Medical Examiners / Coroners:
Information for Radiation Emergencies
Adapted from Guidelines for Handling Decedents Contaminated with Radioactive Materials (PDF - 1.40 MB) (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.
- Information for Medical Examiners and Coroners (HHS/CDC)
- Disaster Mortuary Operations Response Teams (DMORTs) from HHS/NDMS may be available to assist
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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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Assessing Causes of Morbidity and Mortality
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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
- 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)
- Mass Fatality Management for Incidents Involving Weapons of Mass Destruction (DOD, 2005)
- Disaster Mortuary Operational Response Teams (DMORTs, HHS/ASPR)
- 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)
- Mortuary Affairs in Joint Operations, Joint Publication 4-06 (PDF - 2.47 MB) (DOD, 2006)
- 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))
- Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (PDF - 1.61 MB) (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.
- Medical Examiner / Coroner Guidance on Handling of a Body/Human Remains that are Potentially Radiologically Contaminated (PDF - 757 KB) (DOE/TEPP, Rev 5 - 01/2007)
- Hanzlick R, Nolte K, deJong J; National Association of Medical Examiners Bioterrorism and Infectious Disease Committee. The Medical Examiner/Coroner's Guide for Contaminated Deceased Body Management. Am J Forensic Med Pathol. 2009 Dec;30(4):327-38. [PubMed Citation]
