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). 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 ● Deep snoring or gurgling. ● A slow or no heart rate. (Illinois Department of Public Health, 2019) Personal protective equipment Some opioids such as fentanyl can be absorbed through the skin. High standards of personal protection should be maintained. Currently, OSHA does not have a permissible airborne exposure limit for opioids. Other than OSHA document 1910.132 (D), which recommends general personal protective equipment (PPE), nothing more has been written in the way of compliance directives to inform persons what additional precautions must be taken (OSHA, 2019). So what does this mean? It means embalmers are responsible for protecting themselves. As far as PPE, they should follow everything they have learned about universal precautions in mortuary school, a practice that is sometimes lacking in the prep room. PPE equipment includes a face shield or goggles; a full-length gown; booties; a bouffant; gloves; and an N95 face mask, which protects the wearer from inhaling airborne opioids. A regular surgical face mask provides a barrier from splashes of bodily fluids but is not designed to filter out airborne particles. The N95 mask has a charcoal capsule at the front, which actually filters hazardous substances. Embalming the opioid case Opioids cause physiological changes within the body. As an example, heroin can cause premature arteriosclerosis, most commonly seen in young adults. This hardening of the vessel walls creates a significant disruption in the arterial system and restricts the flow of formaldehyde to the distal parts of the tissues. Blood vessels in the heroin user may also become clogged with contaminants. The additional substances added to heroin may not completely dissolve and may become lodged in the vessels of the kidneys, lungs, and even the brain. Also, heroin breaks down muscles and tissues, so it is advisable to formulate a mixture that will produce the best preservation (Renzoni, 2019).
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. A staff member should immediately rinse the body off with water and wash with a cloth accompanied by germicidal soap to remove any opioid residue and prevent the aerosolization of opioids (Alabama Funeral Directors Association, 2017). Considering Occupational Safety and Health Administration (OSHA) compliance directives, the funeral director should make sure that every funeral employee knows not only the location of the Safety Data Sheets (SDS) but also how to read and understand them, as well as how to look up the chemicals and hazards that are directly related to their occupation. (As of 2015, they are no longer called Material Safety Data Sheets [MSDS].) Nitrile gloves, which are a medical-grade synthetic rubber that provides superior puncture resistance, should be worn (Wesco, 2019). Latex gloves are a natural rubber and not as efficient. It has been found that nitrile gloves, which are three times more puncture resistant than latex, are the most effective in this environment. For added protection, the thicker 8-mil glove with a higher cuff length for an additional barrier are recommended. Also, opioid powders will be more visible to the embalmer if they wear darker colored gloves (such as black) rather than using a lighter color (Wesco, 2019). Whichever type of gloves an embalmer uses, it is important to remember that though gloves are a necessary precaution, their defective rate and polymer permeability will diminish after continuous use (Wesco, 2019). Over time, natural oils, body temperature, and heavy acidic perspiration buildup can degrade the efficiency of the gloves. Throughout the handling of remains, embalmers should continually check for any leaks, holes, or advanced wear. When in doubt, throw them out. Because proteins are prematurely broken down before death, rapid autolysis (cellular destruction) can occur at the time of death. With the tissues already compromised from autolysis, decomposition could set in rather quickly. Thus, the embalmer is already at a disadvantage before the embalming operation begins. It would be wise to inject with a low and slow pressure and rate of flow, as repeated intravenous injections of heroin or crushed opioid pills can lead to cumulative damage to the veins and cause them to collapse. The flow of formaldehyde will go only where there is the least amount of resistance. Using too high of a pressure or rate of flow will cause either distention or inadequate embalming in the dependent or distal parts of the body.
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Book Code: FFL1225
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