of directional probes helps to ensure that the measured radiation is from the surface being checked

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Handling of the Deceased


  • In a radiological/nuclear event, radioactive materials may contaminate the deceased.
  • Evaluating the deceased with appropriate radiation survey meters can confirm or rule out contamination. Advice from a health physicist would be useful.
  • Type of event may dictate timing of handling the deceased
    • If cause of death secondary to nuclear weapon detonation: consider delaying recovery of remains for 1-2 days to allow decay of fission products.
    • If cause of death secondary to explosive radiological dispersal device (RDD) (aka "Dirty Bomb"): no benefit to delaying recovery of remains.
  • If the deceased is known or suspected to be contaminated, personnel engaged in handling of the body should be issued personal protective equipment (PPE) and a personal dosimeter.
  • All persons coming into contact with the deceased should be aware that other, more acutely hazardous agents, may be present.
    • Non-radiological contaminant hazards (e.g., chemical agents) may pose more significant risks to health and safety of persons handling the body.
    • Non-radiological contaminant hazards (e.g., chemical agents) may necessitate use of higher levels of PPE.
  • Disaster Mortuary Operations Response Teams (DMORTs) from HHS/NDMS may be available to assist
  • Training for Handling Decedents Contaminated with Radioactive Material (HHS/CDC) Watch video
    • Includes guidelines for how medical examiners, coroners, and funeral home personnel should handle decedents who have been contaminated with radioactive material.

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Field Morgue Procedures


  • Conduct radiation survey of each body coming into field morgue using a radiation survey meter and probe (see above) sweeping 1 inch away from the body surface
    • Decedents without measurable levels of external contamination
      • Confirm absence of contamination by conducting complete radiation survey of the body
      • Transport body directly to city morgue or to uncontaminated field morgue following complete radiation survey
    • Decedents with measurable levels of contamination
      • <100 millirem/hour: may be processed in field morgue
        • Remove and safely store radioactive shrapnel ASAP
        • Conduct forensic examination and victim identification
        • Decontaminate decedent prior to release of body
      • >100 millirem/hour: move to a refrigeration unit
        • Storage of bodies reading >100 mrem/hr will help ensure safety of morgue staff
        • Refrigerator should be at least 30 feet away from work area
        • Radiation Safety Officer or health physicist will help determine how long to store the body based on rate of decay of fission products
    • Release decedents with internal contamination to funeral home
      • Label body with dose rate, distance of probe, date & time

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Autopsies of Contaminated Patients


  • Do not autopsy internally contaminated bodies unless absolutely necessary.
  • Pathologist performing the autopsy may receive significant radiation dose to the hands.
  • If autopsy is absolutely necessary, refrigerate decedent and defer the procedure until a health physicist can assist in planning.

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Embalming and Funeral Home Guidelines


  • Embalming guidelines
    • Embalming increases radiation dose to funeral home staff.
    • Avoid embalming or working near decedents with unknown dose rates.
    • Minimize radiation dose to funeral home staff by burying decedents without embalming whenever possible.
    • Embalming is necessary if decedent to be shipped by common carrier or if there is to be open-casket funeral service with a viewing.
    • Body fluids may be drained into the sewer.
  • Funeral home guidelines
    • Funeral home directors may reject radioactively contaminated decedents not properly decontaminated (i.e., with loose surface contamination or shrapnel).
    • Encourage rapid burial of internally contaminated decedents; encourage conducting a memorial service without the body to minimize radiation dose to mourners and funeral home staff.
    • Special family circumstances (emotional, religious, cultural) may dictate conduct of funeral service with the body present.
      • Family/friends in close contact with the decedent are at risk for contamination and/or exposure.
      • Encourage family/friends to minimize time with and increase distance from the decedent.
      • Closed-casket funeral or cordon around open casket can help minimize risk of contamination or exposure.
      • Potential contamination/exposure risk is small but not zero.

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Cremation of Contaminated Patients


  • Do not cremate internally contaminated decedents.
    • Radioactive contamination of the facility and environment is highly likely.

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Burial


  • Burial of a body with internal contamination constitutes only minimal health risk to humans or the environment.
    • Minimizing release of radioactive material into the environment is good practice, even if the amounts are very small.
  • Coffin/casket types
    • Wooden coffin/casket
      • Not sealed against elements entering or exiting the container
      • Use should be avoided
    • Metal coffin/casket
      • Preferred
      • Has a seal that releases pressure from inside the casket and retards entry of ground water
  • Vaults are used to encase the metal casket
    • May be metal or concrete
    • Optimizing a tight seal is key to effective vault use.
    • For dose rates measured on vault exterior >100 counts per minute (cpm) above background or greater than twice background: bury casket and vault in ground and not above ground.
    • Affix discrete radiation warning label to exterior of vault indicating dose rate from buried decedent and date/time of measurement.

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Shipping Contaminated Remains


  • Common carriers may reject radioactively contaminated decedents not properly decontaminated (i.e., with loose surface contamination or shrapnel).
  • Ship decedents in a sealed shipping container to prevent release of radioactive material into the environment.
  • Label outside of container in accordance with 49 Code of Federal Regulations (CFR) 172.

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References

  1. Page content adapted from Guidelines for Handling Decedents Contaminated with Radioactive Materials (PDF - 1.40 MB), Charles M. Wood, Frank DePaolo, R. Doggett Whitaker (HHS/CDC, April 2007) Video Watch video
  2. Mass Fatality Management for Incidents Involving Weapons of Mass Destruction (PDF - 1.61 MB) (DOD, 2005)
  3. Disaster Mortuary Operational Response Teams (DMORTs, HHS/ASPR)
  4. Management of Dead Bodies after Disasters: a Field Manual for First Responders (About mass casualty situations but not radiation issues specifically) (PDF - 989 KB) (PAHO, WHO, ICRC, IFRCRCS, 2006)
  5. Mortuary Affairs in Joint Operations, Joint Publication 4-06 (PDF - 2.47 MB) (DOD, 2006)
  6. Medical Examiner/Coroner's Guide for Contaminated Deceased Body Management (PDF - 280 KB) (National Association of Medical Examiners, 2007)
  7. National Association of Medical Examiners Mass Fatality Plan (PDF - 1.86 MB) (National Association of Medical Examiners, 2007
  8. Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Volume I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008. (See Chapter 14: Contaminated Decedents (hospital and mortuary))
  9. Medical Surge Capacity, Workshop Summary, Forum on Medical and Public Health Preparedness for Catastrophic Events. See section on Fatality Management Strategies, pp. 44-51, (Institute of Medicine of the National Academies, 2010).
  10. Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (NCRP Report No. 165), National Council on Radiation Protection and Measurements, Bethesda, MD, January 2010. See Section 7.10, "Handling Contaminated Deceased Persons", pages 112-115. Purchase required.
  11. Medical Examiner / Coroner Guidance on Handling of a Body/Human Remains that are Potentially Radiologically Contaminated (PDF - 757 KB) (DOE/TEPP)
 

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