Embalming History, Theory, and Practice - Chapter 25 (SPCollege 2016)

Removal

(First call or transfer of remains) transfer of remains from the place of death to a funeral establishment

Zieglar Case

(Liner) a gasket-sealed container that can be used as an insert into a casket or a separate shipping container.

Receiving Funeral Establishment - Responsibilities for shipment of human remains

- Avoid making promises to the family about thee time and the date of the funeral services. - Cooperate with the shipping funeral establishment in providing statistical information for the filing of the death certificate and disposition information. - Be prepared for unexpected delays due to weather, flight cancellations, and problems with a local coroner, medical examiner, or organ retrieval teams.

Documents Generally Required Shipping Human Remains to another country

- Certified copy of the death certificate. - Noncontagious disease letter issued by the local health department where the death occurred stating there are no contagious diseases or epidemics in the city or county of death. - Embalmer's Affidavit saying the remains were embalmed in accordance with the laws of the state where the death occurred. - Non-contraband letter stating the casket contains only the body and clothing necessary for burial. A FEE is usually paid to the foreign consulate for processing of the documents

Formaldehyde - Odor Triggered in Shipment

Any human remains that set off alerts from a screening procedure must be quarantined and cannot be released back to the shipper until an approved Certified Cargo Screening Facility (CCSF) can then inspect the shipment and resolve the alarm issue. If a human remains shipment triggers an alarm, it WILL NOT be placed aboard any flight until it can be cleared. This can cause delays in the arrival of the deceased to their destination.

Internal Treatments

Arterial, Hypodermic, and where possible internal compress (face) are the most effective.

Federal Regulations - Known Shipper Program - Shipping Human Remains

As of August 1, 2010, all human remains must be screened just as all carry on items are prior to placement on an aircraft.

99% of Human remains were embalmed

Between 1900 and 1960

Interstate

Between two or more states.

Ecchymosis

Caused by Bleeding under the skin - overtime will turn black.

Humectant

Chemical that increases the ability of embalmed tissue to retain moisture.

American Board of Funeral Service Education curriculum committee - 1989 Clarification

Clarified the definition of embalming from the preservation of the dead body to the temporary preservation of the dead human body. Standard never guaranteed a permanent or indefinite preservation of remains.

NO CHARGE CAN BE MADE FOR EMBALMING (shipping)

If a funeral home embalms remains and it was not authorized by the person in charge of disposition, no charge can be made for the embalming. A funeral home serving an out-of-town funeral director must also release the remains, without receiving payment for its services, to another funeral home should there be a request to do so. A funeral home may not hold remains for payment

Preparation of Remains - D-6 (US Military)

Processing View-able Remains: " a thorough preembalming case analysis shale be made in order to determine the best embalming techniques to be used to obtain optimum results. Preferred Method of treatment - Whenever possible, a six-point arterial injection with multi-site drainage shall be accomplished. The arterial chemical injection solution shall contain a 2 to 3 percent concentration, by volume, of aldehyde or aldehyde derivative preservative agents, with equal parts of a humectant chemical also being added to the injection solution. The thoracic, abdominal, and pelvis cavities shall be thoroughly aspirated and injected with full strength cavity chemicals having a 30 index (percent) or greater, using a minimum of 16 ounces for each cavity.

Storage for Delayed Viewing

Refrigeration IS NOT necessary for storage of embalmed remains for delayed viewing, but a cool location is preferred. If refrigeration is available, it would be recommended to use a storage site. Carefully inspect the body before placing it in storage.

Responsibilities for shipment of human remains - Who 's are they?

Regardless of the final destination - within the state, between states, or to a foreign country - there are responsibilities for both the shipping and the receiving funeral establishments.

Declared War between Country and the United States

Remains "CANNOT" be shipped to countries where war has been declared.

Puerto Rico Airlines - Shipping In human remains

Requires a non-certified copy of the death certificate to be presented to the airline officials when the body is delivered to the airport

American Blue Book of Funeral Directors

Shipping Directory Publication

Countries without Diplomatic Relations - Shipping of dean human remains

Shipping remains to these countries may not be possible or may need to be done through another foreign government. Example: Cuba

Provisional Transit Permit (shipping) - Common Carrier

Some states issue this when a death certificate has not been signed by a physician or a coroner; Other states require that the medical examiner or the coroner be notified and provided with the cause of death prior to consent being given for the transportation of the deceased.

Universal Death Certificate and Vital Statistics Registry

THERE IS NONE - that are shared by all states and likewise there are no uniform regulations governing the transportation of dead human remains between states.

Anatomical Embalming

The Anatomical Board provides the directions for the embalming of the body.After the funeral, the body is delivered to the medical school and is re-embalmed.

Intrastate

Within one state

International

between countries.

Objectives of embalming for Funeralization

Not only involve preservation of the body, but also the creation of an acceptable appearance of the body but also the creation of an acceptable appearance of the body.

Unionall

Plastic garment designed to cover the entire body from the neck down to and including the feet.

Storage for Delayed Viewing - Suggestions

- Lay a large sheet of thick plastic down, place body bridge on top of the plastic sheet, and lay remains on top of body bridges. - Cover the remains with a cotton hospital gown or sheet, but do not cover the face or feet. - Prepare a chemical wetting agent by mixing two-thirds of a gallon of hemectant, 4-oz mold retardant (thymol or phenol), and 1 gallon of water. Semi-saturate the body covering with the wetting agent. Reserve the rest in a spray bottle. - Loosely cover the remains with the sheeting, trapping a moderate amount of air inside the sheeting. - Place in a cool area - Check the remains every 3 to 4 days; aspirate or sponge out any liquid that has collected on the plastic, spray the gown or the sheet with the wetting agent, and reapply massage cream to facial and hand areas. - Follow these guidelines until day of final viewing. - Thoroughly wash and dry (so that no evidence of moisture exists) the remains, dress, and cosmetize.

Shipping Human Remains Overseas - Unusual Requirements

- Need for a sealing casket or a wood casket with a sealing Zieglar case inside - An all-wood shipping container possibly lined with zinc and soldered closed - Exact dimension for the outer shipping box and the material of composition - Bottom of the casket be filled with sawdust (EGYPT) - Israel does not require embalming, but if embalmed, the remains must be embalmed by the gravity method and no drainage taken - Require embalming using chemicals illegal in the United States such as BICHLORIDE OF MERCURY (ITALY)

Embalming for delayed viewing can adversely affect the remains.

- Over-drying or Desiccation of tissue - Development of mold on the surface of the remains - Insufficient preservation, requiring reembalming

Preparation of the Body - Shipping (ALL) Carriers

- Thoroughly cleanse and embalm the remains; thoroughly dry the body. - Pack all external orifices. - Place the remains in a plastic garment (pants, coveralls, or unionalls). - Partially dress the remains using underclothing, pajamas, or a hospital gown, and envelop in a clean sheet. - When shipping by common carrier place the shrouded body on a sheet of plastics that can envelop the body. - DO NOT place one hand over another, as this might not be the desired position. - When shipping casketed remains, place a very heavy layer of cotton around the head and the face to protect the casket and clothing from any purge; be certain to turn the pillow over for shipping to prevent soilage from purge or cosmetics. - Secure the body on a cot if shipping within the container; if casketed, place the bed of the casket in the lowest position and move the feet to the furthest end; secure the head end so the body will not slide. - Document the condition of the body before, during, and after embalming. Send a copy of the embalming report with the remains. - Notify the receiving funeral director of any unusual conditions (e.g., trauma. obesity, edema).

Inspection of the Shipped in body "NOT CASKETED"

- Undress the remains and inspect all body areas for adequate preservation - Re-injection of localized areas may be necessary, small areas can best be treated by hypodermic embalming. - Re-aspirate the body and if necessary re-inject the cavities - Remove excess massage cream from face and hands. - Be certain the mouth is dry and free of any purge material; reset and glue the mouth. - Dry eyes and re-set and glue eyes (often bodies shipped the mouth and eyes are NOT glued). - Tissue build hands and face where necessary. - Apply Cosmetics - Dress and casket the remains. - Prepare (2) two copies of the Embalming Care Report - noting the condition of the body at the time of arrival and any necessary corrections and treatments. Retain one copy and send the other to the shipping funeral director or embalming facility.

Three methods to Re-embalm body or area of a body

1. Arterial Injection 2. Hypodermic Injection 3. Surface Embalming (Time may play a significant role in selecting a method of treatment)

Desiccation Issues to the dead human body

1. Can make it difficult to keep the eyes and mouth properly closed. Remedy: Closure should be done preferably with a superglue; this will help to retain the closure for the duration of storage. 2. Use of liberal amounts of massage cream throughout the storage period will also help to reduce dehydration. 3. Mold formation can be prevented by the topical use of a mold-retardant chemical. 4. The remains should never be placed in a closed, dark environment as this promotes the growth of mold. 5. During the time of storage, if any area exhibits inadequate preservation, it should be treated by hypodermic injection of undiluted preservative chemical or re-injected using undiluted preservative chemical. This should be done as soon as problems are identified.

Common Carrier - two types of trays

1. Combination Air Tray 2. Air Tray "CAN ONLY BE USED ONCE" They come in these sizes: 1. Infant 2. Child 3. Adult 4. Over-sized Units

Three major factors affect the degree and length of preservation

1. Condition of the body at the time of the preparation 2. Embalming thoroughness and chemical formulations 3. Aftercare Standard embalming and preservation practices should conceivably keep the remains intact for months or possibly years with no special treatments.

Common Carrier

Any carrier required by law to convey passengers or freight without refusal if the approved fare of charge is paid; travels according to a set schedule (e.g., airlines, railroads)

Inspection of the Shipped in "CASKET WITH HUMAN REMAINS"

1. Inspect the remains and the external areas of the casket upon arrival at the funeral home for any problems or issues needing resolution. (Ideally, this should be within hours of the arrival). 2. Use an "Embalming Care Report" to document the condition of the remains and to identify any action that was taken to further prepare the remains. (This would include cosmetics, dressing, or any "embalming" that might need to be done.) 3. If extensive problems are present, a decision about family notification needs to be made. More documentation of the condition (i.e. photographs) may be required: a. Minor adjustments such as cosmetics or clothing generally do not require family notifications unless the funeral home will be making a charge for the work done. b. For extensive problems, the funeral home will have to decide about charges for the care of the remains and whether a replacement casket is needed. the shipping funeral home may also need to be contacted if there are extensive problems.

Shipping can be divided into three categories

1. Intrastate 2. Interstate 3. International Each of these divisions can have its own rules and regulations for the transportation of human remains

All three groups of embalming chemicals may be necessary to use in the preparation room of bodies for extended preservation and delayed viewing

1. PRESERVATIVE embalming chemicals 2. SUPPLEMENTAL embalming chemicals (injectable chemicals such as humectants, co- or pre-injection chemicals, dyes, and other preservative chemicals 3. ACCESORY embalming chemicals (noninjectable chemicals such as mold retardants, embalming powders and gels, and autopsy compounds)

Estimated number of remains transported every year by common carrier

20,000

Human Remains

A Dead human body or cremains.

Certified Cargo Screening Facility (CCSF)

A Funeral Home can be certified as a CCSF

Death Certificate

A Legal document containing vital statistics, disposition, and final medical cause of death pertaining to a deceased human body.

Burial-transmit permit

A disposition permit which is a legal document issued by a governmental agency, authorizing transportation and/or disposition of a dead human body.

Long term protection of dead human body

A thoroughly embalmed, well preserved body is fundamental to long term protection of that body. Without initial preservation, no casket, crypt, or other product will retard decomposition and protect the body in the efficient manner that embalming can accomplish.

Combination Case

A transfer container consisting of a particleboard box with a cardboard cover used to ship a remains in place of a casket or airtray

Hermetically Sealed

Airtight, impervious to external influence; completely sealed by fusion or soldering.

Private Carrier

An individual or a company that transports only in particular instances and only for those it chooses to contract with, for example, livery companies, private aircraft.

Desiccation

An over drying of the tissue that causes dehydration or a leathery appearance to the remains

Preparations of remains for Remains for delayed Viewing

Considerations: 1. restricted cervical injection allows the injection of large volumes of arterial solution without over-injecting the facial tissues; one solution strength can be used for the face and another for the trunk and limbs. 2. Intermittent or restricted drainage 3. Delay aspiration and cavity treatment. This helps the arterial solution to thoroughly saturate the body tissues and organs. 4. Place the remains on "body bridges" or "blocks" so that as little body surface as possible makes contact with the surface it is lying on. This is important during embalming and storage of the body. 5. Avoid excessive elevation of the head. This can cause fluids to drain from the face and neck, bringing about a sunken appearance. 6. Because some tissues and embalming fluids can be removed from facial tissues by dehydration and gravitation, it is recommended to do some feature tissue building prior to storage of the embalmed body. Restore by filling out the areas of the cheeks, temples, lips, and fingertips. 7. Hypodermic-ally treat all areas of ecchymosis; left untreated over time they will turn black. Use a phenol cautery solution or cavity fluid; this will bleach the tissues and ensure good preservation. 8. Apply liberal amounts of massage cream to the face, neck, hands, and wrist areas. these areas can also be covered with cotton to prevent further evaporation of the massage cream. 9. Spray the remains with a mold retardant (there are some specific mold retardants available, but any topical embalming spray should prevent the growth of mold) initially, and at regular intervals, during storage. 10. Do not place the remains in closed, sealed environment; it encourages mold growth. 11. The remains must be inspected on a regular basis once in storage. If problems develop, they can be corrected immediately.

Putrefaction

Decomposition of proteins by the action of enzymes from anaerobic bacteria.

Security Endorsement - Shipping Human remains overseas

Document stating the container has no explosive devices, requiring the person dropping off the shipment to have two picture ID's, and a letter of certification that the shipment meets all Federal Aviation administration rules and regulations. the shipment may need to be x-rayed, must arrive in the cargo area at a certain time, and no additional items are allowed to be placed inside the container. - Shipments sent unembalmed can either be packaged in DRY ICE or in FREEZER PACKS similar to the kind used for food. Many airlines charge a PREMIUM FEE for the shipment of dry ice because it is considered a hazardous material. - The length of time involved to process an international shipment can take anywhere from 5 to 14 business days. Most foreign consulates observe American Holiday and do not work on weekends. - Some foreign consulates require that one of their officers inspect the casket and container, and seal the outer box with wax and the seal of their government. This may require that the shipment first go to another larger city (ex: New York, Chicago, Los Angeles) to fulfill this obligation.

Embalming for Delayed Viewing

Embalming for delayed viewing or interment can be defined as a preparation of a remains that will allow the initial viewing up to several weeks after death.

Just how long embalming will preserve a loved one?

Federal Trade commission - FTC that prevent the funeral director from representing that preservation will delay the natural decomposition of human remains

Long term preservation

Federal regulations forbid the funeral director from making statements guaranteeing long-term preservation.

United States Post Office - Shipping Cremains

For Interstate and intrastate shipping of cremains, the USPS is the ONLY METHOD AVAILABLE. FedEx, UPS, and other carriers will not accept cremated remains for shipment. The majority of airlines will accept cremated remains for shipment within their small package cargo systems.

Re-aspiration before Arterial injection - after embalming has been done

In the treatment of the unautopsied body, a multi-point injection may be required depending upon the extent of the problem. This is necessary because the cavity embalming has been completed. -In this manner, the drainage can be taken from the heart. It is not necessary to drain from each site of injection. As only a minimum amount of fluid is used in the re-injection process, drainage should not be a big concern. -After Injection, thoroughly aspirate again, and then inject a minimum of two or three bottles of concentrated cavity fluid into the cavities. -It is always suggested that these bodies be reaspirated before dressing. - If time is a serious factor areas such as the trunk walls, buttocks, shoulders, and legs can be directly injected using a trocar directly attached to the embalming machine. Undiluted cavity fluid or high-index fluid should be injected. points of entry can be sealed using trocar buttons. - Small areas of the face that appear under embalmed can be re-injected from within the mouth by hypodermic treatment. Undiluted cavity fluid works best for this embalming. - Eyelids and Mouth. These areas can be easily treated by placing cotton under the eyelids or over the teeth. Saturate the cotton with a few drops of undiluted cavity fluid and seal the lids or mouth with superglue. This will server as an internal compress which in a few hours should have the surrounding tissues well preserved. - If the entire side of the face or hand needs to be re-embalmed, arterial injection is recommended.

Embalming slows the reduction process

In time, all organic matter will be reduced. In time perhaps many years - a gradual breakdown of the embalmed body will take place, rather than a putrefactive process involving liquefaction and odors.

International Shipping of human remains

Is by far the most complicated type! Funeral Director must notify the "Embassy" (Washington DC) or local "consulate" (branch offices of the embassy within the USA) before shipping. the country where the body is to be buried has rules and regulations that must be followed before the transportation can take place. permission must be granted for the deceased to enter the country.

Shipping

Is the transportation of human remains away from the place of death to another location for final disposition

Tissue Gas - if the body has developed after re-embalming

It is recommended that each section of the body be injected using a water-less solution. Gasses can be forced from incision sites where arteries are raised.

General Rule (shipping) - Common Carrier

MUST be accompanied by a burial-transit permit (or similar document).

Shipping Regulatory Agencies

May include a local or a state board of health, local or state bureau of vital statistics, state board of embalmers and funeral directors, local or state coroner or medical examiners office, and transportation agencies (airline regulations, livery regulatory unions, etc.)

Anatomical Embalming - Method

The majority of schools use a combination of pressure injection and gravity injection overnight to thoroughly perfuse the embalming fluid. Gravity injection is done through large "percolators"; some will hold as much as 8 gallons of solution. -These are raised to a height of 6 to 9 feet above the body creating the pressure for the perfusion. The use of large arterial tubes helps to increase the rate of perfusion. - Most schools inject between 4.5 and 9 gallons of preservative, depending on the size of the body. - Depending on how the body will be used, some schools drain the blood while others do not. - There is NO ASPIRATION of bodies for medical schools. - Many of the bodies used by medical schools are kept for 2 years or more. - Desiccation and Mold are 2 major concerns in keeping bodies for long time periods at medical schools. - Some schools refrigerate the bodies - not so much for preservation but for mold growth prevention. - depending upon the use of the body, some bodies or body parts may indeed be FROZEN. Preservation in this manner would be of value for either teaching or developing new surgical techniques.

Care and Disposition of Remains and Personal Effects - The United States Army Regulation 638-2

The military takes an aggressive methodology toward the preparation of its deceased members

When the body is to be shipped in a casket

The remains should be secured in place with padding along the elbows and at the feet to prevent sliding during transit before shipping - Plastic should be placed around the head and neck to prevent any soilage should purge occur. - The pillow should be turned over or have a piece of plastic covering it. - Cover the Face and Hands to prevent any make-up from damaging the interior of the casket. - If the casket has a movable bed, it should be lowered to its lowest position. - If the casket is a sealing type, it should NOT be cranked all the way shut to allow for any air pressure changes inside the cargo hold of the plane. - The crank for the casket should be wrapped and placed on the outside of the casket so that it can be used by the receiving funeral home to open the casket. (This is important as there are many different casket companies and some have a crank that is unique to a particular casket). - The casket will be placed in an air tray and the information placed on the outside as suggested.

Sending Funeral Establishment - Responsibilities for shipment of human remains

The shipping facility must - Remove the remains from the place of death - Embalm and thoroughly preserve the remains, the exception being if shipping to Israel. - Prepare the Embalming Case report - one copy to accompany the body and a second to remain in the shipping funeral home case file. If the deceased exhibits, facial disfigurement photos before and after preparation may be taken (with permission) to document the disfigurement. - Secure the necessary documents for shipping and disposition. - Arrange for private or common carrier transportation and, if necessary, the required container. - Communicate to the receiving funeral establishment the condition of the remains and the time schedules of the carrier and provide the service as expediently as possible to relieve any anxiety on the part of the family and the receiving funeral establishment.

Purge and Gas - During visitation

The time slots between the visitation hours or the time period after the visitation may be when the corrections can be made

Re-Embalming - Bodies that Require This

There are occasions when it may be necessary to re-embalm a body or section of a body: 1. Fluid was not distributed to all areas 2. Too little solution was injected 3. The concentration of the fluid was too low to meet the preservative demands of the body 4. The injected solution was neutralized by the body chemistry (often seen in bodies dead from renal failure or edema) 5. Rigor mortis was mistaken for embalming fluid tissue fixation

The Lid of the container must be nailed or screwed in place

This prevents it from collapsing inside the container and causing damage to the remains. - The body should be securely tied in place. (This will prevent the wooden bottom of the combination unit from becoming soaked with body fluids in the event that the body develops leakage during transportation) - The head should be placed on a STYROFOAM HEAD BLOCK or other elevation device. - When the lid of the container is in place, it should not touch the nose or forehead.

Perfusion

To force a liquid through (an organ or tissue), especially by way of blood vessels. Injection during vascular (arterial) embalming.

TSA

Transportation Security administration - put in place September 11, 2001. They put in place the "Known Shipper Program" to identify all shippers of cargo (including funeral homes/services) and freight.

Air Tray

Used for casketed remains, only the bottom is made of wood, top sides and ends are made of heavy grade cardboard

Embalming for Delayed Viewing for More Than 1 Month

When no signs of decomposition exist in the remains, use the following solution (1 gallon of solution): - 32 oz arterial humectant fluid - 32 oz co-injection - 16 oz water corrective - 16 oz humectant - 32 oz tepid water For remains showing early or intermediate signs of decomposition, use the following solution: - 32 oz high-index fluid - 32 oz co-injection fluid - 32 oz water corrective - 16 oz humectant - 0 oz water (NONE)