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Haz Mat "Specialist Course"
Saturday
Mar022019

Mortuary Response to VHF - 7 Burial Procedure

Preparing the gravesite is not going to be a ceremonial site or operation. This is going to devastate most family members. Many older cultures have extreme burial procedures by modern standards. Various peoples are rich in culture surrounding the burial practice. This is part of the “farewell” process for the soul of the dear departed family member. These types of burial rites extend back farther than the Egyptians before they built the pyramids!

These ceremonies involve everything from touching and bathing the body before burial to clothing the body in various ceremonial dresses before being placed into the burial vault. A culture deep in these practices are going to view their loved one placed in a bag and tossed into an earthen hole as an assault on their family member and culture as a whole.

At this point, your burial team should have coordinated a position and person respected in the community for which you are operating in. This person (team member) must not only have the translation skills for the local language, but also be an honored member of the community that can ease tensions and spend the appropriate time counseling these family members. It is a good idea to plan this position with international hope or welfare organizations that are intimately involved with all aspects of these communities.

Have them explain why the actual burial and site can only be for immediate family alone. If a mass grave area needs to be chosen for review, this may complicate this directive. Consult with the director of operations from the CDC/WHO (Center for Disease Control/World Health Organization) regarding the particular situation you are operating in and if this guideline can be observed. This may change from situation to situation. Often your team will have to adapt, improvise and overcome these obstacles. What you ultimately DO want to accomplish is to RESOLVE this issue amicably for the local family members. Failure to provide this service could result in rioting which can endanger your personnel and risk subsequent contamination.

Once this process for your locale has been decided, the minimum standard is for the actual burial tomb to be two (2) feet in depth and slightly larger than the body bag to be deposited. This minimizes a lot about what we have just discussed. Any improvements to this minimum will have to be approved by the site coordinator and take into account the size and need of the overall burial area for any anticipated increases in body counts.

Once all transports have been completed, decontamination of the vehicles will need to be established. The following steps must be accomplished for each transport vehicle used in the body transport operation;

1] Staff who disinfects vehicle must be in CPC as in isolation procedure

2] Rinse body carry area with 1:10 bleach solution

3] Let solution soak for ten (10) minutes

4] Rinse well with clean water and let vehicle air-dry. Be sure to rinse well as the solution is corrosive to the vehicle.

To be ready for the next VHF strain outbreaks appreciate some of the many roles of the Mortuary Team members may have to be adapted for each successive strain that becomes a pandemic. By training all your personnel from the responder level up, you will minimize exposure, contamination, and maximize personnel if they have to temporarily substitute into positions other than their intended role. Each new strain will challenge your teams’ adaptability to be successful.

        Haz Mat Mike

Saturday
Feb022019

Mortuary Response to VHF - 6 How to Transport the Body

The transportation crew to the burial site or wherever chosen per agreed protocol must be under the same CPC/PPE (Chemical Protective Clothing/Personal Protective Equipment) that all the other HCW (Health Care Workers) are following. Depending on the situation, country, etc., bodies will be transported. Be advised, CDC (Center for Disease Control) recommends the procedure to NOT store bodies for ancillary reasons. This idea will increase the possibility of cross-contamination and continued pandemic. BODIES should be buried or incinerated as soon as possible ASAP!

Once this decision has been made, transport the body to the burial site ASAP. Assure you have some kind of documentation, or accompanying HCW to assure safety decontamination protocols have been followed on the journey to the burial site. Plan the shortest route for security and disease transmission possibility through accidental contact.

HCW who may be onsite working as burial teams, MUST also follow VHF/CPC protocols mentioned above as they will be unloading and burying the victims. There should be onboard the transport vehicle sufficient volumes of the 1:10 spray solution in spray bottles for accidental contact.

If your team is using transport vehicles where the driver is isolated from VHF contact due to the design of the vehicle, they may not where VHF protocol CPC. However, at NO TIME may they be exposed to VHF bodies in any way, shape, or form. If this SOP can be used for your specific vehicles nature, it does free up personnel from transport needs. Re-used drivers will need relief every 4-8 hours, if possible.

After the first load of bodies have been delivered, have the burial Team use the 1:10 solution spray to clean the bodies transport vehicle. Pick-up trucks are a good vehicle for this type of work as they are easily cleaned by HCW or burial team member. If there are multiple vehicles involved, a route, time frame, expected arrival and drop-off time all need to be coordinated and planed. If possible, portable radio communication between vehicles and burial/transport team coordinator is the best way to accomplish these goals. Always think portable communications when searching for accountability needs.

                     Haz Mat Mike

Tuesday
Jan012019

Mortuary Response to VHF - 5 How to Prepare the Body

To begin the process of proper preparation of the deceased victim (body), the first step is to create the appropriate disinfection solution. This is done by choosing household bleach as the key disinfectant. There are two reasons for this;

1] Household bleach is a globally accessible appropriate disinfectant, and

2] Bleach has the capability to mount a three (3) prong chemical attack upon contagions.

This is done by the precursors of the bleach compound; hydrogen, chlorine, and oxygen. All these elements do have the ability to kill VHF life forms.

In an isolated, clean area from VHF and other contaminants, choose a location to prepare the disinfection solutions. This is critical, as you will revisit this area to replenish these solutions as they are used during the incident, so this area must remain “clean” and under control of the VHF response team security. This area may become busy as the need for additional solution becomes necessary so it should be located adjacent to the isolation treatment area.

You will require two (2) basic solutions to prepare for use during and after the VHF incident;

1] A 1:10 solution for excreta spills, bodies, and laundry this will be a (0.5% solution).

2] A 1:100 solution for cleaning materials, VHF/HCW decontamination, VHF waste bio-hazard bags this will be a (0.05% solution).

If usage is minimal, these bleach solutions MUST be prepared daily on a minimum of a 24hr basis. This is because they lose their strength after 24hours in time. Anytime the odor of bleach is not present the solution must also be discarded.  Anytime the solution becomes clouded or visible contaminant pieces are seen in this solution, discard and remake a fresh batch. Note to personnel making the solution: this solution is caustic; avoid direct contact with the skin and eyes. Be sure the selected mix area is well ventilated. Make sure you have the following supplies on hand at a minimum;

1] Large container for the 1:10 solution

2] Smaller containers for the distribution of 1:100, and 1:10 solutions

3] Measuring cups for volume correct amounts

4] Household bleach in gallon containers (unopened and unscented)

5] Water source

Bleach will hold its strength better when it is unopened and in the unscented form. Once opened and or if the scented type this will decrease the 24hr effectiveness rule. For creation and developing a mixing staff SOP follows the exact following procedure.

1] Mix one (1) part chlorine bleach to nine (9) parts water in whatever total volume you choose to use in a 24hr period. This will take experimentation, so appreciate this starting volume will fluctuate from incident to incident.

2] In the smaller containers mix one (1) part of this mixture to nine (9) of fresh water. This solution is now 1:100 strength.

Mark all containers clearly either 1:10 or 1:100 HCLO. Distribute these to the desired location in your isolation area for use by healthcare personnel. Monitor these solutions every half (1/2) hour or more frequently as needed for patient/healthcare worker usage. Solutions MUST be kept contaminant free to be effective in VHF decontamination.

REPEAT PROCEDURE every 24hrs or as needed depending on time or contamination.

Remember this is an ongoing process, so the Goal is to develop a system that will work for your operations on a continual basis and give you the documentation to demonstrate a sustainably safe incident decontamination solution operation.

Next; the procedure for the deceased should be followed using the freshly made solutions.

1] Place the deceased into a body bag or (mortuary sack) and close it securely.

2] Spray the exterior of the body bag (mortuary sack) with the 1:10 bleach solution.

3] If body bags are not available, wrap the body in two (2) thicknesses of cotton sheets and spray with the 1:10 bleach solution. Then wrap the body in plastic sheeting and secure this wrapping with plastic tape. Next; spray the “body bag wrap” as in step 2.

4] Place the body in a coffin if available. If not, place the body in something that can be used to transport the body to either the burial site or burial site transportation vehicle.

Appreciate; if the “coffin” device to transport the body is to be re-used, it shall have to be decontaminated with the 1:10 spray bleach solution before re-use.

Next month we will look at safe transportation of the body.

               Haz Mat Mike

 

 

Friday
Dec072018

Mortuary Response to VHF - 4 CPC

Wearing specialized CPC (Chemical Protective Clothing) is a must for all Mortuary Response Operational Teams. Specialized Guidelines are also needed for base knowledge of “Donning & Doffing” of this equipment. Correct preparation of the body is essential before the transport and burial practice can be undertaken. Each response team must highlight these practices for Mortuary Responders protection.

While CPC is recommended for all staff in the patient isolation area, Mortuary Teams need specialized CPC due to the nature of their task. While patient staff is creating a barrier between the disease and the caregiver, they are not involved in the rigorous exercises that handling bodies with great weight and size are common between Mortuary workers. For this type of patient/body work additional precautions must be taken. Due to heavy lifting and manipulation of bodies, thick rubber outer gloves will need to be added to your CPC ensemble’. This protects the responder and allows the CPC choice to yield a higher level of gripping strength. This choice is essential to your Teams needs so choose carefully for the best fit in “workability”. Also, more solution volumes will be used and come into contact with the Mortuary Team member. Therefore thicken or increase your durability materials for your outer splash protective garments to upgrade responder protection.

Mortician Guidelines for the wearing of VHF/CPC are also necessary for safe Team operations to be successful. For the Mortuary Team, who wears VHF/CPC?

1] All Doctors Nurses< healthcare workers who provide direct patient care to VHF patients

2] All support staff cleaning isolation site and or equipment/waste

3] All Laboratory support and analysis staff using VHF specimens

4] Security Officers that MAY operate near patients infected

5] BURIAL TEAMS/Mortuary Responders who are responsible for removing bodies of deceased VHF patients and prepare them for burial

6] Family members who care for VHF patients.

Seeing guidelines demonstrate the clear use of CPC for Mortuary Responders, how do we wear CPC? This process also involves a distinct set of guidelines for the Mortuary Responder. These steps taken from the VHF series on VHF response are summarized as follows;

1] Remove body jewelry and ALL personal items. Store them in a secure area.

This initial step is common to ALL Haz-Mat Responders. Many a story can be told on how responders have lost personal items to contamination by forgetting to remove them first. Having a secure place for personal items, cash, wallets, phones, etc., is critical to future responses and communication between Teams and command. Usually, this can be accomplished through the use of one secure container and one Team member that are NOT entering the Hot Zone of contamination. This person could range in duties from IC to Team leader or anyone in between that is trusted by the Mortuary Team members.

2] Remove street clothes and “don” scrub suit.

This practice is best for preventing contamination contact with personal street clothing. “Scrubs” can be carried or supplied and are easily transported, decontaminated, or destroyed after use. Generally, each Team member should always carry at least one set of scrubs in their personal response bag. These can be replaced whenever possible from scene to scene as they are used. If in the “field” a tent or transport vehicle that one can stand up inside to change clothes is desirable. If at a fixed site, locker-rooms are best utilized by the Team member.

3] Progress through a clean travel route to the CPC donning area, Don level “B” SPLASH protective equipment.

4] “Don” respiratory and face splash protective equipment.

5] “Don” 1st pair of inner nitrile protective gloves, tuck under sleeves.

6] “Don” 2nd pair of outer heavy rubberized work gloves, secure over sleeves.

7] Using the “Buddy” system secure all flaps and tape all openings to skin surface.

Steps 3-7 are not only covered in detail inside the VHF response course, but must be altered in a separate course given to specific Mortuary Team members. This is due to the nature of the work task and MUST be done before responding to these incidents. With all CPC and respiratory equipment, remember once a secure and comfortable fit is achieved, DO NOT adjust(s) AFTER patient or body(s) contact is made. This may cause exposure to the Mortuary Team member. Once CPC has been donned, DO NOT re-enter the general health care facility without first passing through your decontamination process.

In case of an emergency need or a replenishment act for the Mortuary Team, designate a “Buddy” member to serve as a liaison’ in between your work site and the “clean” health care facility. This includes any area that contains equipment caches. Next month we will explore “Hoe to Prepare the Body” for transport and final burial.

  Haz Mat Mike

 

Friday
Nov022018

Mortuary Response to VHF - 3 "Beginnings"

Before we continue with our preparation of proper Mortuary Response it is important as we move towards the decontamination and physical handling of victims and bodies, to understand the complexities of VHF transferrence to infection of Mortuary personnel.

Ebola Virus is just one (1) of the many viral hemorrhagic Fever Pathogens that some feel may have evolved into the environment possibly due to jungle deforestation. As plants check and balance many infectious compounds during growth through photosynthesis, the removal of the natural “balance” of the forest floor may have an impact on the mutation of viral infectious agents and their relative exposure towards man and animals. When the system is altered due to mankind’s interruption of this self-managing ecosystem the release of these agents may be possible.

Ebola is a filovirus which is enveloped, non-segmented, and a negative-stranded RNA virus. This result is a severe disease result with a high case fatality of 50% to 90% mortality amongst those exposed. While advances are constantly being made in medical research, in 2014 there was an absence of a specific treatment or protective vaccine.

From 1970 to present there have been greater than 20 previous Ebola and Marburg (Ebola type) virus outbreaks. The 2014 West Africa Ebola outbreak was caused by Zaire Ebolavirus, currently of which there are five (5) different types known? This is questionaries’ as these five derivatives are the current one’s known to medical research. Are there others unknown? Medical authority experience dictates there is a strong possibility of additional unknown types yet to be found.

Ebola like or VHF viruses are many times referred to as a Zoonotic virus, or one in which comes from animal contact. For this to spread a “host reservoir” is required. Host reservoirs are frequently animals included in the local population’s diet. Evidence suggests that bats may be one of the reservoir hosts for the Ebola virus. Bats that carry the virus can transmit it to Apes, antelope as well as others that may be in the local human food source. Additionally any bat in contact with humans is also capable of transmitting the disease to the local population.

Spillover from ingestion incidents occur from this contact. A Spill-Over event occurs when these animals or humans make contact with a reservoir host. Usually this occurs through the hunting and preparation of the animal meat for cooking and consumption.

Once the first human has been infected, human-to-human contact passes the virus from person to person by contact with blood or bodily fluids of the infected person.

Haz Mat Mike

 

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