Funeral Directors - Transcript

Doggett Whitaker: Hello. I'm Doggett Whitaker, a licensed funeral director and embalmer, and a Past President of the National Funeral Directors' Association. This video is based on CDC's Guidelines for Handling Decedents Contaminated with Radioactive Material. The purpose of this video is to teach embalmers, funeral directors, cemetery operators and other death care professionals the risks associated with radioactively contaminated human remains, the techniques for safely dealing with them, and how to communicate these risks to family members. This video will also demonstrate the procedures and equipment used in embalming and burial for health physicists. CDC's guidelines recommend medical examiners, coroners, or pathologists remove all external contamination and shrapnel before releasing the body to the funeral home, so funeral directors should only have to deal with internal contamination. If radioactive material is suspected, funeral directors should ask if the medical examiner or coroner has complied with CDC's guidelines; if they have not complied the funeral director should refuse to accept the body. In addition to following CDC's guidelines, the funeral director should contact the appropriate state Radiation Control Program Director before dealing with human remains ontaining radioactive material.

Narrator: If the body contains internal contamination, the medical examiner should have attached a tag showing dose rate, distance at which measured and time and date of the measurement. In the case of the radioactively contaminated human remains, burial without embalming and a memorial service without a viewing will minimize the radiation exposure to all concerned, but this may not be acceptable to the family for emotional, cultural, or religious reasons. The death care professional will need to understand the significance of the potential radiation exposures well enough to explain them to embalmers and family members. Remember, with internal contamination, you are dealing with the body of a person who inhaled or swallowed radioactive material before death. When a person inhales or swallows radioactive material, it is resident in the lungs or gastrointestinal tract for a while. Then it is absorbed in the blood and transported to organs or tissue where it remains. The amount in the blood at any given time is small. The radioactive material will either be in the lungs or GI tract if the person died soon after exposure; or deposited somewhere else in the body if death occurred several hours after exposure.

Patty Hutcheson: Hello. I'm Patty Hutcheson, President of Gupton-Jones College of Funeral Service. In this sequence we will demonstrate for health physicists the procedures and equipment used in the embalming process. Pay particular attention to the distance of the embalmer and his hands from the body. This is a preparation room. The use of universal precautions and personal protective equipment by the embalmer and any assistants is necessary for the preparation of all bodies, and especially radioactively contaminated human remains. After the body has been placed on the table, all clothing is removed. The body is washed and disinfectant spray is topically applied. The body is then properly positioned on the table. The mouth and eyes are closed. An incision is made to expose the artery and vein that will be used to inject the embalming fluid and drain the blood. A canula is inserted into the artery and a drain tube into the vein. Embalming fluid is then injected into the artery. The embalmer stays close to monitor the injection of fluid and look for signs of arterial solution distribution. The drained blood is discharged into the sewer system. This is acceptable because the amount of radioactive material in the blood will be very small. If state regulators consider it desirable to retain the body fluids for analysis before disposal, move the drainage tube to a container. Ensure there is a splatter shield over the container. The embalming process will take about an hour or so. The embalmer remains in the room during the entire process, monitoring the progress and flexing limbs as required for through fluid distribution. The death care professional should estimate time required based on the condition of the remains, and he or a health physicist can then calculate the expected radiation dose to the embalmer. The next step in the normal embalming procedure is to aspirate the thoracic cavity, abdominal cavity and pelvic cavity, removing liquids and gases that are present there. This step is followed with the injection of cavity fluid for preservation of the aspirated areas. When treating a radioactively contaminated body, the embalmer should NOT aspirate, but simply inject the cavity fluid into those areas.

Narrator: CDC strongly recommends not cremating a body containing man made radioactive material. Let's look at the reasons for this recommendation. This is a crematory. The body is cremated inside this structure. All volatile materials go up this ventilation stack. This would include any volatile radioactive material. After cremation is complete, the ashes are manually pulverized at this work station. Any non volatile radioactive materials remaining in the ashes could contaminate the worker or the room. Finally, any cancer treatment seeds or shrapnel could remain in the ashes when they are returned to the family.

There are no laws in the United States covering burial of radioactively contaminated human remains. It is extremely doubtful that the radioactive material from an internally contaminated decedent would ever be measurable in the environment. However, it is good practice to retard the introduction of any man-made radioactive material into the environment. Recall the principle of ALARA - As Low As Reasonably Achievable.

Glen Bowen: Hello. I'm Glen Bowen, Chief Operating Officer of Wilbert Burial Vault Company in Atlanta, Georgia. CDC's guidelines recommend burial of a body with internal radioactive material in a container designed to keep ground water out. If neither rain nor ground water come into contact with the body, no radioactive material will be leaked into the environment. The family should select a grave site above the water table. If a body contains internal radioactive material, The manufacturer of the casket and vault to use his professional judgment to select the best container, considering the objective of keeping water out. Specially constructed containers are not necessary. A common practice in the U.S. is to place the body in a casket for the funeral service, than place the casket inside a lined vault for burial. For the benefit of the health physicists watching this video, we will now show some examples of burial containers. Caskets may be made of wood or metal. Wood caskets are biodegradable and do not have a gasket. Metal caskets are not biodegradable, and most have a gasket. The casket should be lowered into a concrete vault for burial. Some outter burial containers are manufactured as a dome with a flat base. These vaults are not water resistant. A concrete vault is lined with plastic or plastic and metal and has a tongue in groove butyl compound seal that helps resist the entrance of rain and ground water. The best choice, then, for burial of a body contaminated with radioactive material is a metal casket inside a concrete lined vault as shown here. It is common practice at the cemetery to lower the base of the vault into the grave, and then lower the cover. However, to ensure a quality seal, it is preferable to seal the base and the cover above ground where it can be inspected.

Narrator: CDC has received occasional queries in the past about the necessity for lead lined caskets for human remains containing radioactive medical sources. Lead is a far more severe environmental hazard than the radioactive material. The Agency for Toxic Substances and Disease Registry (ATSDR) has published a Toxicological Profile describing the hazards of lead in the environment.

The embalmer did not have much choice in how close he stood to the contaminated body or how long he had to stand there. This is not true for family members and the public at a viewing. Remember, radiation exposure is reduced by time and distance. If the family wants a viewing encourage them to view from a distance, and for minimal amount of time if that is acceptable. A short stay immediately adjacent to the body or touching the body by family members are both allowable. If there is to be a viewing, the funeral director will need to put the potential exposures into perspective for the embalmer and for the family members. Dose rate decreases with the square of distance. If the dose rate from a body is 5 millirads per hour at 1 inch, it would be .05 millirads per hour at 10 inches. In this example a person standing one foot from the body for one hour would receive on tenth of a dental x-ray.

This table is from CDC's printed guidelines. CDC suggests using this table to help death care professionals put radiation exposures into perspective for family members. CDC recommends printing and laminating this table for use of the staff and the public. Funeral directors can contact CDC for assistance in preparing briefing materials for family members or their own staff. Death care professionals may be more comfortable actually measuring the radiation dose rates they are working with. However, radiation detection instruments are fairly expensive, buyers must be trained in their use, and they require periodic calibration. Death care providers should consider identifying resources in their communities where they can find help if they need it. A nearby nuclear facility or a hospital with a nuclear medicine department may be available. The Radiological Emergency Assistance Center Training Site (REAC/TS) at can provide telephone advice and assist in identifying other resources. Finally, funeral directors working with human remains containing man made radioactive material should always contact their state Radiation Control Program Director before proceeding.

In this video we have seen how radioactively contaminated human remains may be handled safety and how to reassure family members and the public.