process, it would be wise and less confusing if the funeral director were to inform the family that they cannot promise an open casket until they have actually seen the deceased. The funeral director should inform the family that they will make the decision once they observe the condition of the deceased. Visitation and services We are now going to discuss the visitation and funeral ceremony for someone who has died of an overdose. As noted previously, there usually is a stigma surrounding this particular kind of death. Usually, most people are curious about the circumstances of how someone died. They are not only grieving the loss of their loved one but also trying to continue to honor their loved one by combatting rumors and negative small talk during the visitation. To say the family is ashamed and anxious would be an understatement. During the visitation, the funeral director needs to be vigilant for potential arguments or fighting between family members and the friends of the deceased. This is displaced aggression toward the friends, as the immediate family may have decided that the friends could have done more or somehow interceded to help their loved one. Another issue could arise with individuals using or having an actual overdose in the funeral home or in the immediate area. As previously discussed, a friend attending a visitation honoring someone who has died of an overdose may inject an opioid substance in the funeral home bathroom or in the parking
Another issue is the finalized death certificate from the coroner or medical examiner. The funeral director should discuss with the family that because of the circumstances of death, there will most likely be a temporary death certificate. This prolongs the filing of life insurance and other important paperwork. Depending on the county in which the death certificate is filed, the waiting period can be two weeks to six months. lot. For instance, during the visitation the funeral director is approached by a female mourner inquiring if there is another restroom that she can use, indicating that the women’s bathroom has been occupied for a significant amount of time. The funeral director knocks loudly on the bathroom door and receives no response. This should raise a red flag that should not be dismissed. It is important to understand that no location is immune to someone having an overdose, including the funeral home property. If the death occurred from an overdose and law enforcement is trying to establish who was responsible for selling the opioids and the circumstances surrounding the death, it is would not be unusual for law enforcement personnel to arrive at the visitation or funeral. Often, disguised as mourners, they record the license plates of visitors in the parking lot and check the plates at the station. There have been reports of police officers taking photos of the register book to cross-check names. In both of these instances, it allows law enforcement officers to develop leads for an arrest.
DANGERS TO FUNERAL DIRECTORS AND EMBALMERS
friend who recently died of an overdose. As one last “hurrah,” the friend goes into the funeral home restroom or parking lot and uses some heroin and has a fallout (overdose). Coroners and medical examiners face the same issues as funeral directors and embalmers. Coroners and deputy coroners are often called to scenes of overdose victims. They arrive at a known location where drugs are used, and there is a strong possibility that active drug users will still be there. At that time, there is the potential that the drug user at could overdose while the deputy coroner is there. Also, the coroner’s office can be contaminated by opioids while removing the clothing before the autopsy, thus affecting the coroner or medical examiner. Also, there is always the possibility of an inadvertent stick of a syringe when removing a body from a residence. It is important to remember that opioid residue can remain on the skin, clothing, or personal belongings of someone who died of an overdose. The residue can be absorbed through the tissues or inhaled and cause an overdose. When doing the transfer at the place of death, funeral home staff should be conscious to not disturb the clothing of the deceased. They should wrap the individual in the bed sheet that accompanied the funeral cot, securely wrapping and keeping all potential powders from becoming airborne (Alabama Funeral Directors Association, 2017). When arriving at the funeral home, staff should carefully move the body off the cot and place it on the embalming table. As far as the interior of the cot, with the proper personal protective equipment in place, someone needs to wipe down the inside with soap and water to remove any residual opioids in an effort to avoid accidental exposure. It should be air dried before being put away. Before removing the clothing, it is important to apply water or a disinfectant from a spritz bottle or the mortuary water tube with low pressure on the contaminated clothing to keep the substances from becoming airborne and then carefully place them in the medical waste container (Alabama Funeral Directors Association, 2017). Extreme caution should be used when removing the clothes. To avoid being inadvertently stuck with a syringe, do not reach in or around areas that cannot be seen.
So why is the opioid overdose crisis so important to understand? How does it affect the death care industry and the medico/legal offices of the coroner or medical examiner? First, let us discuss how funeral directors and embalmers are affected. As discussed earlier, pills are often crushed and snorted for immediate relief, so many opioids can be turned into a powder form. These powders can become airborne while removing or disturbing clothing before embalming. The embalmer unknowingly breathes in the opioid and thus encounters direct contact with the dangerous drug (Wesco, 2019). Another example is removing patches from the deceased before embalming. Patches containing fentanyl may be offered to patients for pain relief during hospital stays. By carelessly removing the patches, the embalmer can come into direct contact with fentanyl and have an accidental overdose. Finally, and in the most extreme case, someone arrives at the funeral home for a visitation to pay their last respects to their First call transfer It is imperative for funeral home staff to know the signs and symptoms of an overdose: ● Blue or purple lips. ● Pinpoint pupils. ● Pale, clammy skin. ● Infrequent breathing. If it is known that the death was an overdose from an opioid, two individuals should do the transfer so that they can observe each other in case of accidental exposure (Alabama Funeral Directors Association, 2017). Certain items should be stored in the funeral transfer van before the body is removed: N95 mask, nitrile gloves, and a naloxone kit. Caution should be taken when handling personal effects, as drug residue may contaminate cell phones, wallets, and purses (Alabama Funeral Directors Association, 2017). Unintentional contact can result in an overdose, so it is important to know the symptoms (Alabama Funeral Directors Association, 2017). ● Deep snoring or gurgling. ● A slow or no heart rate. (Illinois Department of Public Health, 2019)
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