OCD 3033 October 1942 Medical Division Bulletin No. J

EMERGENCY MORTUARY SERVICES

United States Office of Civilian Defense

Washington9 D. C. TABLE OF CONTENTS

Page General Considerations 1 Preliminary Procedure 1

: Organization „ 2 A. Morgue 2

B. Insignia * 2 C. Transport Facilities 2 Operation 3 A. Marking and Segregation 3 B. Transport. 3

C. Morgue Reception - 3 D. Personal Property 4 E. Morgue Storage 4 F. Identification Procedures 4 G. Release and Disposal of Bodies 4 Special Treatment of Gas-Contaminated Bodies 6 Emergency Mass Disposal of Bodies 6 Casualty Reporting 6 Completion and Storage of Records 6 EMERGENCY MORTUARY SERVICES GENERAL CONSIDERATIONS PRELIMINARY PROCEDURE

In some air raids forty percent of the casualties The local Chief of Emergency Medical Servic« may be fatal, but fortunately the total number of should call into conference the following officers casualties is usually small in proportion to the who, besides himself, may have normal or emer- amount of property damage. While the wounded gency responsibilities in the collection and dis- require first attention, the dead should be cared posal of the dead. Under his leadership, this for promptly and inconspicuously, and always group should create the necessary organization with proper reverence and respect. The mortuary and clarify the lines of responsibility for handling service is an essential part of the casualty organi* the fatalities. A careful survey of existing morgue, zation and of the war effort, and must be con- mortuary and cemetery facilities should be the ducted with tact and efficiency. Detailed in- first step in planning for emergencies. structions for all communities are impossible be- 1. Medical Examiner, Coroner or similar cause of wide variations in local legal practices official who has legal responsibilities in connection and responsibilities, but general principles and with the investigation of deaths from violence and procedures may be indicated. disposition of remains. Normal funeral services, including embalming, 2. Chief of Police, who usually has legal re- caskets and individual burial or cremation, should sponsibilities for identification of the dead and be provided by private morticians insofar as disposal of their personal effects. circumstances permit, and every opportunity 3. Health Officer, who has public health re- should be given for appropriate religious observ- sponsibilities in the disposal of bodies and record- ances. There must be sufficient mortuary and ing of deaths. burial accommodations as well as sufficient staff 4. Representative of the private funeral and transport to deal with the number of bodies directors and cemeteries, to act as liaison officer which may reasonably be expected in view of the with that profession in planning for the collection, size and density of the population and the degree transportation and temporary storage of the dead of exposure to enemy attack. It is essential to and for the preparation of bodies few burial. provide for prompt removal of bodies from the Several national and local organizations of funeral scene of the incident to a mortuary, followed by directors have made plans to cooperate with local identification and rapid clearance of the mortuary. civilian defense authorities. Speed and efficiency must be coupled with con- These officials in conference should provide for: sideration for the feelings of bereaved relatives. a. Location of the morgue and of supplementary A breakdown in this important service may have morgue facilities. a serious effect upon public morale and the prose- b. Administration of these facilities by the cution of the war. police, medical examiner or coroner under whom To facilitate identification, each civilian in they are customarily operated. target areas of the country should be encouraged c. Training of supplementary mortuary per- to carry an identification bracelet or necklace, or sonnel in adequate numbers for emergency duty a metal identification pocket piece. These may at morgue and on mortuary vehicles. be obtained at jewelry stores, five-and-ten-cent d. Responsibility for the collection and prep- stores, novelty shops and from public vending aration of the dead and for burial. machines. Lucky pocket pieces and key tags e. Rules governing the emergency issuance of with names are examples of useful vending ma- death certificates and burial permits for both chine products. Metal “charga-plates” issued by identified and unidentified casualties. some department stores for credit purposes make f. Type of inquests, if any, to be required. satisfactory identification tags. Although inquests should not be required for

483691°—42 deaths due to enemy action, autopsies are of great 3. Recorder, to supervise the reception and value in planning better means of future protec- disposal of bodies and to keep the Morgue Record tion and should be encouraged whenever possible. Book. g. Safeguarding of personal property of the 4. Property Officer, to keep personal property identified and of the unidentified dead. and the records pertaining thereto. h. Manufacture of board coffins in adequate 5. Identification Officer, who controls the numbers. viewing of bodies and completes the identification i. Pooling of equipment and personnel of private record, including fingerprinting, photographing mortuaries in emergencies. and recording identifying marks or anatomical j. Identification procedures: Viewing by rela- features. A police officer, experienced in identi- tives and friends, photography, fingerprinting, fication procedures, serves well in this capacity. and other means of identification. He may require assistance in the making of finger- k. Location and preparation of burial places for print records and identification photographs, and unclaimed and unidentified bodies. the services of a dentist to make dental charts. l. Preparation of mortality lists and determina- 6. A Coroner's or Medical Examiner’s Rep- tion of policy concerning their publication or post- resentative, who has authority to sign death ing by the police, the health officer, or other cas- certificates and order disposal of unidentified ualty information officer. bodies. m. Arrangements with neighboring communi- 7. Morgue Attendants, for handling bodies; ties for mutual aid, which should include provision one per 10,000 population with a minimum of for the loan of mortuary personnel and equipment. four part time attendants in each morgue. 8. Clerical Assistants, at least one per 50,000 ORGANIZATION population with a minimum of two per mortuary. 9. Receptionists, tactful and intelligent female A, Morgue attendants, who should be available for interview- ing and consoling the relatives and friends. cities, In large the morgue facilities and equip- In small cities, several of these functions may ment should not be concentrated in one place. be assumed by one person. Fewer personnel are (designated “A”) The main morgue should be needed in less exposed areas. located centrally; it will usually be the regular public morgue of the community. Tentative B. insignia arrangements should be made for the use of skating All volunteer members of an emergency mortu- rinks, gymnasiums, auditoriums, or similar build- ary organization are to enroll with the Civilian ings for use as supplementary morgues (designated Defense Volunteer Office and be registered offi- B, C, D, etc.) as necessary to provide space to lay cially by the Director of the Mortuary Service as out bodies in the ratio of two per thousand popu- members of the United States Citizens Defense lation, in target areas. Corps. They are then entitled to wear the arm- The normal morgue personnel should be supple- band and insigne of the Emergency Medical Serv- mented with auxiliaries who have been trained by ice, of which the Mortuary Service is a part. instructors furnished by the morticians of the f. Transport community. Some of the morgue personnel may Facilities be employees of the police department or of the To insure the most economical use of transport medical examiner’s office, assisted by trained vol- vehicles, the hearses, flower cars and other vehicles unteers from private funeral establishments who of private mortuaries should be in the transport are accustomed to handling the dead. pool of the Emergency Medical Service and be The staff of the Emergency Mortuary Service under the direction of the transport officer during in large cities should consist of the following during and after a raid. If other vehicles are used, the emergency periods: floor and a short distance up the sides should be 1. Director, in charge of morgue operations. lined with some suitable non-absorbent material 2. Physician, to confirm deaths. that may readily be washed down. OPERATION in hospitals or homes, ifreleased by the coroner or medical examiner or by the health officer, may be

. Marking and A Segregation transferred directly to private mortuaries. Un- The dead should be tagged in the field with identified dead should always be sent to the identification tags in the same manner as the morgue. wounded, covered with clothing or sheets if It may at times be necessary to employ the possible, and segregated from the living while same vehicle for the dead as for the wounded, awaiting transport. A record of the site where although some cities prohibit such use. the body was found is important, for it may pro- C. Morgue Reception vide a clue to identification. The dead should not be brought by stretcher Immediately after arrival at the morgue, a teams to a first aid post, casualty station or hos- physician should again examine each body to con- pital. Those who die after reaching these places firm state of death; ifthere is any possibility of life, should be placed in a separate room or yard from the body should be removed at once to a hospital. which they are later removed, preferably by When a body is received, a metal tag showing a separate exit. letter to identify the morgue and a serial accession Whenever possible, a physician should examine number should be fastened around the neck with the body before it is moved to the morgue so as to a wire. This tag should be removed only from determinewhether life is actually extinct. To the identified bodies ready for private interment or inexperienced, a condition of profound shock with cremation. The tags should not be removed from extremely shallow respiration may give the appear- unidentified bodies, even at the time of burial, as ance of death. When there is the slightest doubt, they may be important for later identification. the body should be taken to a hospital or casualty These tags may be prepared from scrap galvanized station for observation. iron or other metal obtained from a tin shop and marked with a tool marking set and hammer, B. Transport obtainable in tool and machine shops or in hard- After necessary transport has been furnished the ware stores. living, the transport officer will promptly dispatch In the morgue receiving room a record book appropriate equipment and personnel to remove all (fig.-1), supplied by the Office of Civilian Defense, bodies from the scene of the disaster, and from first should be filled in as completely as possible. The aid posts, casualty stations, and hospitals, to the morgue accession number in the book should official morgue. The identified dead may later be correspond to that on the metal tag attached to the taken to private mortuaries. The identified dead body.

S , o Received < Diepoiition

* » ~ ~ " ' Nom Addreil Z j! 5 b,- BoJ, Received ky- s w Dot« Hour To— OrdaroJ Wy— PropertyK Received 3rs5 g I Hour From— Data (Si*nah»r«) (S**i»«»wr«) (Thom)

FIGURE 1.—MORGUE RECORD BOOK Dm Personal Property embalming bodies if private mortuaries become In the receiving room of the morgue, clothing, overtaxed. For this purpose suitable tables and contents of pockets and jewelry should be placed equipment should be available. It may be wise in a strong paper bag marked with the number to use volunteer embalmers from the private assigned to the body. The objects should be mortuaries for central embalming service at the listed on a form pasted or printed on the outside of morgue in case of any considerable number of the bag. This list must be checked when the deaths; this would permit more effective use of body and property are removed from the morgue. the available embalmers and would allow bodies Property bags of unidentified dead should be to be held longer at the morgue for identification. transferred to the custody of the police or other F. authorized officials and a receipt signature Identification Procedures obtained by the morgue recorder. For the identi- Before the disposal of unidentified bodies, cer- fied dead, the property bag may be delivered to tain information must be recorded on identifica- responsible relatives or their agents upon a proper tion record cards (fig. 2), supplied by the Office receipt. of Civilian Defense. This should include photo- Ration books and registration identity cards graph, fingerprints, a dental chart and a record should be transferred to the police who will forward of physical abnormalities and blemishes. them to the Rationing Board or other appropriate G, Release and Disposal agency. of Bodies Identified bodies should be released to private Em Morgue Storage funeral directors as soon as they are claimed by As soon as possible after bodies have been placed responsible relatives. Unidentified bodies may in the morgue and before they are viewed for also be consigned by proper officials to private identification purposes, they should be cleansed funeral directors for disposal. Bodies should be thoroughly so as to be as presentable as possible. removed from the mortuary only at specified They should be laid out on the floor in orderly periods when viewing is not permitted. rows, covered with clean sheets or blankets. Pending appropriate permanent legislation, Proper cleansing and laying out is important for burial expenses for all persons deceased as a public morale. When mutilation of the features result of enemy action will be paid by the Federal or of the body has occurred, an effort should be Government, at rates not to exceed $100 in any made to dissuade the relatives from viewing the one case for complete burial including ground for body, provided other means of identification are interment. Such payment will be in lieu of, but available. not in addition to, payments made by the dece- Unidentified bodies should be kept in a room dent’s family or friends. Prior authorization is not separate from those already identified, so that a required for the payment of such costs, provided minimum number will be seen by persons viewing that a certificate has been issued in each case by the the bodies for purposes of identification. Inspec- Commander of the appropriate Citizens Defense tion of unidentified bodies should be by permit Corps or his designated representative, stating only, such permits to be issued at police stations that death occurred as a direct result of enemy or the Casualty Information Service office to action. Bills for burial costs must be accompanied individuals who may be able to make an identifi- by these certificates. Such bills and certificates cation. should be forwarded through the local Chief of The period during which unclaimed or uniden- Emergency Medical Service to the State Chief of tified bodies are to be retained in the morgue will Emergency Medical Service for official voucher - be determined by local laws, morgue capacity, ing, certification, and transmittal to the Office of weather, and the speed of disposal methods used. Civilian Defense Regional Medical Officer, and Forty-eight hours is suggested as the time limit thence to the Emergency Medical Section, United without embalming or refrigeration. States Public Health Service, Washington, D. C. Provision should be made at the morgue for Every effort should be made to facilitate the OCT) Form No. 1ST IDENTIFICATION RECORD CARD

Possible or partial name Morgue No. (Surname) (Given name) Possible orpartial address Dental Chart Where found

By whom — Date

Sex Race Hair Eyes Build

Approximate: Age Height Weight

PICTURE OF FACE. MORGUE NUMBER. CONTENTS OF POCKETS. JEWELRY, ETC.

Crown Dummy On Bridge Den taro Mbataf

Rjkmaeks:

10—30148-1 i>. 8. oovhr*«ekt nttm-mc omcc

Scars, old deformities, and marks

Clothing, laundry marks, jewelry, etc.

Disposal: Body— Property— Delivered to —: Delivered to Place of interment Date

Date -— - RIGHT HAND 1. Thumb 2. Index Finger 3. Middle Finger 4. Kino Finger E, Little Finger

LEFT HAND

6. Thumb 1• Index Finger 8. Middle Finger 9. Ring Finger 19. Little Finger

dsniinatifnn: i»—aota-t

FIGURE 2.—IDENTIFICATION RECORD CARD conduct of burial services in accordance with the 1. Mass burial in a common grave, without rites of the deceased’s religious denomination. embalming, in board caskets if available. Pro- The American Flag may be used as a pall at the visional arrangements should be made in advance funeral of any civilian, whether a civilian defense for the production of such caskets. Identification worker or not, whose death is due to enemy action. tags attached in the reception room of the morgue should in all cases remain attached at the time of burial so as to facilitate future identification on SPECIAL TREATMENT OF exhumation. A chart should be made of each GAS-CONTAMINATED BODIES common grave showing the relative locations of the bodies by tag number. The common grave The Director of the Emergency Mortuary should be located in an established cemetery. Service should call on the Senior (local) Gas Officer 2. Mass cremation would be necessary only after for technical advice and assistance in setting up a great catastrophe, if bodies have remained at the procedures for handling bodies contaminated, or scene of disaster for several days and require col- suspected of contamination, with persistent gases. lection and cremation as a public health measure. It is important that the identification tag on such Mass disposal of bodies disturbs public morale. bodies be distinctively marked “Gas Case” in It should be considered only when there is abso- order that persons handling them will be warned lutely no other alternative. to give them special treatment. Such bodies should be collected and moved only by workers wearing protective clothing and masks. All CASUALTY REPORTING clothing body, and effects should be taken from the The Casualty Information Service mentioned marked for and identification, decontaminated, in Medical Division Bulletin No. 4 should have a taken to the morgue. The bodies should be representative in the morgue during periods of cleansed by approved methods before being activity, so that he may prepare and transmit to admitted to the morgue. This cleansing may be that service the necessary information for compila- out of doors or at the gas- performed regular tion. This information may be transcribed from cleansing stations after living casualties have been the Morgue Record Book and the Identification cleansed. Persons undressing and cleansing the Record Cards. To insure accuracy, the informa- bodies out of need doors wear only protective tion should be forwarded to the Casualty Informa- shoes, gloves, aprons, and gas masks. After tion Service by messenger, not by telephone. To bodies be admitted to the cleansing, may morgue, reduce confusion at the morgue, mortality lists placed in shrouds, and dealt with in the usual should be released to the public at the Casualty way. Persons who have performed these pro- Information Service or at police headquarters or cedures must subsequently go through the cleans- precinct stations and not at the morgue. ing prescribed for decontamination unit members. Vehicles used for the collection of such bodies should be decontaminated in the same manner as COMPLETION AND STORAGE OF RECORDS vehicles used for the transportation of the wounded. The Morgue Recorder shall be responsible for the careful completion of all entries in the Morgue EMERGENCY MASS DISPOSAL OF BODIES Record Book and on other information forms. After disposal of bodies, the Record Book should It is desirable to organize existing facilities as be retained at the morgue fofr future reference. completely as possible in order to avoid the The field casualty identification tags and special necessity for resorting to mass methods of disposal. identification cards of unidentified dead should be Only in the event of extremely large numbers of stapled together and transferred to the custody of casualties, which make usual disposal methods the police or other authorized officials who will impossible, should one of the following methods make them part of a public file and will continue be employed: identification efforts.

B. S. GOVERNMENT PRINTING OFFICE: 1942