SUMMER 2014 Dodge is proud to announce our partnership with WREATHS across AMERICA.

WREATHS across AMERICA (WAA) is a program of coordinated wreath laying ceremonies on a specified Saturday in December at Arlington National Cemetery, as well as veterans’ cemeteries and other locations in all 50 states and beyond. Wreaths from the Worcester Wreath Company in Maine are placed on the graves of our fallen heroes by thousands of volunteers. The Dodge Company has deep roots in Maine that make this partnership especially meaningful.

The Funeral Service WAA Tour includes visits to significant sites in and around our Nation’s Capital led by long time coordinator Sally Belanger. Join your Funeral Service colleagues for this rewarding experience!

Want more information on the Funeral Service Tour? There are three ways to request additional information - contact your Dodge Representative, download the information from Dodge’s website: www.dodgeco.com, or contact our coordinator, Sally at: [email protected].

COME WITH A MISSION...LEAVE WITH A MEMORY!

FUNERAL SERVICE TOUR DECEMBER 11-14, 2014 for additional information on the waa program VISIT wreathsacrossamerica.org/2014 © 2014 THE DODGE COMPANY SUMMER 2014 Volume 106 No. 3

SUMMER 2014

Quarterly Publication Dedicated to Professional Progress in Funeral Service

CONTENTS Jaundice 4 Matt Black Presenting the Perfect Remains With Waterless Preparation 7 Bill Martin Embalming CJD Cases: The Facts 11 Karl Wenzel, CFSP, MBIE Disease of the Month: MERS-CoV 14 Kim Collison, MSA, M.T. (ASCP)

The Cover Hawaii seashells - 16 Long-term Embalming photo by Kristie Dodge Steve Labrash, CFSP We’ll Do It Tomorrow 23 Dennis Daulton Editor Keith Dodge Searching For the Beautiful Question 25 Glenda Stansbury Assistant Editor Kristin Doucet I Have an Awesome Dragon and Courage is Her Name 28 Joy Johnson Contributing Editors Matt Black Formoids Bill Martin 30 Jacquie Taylor, PhD Karl Wenzel Kim Collison He Profits Most Steve Labrash 32 Jerome Burke Dennis Daulton Glenda Stansbury Published by Joy Johnson Jacquie Taylor The Dodge Company The Dodge Company (Canada) The Dodge Company Jerome Burke 9 Progress Road 1265 Fewster Drive, Mississauga Unit 15 Ardglen Industrial Estate Billerica, MA 01821-5731 Ontario, L4W 1A2 Whitchurch Hampshire RG287BB © 2014 The Dodge Company Phone: 1-978-600-2099 Phone: 1-905-625-0311 United Kingdom Printed in U.S.A. For Orders: 1-800-443-6343 For Orders: 1-800-263-0862 Phone: (011-44) 1256-893883 Fax: 1-978-600-2333/ Fax: 1-905-624-1109 Fax: (011-44) 1256-893868 The opinions expressed by contributors to this 1-800-443-4034 magazine are those of the authors and do not necessarily represent the opinion of the publisher. Website: www.dodgeco.com E-mail: [email protected] Most articles in this magazine are available as reprints at our cost.

3 Summer 2014 Jaundice by Matt Black

Jaundice is one of the most challenging situations to using a preservative arterial solution. an embalmer can encounter. Failure occurs in Metaflow is in a class of its own. This unique embalming jaundice cases when there is poor accessory chemical is a Plasdoform-based chemical. preservation, a lack of dye, or a lack of accessory A special characteristic of the Plasdoform chemical arterial chemicals. In all embalming cases, is its similar consistency and molecular weight to preservation takes precedence over any cosmetic human blood. Metaflow is a chemical specifically issue due to discolorations. Cosmetic issues can be formulated to intensify embalming formulation covered with cosmetics, decomposition cannot! I receptiveness within the vascular system and the feel it’s always better to over-embalm than under- tissues beyond. Its conditioning factors include: the embalm a body. An under-embalmed jaundiced stimulation of drainage and circulation, the dispersal body is a time bomb. A pre-embalming analysis is of arterial obstacles, and the fortification of the a must for all embalming cases, but a jaundice case preservative action of embalming solutions. Metaflow adds a few more considerations. penetrates blood cells, restores permeability to cell The key to embalming is preservation of the membranes, prevents loss of tissue moisture, and tissue. Preservation can be regarded as complete releases toxic deposits from the cell, rendering them only when the arterial chemical used has penetrated non-toxic. It’s a powerful diffusing agent which the cells and achieved “firming” of the tissue. When increases the range of your preservative chemicals. the arterial fails to enter the individual tissue cells By using Metaflow correctly your worries about fully, these cells remain active and decomposition dehydration could be eliminated. As a pre-injection breakdown will continue. or co-injection Metaflow has neutralizing effects on The washing Preservation is the most important factor in drugs and toxins in the body. The effects of Plasdo-based arterial chemicals, technique of using embalming a jaundice case. Jaundice cases will present challenges in preservation because of high in terms of both controlled and gradual preservation, numerous gallons levels of nitrogenous waste, ammonia, drugs, allow us to overcome jaundice by staining the tissue of water and low edema, and a pH imbalance. The administered drugs and then preserving it. The Plasdoform molecule index fluid will and the drug therapy will change the permeability helps replace the bilirubin in the cell with the cause nothing of the cells in the body. This will offer an additional arterial dye prior to the denaturing of the cell, but waterlogged challenge for preservative chemicals trying to pass which keeps the embalming process from locking in the stain, which would then change to the green tissue and through the cell wall to cross-link these proteins. We have to remember that the longer we wait to biliverdin stain. The Metaflow Plasdoform cell numerous embalm, the more decomposition waste products has a superb ability to penetrate cell walls and to preservation and pH changes we see in the body. Not to mention achieve higher cosmetic values, as well as deeper issues on true that decomposition will generate more fluid in the seated tinting of the cells from the dye. The use of jaundice cases. body from the autolytic process. all Plasdoform chemicals from Dodge allows cells Your formaldehyde demands become very to be cosmetically dyed and preserved in a manner high in these challenging cases. You can dangerously from the inside out, in a gradual, controlled manner. under-embalm these cases while worrying about I like to call this a microwave concept. Just like a the jaundice color change. True chronic jaundice microwave cooks from the inside out, Plasdoform- causes a staining of the tissue. Once the tissue is based chemicals preserve from the inside out for stained there is no washing this stain out. We can total preservation. This allows the embalmer to cover the green tint and discolorations caused by control the rate of preservation on a gradual demand jaundice. But I haven’t found a cosmetic that covers basis and enables total cell penetration of dye and decomposition. The washing technique of using preservation, eliminating “walling off” caused by numerous gallons of water and low index fluid will some other types of arterial solutions. cause nothing but waterlogged tissue and numerous The use of Rectifiant is a must in jaundice cases. preservation issues on true jaundice cases. The average human body is more than 60% water, Distribution and diffusion of the chemicals with blood being around 92% water and muscle is the only way to get preservation. As we know, and brain being around 75% water. (waterinfo. distribution is physically injecting the chemical into org). If we look at weight statistics (gallup.com), the arterial system and moving the chemical out in 2011 the average adult man weighed 196 pounds into the tissues. Diffusion can be explained as the and the average adult woman weighed 160 pounds. full movement of the chemical into the cell tissue. I These average weights are up 20 pounds since believe the use of Metaflow and Rectifiant is a must 1990. If an average male weighs 196 pounds this for ALL embalming cases, not just jaundice cases. means that there is 118 pounds of water in him. These two chemicals can be used as a pre-injection One gallon of water weighs about 8.8 pounds. or a co-injection. After death 85% of the blood in So we can say that there is about 13.4 gallons of the body is in the capillaries. A pre-injection would water in an average adult male, before we even be a great way to prepare the vascular system, prior start embalming. This is why using Rectifiant is

The Dodge Magazine 4 so very important in every embalming case. Just vascular pressure present. Why would we remove imagine the water/moisture levels in edema cases. the arterial fluid you just placed into the body during Rectifiant corrects and conditions the water in the embalming? A thorough aspiration is a must for any body and the water used in embalming. It will adjust case but I do recommend delayed aspiration. A dull and stabilize the pH and it helps neutralize drug or dirty trocar is also detrimental to the process of therapy and chemotherapeutic drugs. Rectifiant’s thorough cavity treatment. The goal while aspirating ability to neutralize ammonia, nitrogenous waste, is to remove the liquids and gases, and to puncture and urea are very important. Those three waste all the hollow organs. You should never ignore the products will neutralize formaldehyde. Rectifiant trocar. It is a valuable piece of equipment in the Some embalmers will alleviate color blotching and allow a smoother preparation room. It should be cleaned thoroughly have been tinting and counter-staining in a jaundice case. I’ve and not allowed to get dull. The tip should be replaced known to call only touched on a few of the numerous advantages when it is noticeably dull. A great amount of force these accessory of Rectifiant. In all chronic jaundice cases we are should not be needed to puncture the abdomen chemicals a waste trying to counter-stain the jaundice stain with when inserting it. Having a sharp trocar will allow dye and our pre-injections, co-injection accessory us to puncture the organs in the nine regions of the of money. I like to chemicals, and arterial chemicals. The use of these thoracic and abdominal areas. A minimum of two call them “cheap pre/co-injections are the best answer for jaundice bottles of cavity fluid for treatment should be used: insurance,” for cases. Some embalmers have been known to call one bottle in the thoracic cavity and one bottle in the unforeseen these accessory chemicals a waste of money. I like the abdominal cavity. Remember, we are treating all problems to call them “cheap insurance,” for the unforeseen the hollow organs, the walls of these organs, and the caused during problems caused during embalming. liquid that is found between the organs and cavities For jaundice cases, and really all embalming in these nine regions. If these areas are not treated embalming. cases, we must make sure we get a full distribution correctly you will end up with gas, odors, purge, of arterial chemical to all areas of the body. decomposition, and more work. Here are some suggestions on how to reach With a jaundice case pre-injection is a great these areas: advantage. By using a Restricted Cervical Injection • Use high pressure and low rate of flow. (RCI) we can pre-inject the head separately. The RCI • Use injection with pulse. offers the greatest control method of injection. You • Use a drain tube which will help prevent can control the strength of the solution, pressure, short circuiting of your chemicals. and rate flow. Two different solutions can be used • Remember fluid will follow the path of least and you can pre-inject the head separately. By resistance. using two different solutions we can choose to use Your chemical will travel from the arteries to a formaldehyde-free solution in the head only, and the veins using only a portion of the capillaries. normal arterial solution in the rest of the body. The The magic takes place in the capillaries. Using RCI will enable us to pre-inject the head with a high angular forceps and unrestricted drainage is a great dye pre-injection solution to overcome the jaundice concern. Unrestricted drainage can often cause stain. Normally, the edema in a jaundice case is found short circuiting of your chemicals and cause shell in the legs and arms. This allows the cells to become embalming, and the high levels of dye used in a stained with dye before the formaldehyde causes jaundice case will never reach its full potential. the reaction of bilirubin to biliverdin. Bilirubin Shell embalming will give the embalmer a false combines with HCHO to give you biliverdin, that impression of an embalmed body because the only lovely green. I personally like to over-stain the The cosmetic areas that received any embalming fluid would be tissue. It is much easier to use cosmetics on tissue effects of the superficial areas of the body. The underlying and that is red/pink tissue, rather than green. Freedom Art are deeper tissue never received sufficient embalming For all jaundice cases, I recommend a RCI amazing and I fluid. Shell embalming is a major everyday injection. I pre-inject the head first to allow the personally think embalming failure. The use of high pressure and dye and accessory chemicals to work at their a low rate of flow with pulsation is a tremendous full potential. I also suggest in using less water in better than many advantage for all embalming. A low rate of flow will arterial solutions. I’m a firm believer in waterless formaldehyde- give you a better, more even distribution. Trying to embalming and low-water embalming. I think we based arterial increase your rate of flow during embalming doesn’t can all agree that water doesn’t preserve tissue. I solutions. increase vascular pressure, it only causes swelling, personally believe water is only a dilution factor. Freedom Art blotching, and a lot of headaches. High pressure Customers using glutaraldehyde-based spe- can be used embalming has never caused swelling, blotching, cialty jaundice chemicals, please be aware that glu- and these other problems. This is all caused by rate of taraldehyde is a five carbon molecule and is much with any Dodge flow. Please recall the Dodge Magazine article written larger than formaldehyde. When embalming we formaldehyde- by Bill Martin, “Embalming Using Elevated Pressure are cross-linking protein, which will cause a pep- based chemicals. and Lower Flow with Pulsation.” (Fall, 2013) tide linkage (site) between every two amino acids. This is a must read. You can view this article and Formaldehyde will bond at every peptide link- many more on Dodge’s web store at https://shop. age (site); glutaraldehyde will NOT bond at every dodgeco.com. peptide linkage (site). This is because glutaralde- A delayed cavity aspiration is important. By hyde is such a large molecule. This why we see soft delaying aspiration we are allowing preservation and tissue and rapid problems with specific jaundice- the cosmetic effects to continue by keeping your type fluids.

5 Summer 2014 Pre-Injection for the head: formaldehyde-based chemicals. When using only 1 – 16 oz. bottle of Rectifiant Freedom Art, you will see no tissue fixation. But 1 – 16 oz. bottle of Metaflow with the techniques discussed in the following ½ bottle of Restorative formula, you will see tissue fixation. 2 oz. - 16 oz. of dye to overcome the jaundice The mixture below is for embalming the head green or yellow stain. only. I suggest a ½ gallon solution at a minimum. As 16 oz. of tepid water (optional). You can use a always, use your discretion and watch for distribution bottle of Rectifiant or Metaflow instead. while injecting up both sides of the head. Follow up with your choice of preservative 3 – 16 oz. bottles of Metaflow solution for the trunk and extremities as listed 3 – 16 oz. bottles of Rectifiant below. Then return to the head using a preservative ½ bottle of Edemaco solution in the head. I would suggest: 1 – 16 oz. bottle of Restorative Choice A 1 – 96 oz. jug of Freedom Art Use a normal embalming procedure and use Icterine Dye (use your discretion on the amount cosmetic to cover the green. to help overcome the jaundice stain) Choice B Fill to two gallons Use Rectifiant and Metaflow. I recommend Make sure the left carotid is tied off before you at a minimum one bottle of each per gallon of start injecting. After injecting the minimum of ½ water with lots of dye. The entire mix of accessory gallon of the above solution into the face and head chemicals is a must. Use Metasyn Normal using a RCI, use the remaining fluid in the tank to (remember, preservation, at minimum, requires a treat the rest of the body. Look for distribution and 2.5 % solution). Use Edemaco to control edema. I color change. You will see some tissue fixation. For would suggest thinking of using more Metaflow and a normal case, use the above solution in the tank Rectifiant per gallon and less water in your arterial but add a 16 oz. bottle of Edemaco, and 8 oz. of solution. Metasyn. If edema is present, use an additional one to two bottles of Edemaco. If emaciation is present Jaundice with Chemical Agents use Restorative in the head, face, and body. FIRST Injection (Pre-Injection) SECOND Injection THIRD Injection FOURTH Injection Only if the body is over 250 lbs. 24 oz. Metaflow 4 oz. Metasyn 8 oz. Metasyn 12 oz. Metasyn or Introfiant Inject the entire solution as mentioned above. 24 oz. Rectifiant 24 oz. Metaflow 24 oz. Metaflow 16 oz. Metaflow 4 oz. Restorative 24 oz. Rectifiant 24 oz. Rectifiant 16 oz. Rectifiant Follow this up by injecting the solution below using 4 oz. Edemaco 8 oz. Edemaco 8 oz. - 16 oz. Edemaco 8 oz. - 16 oz. Edemaco the RCI injection, drain tube, and high pressure low 8 oz. - 16 oz. Icterine Regular 2 oz. - 16 oz. Icterine Regular 6 oz. Restorative 12 oz. Restorative rate of flow. Left carotid should be tied off. Warm water to make 1 gal. Warm water to make 1 gal. Warm water to make 1 gal. 1 – 16 oz. bottle of Metaflow Pre-Inject Head First Cavity: 2 bottles Dri Cav DELAYED Aspiration 1 – 16 oz. bottle of Rectifiant 1 – 16 oz. bottle of Metasyn or Introfiant Jaundice with Edema You can also use the Freedom Art in the head FIRST Injection (Pre-Injection) SECOND Injection THIRD Injection FOURTH Injection and face only. A formaldehyde solution can be used 24 oz. Metaflow 6 oz. Metasyn Acc or Introfiant 12 oz. Metasyn Acc or Introfiant Repeat 3rd if necessary for the rest of the body since generally we see the 24 oz. Rectifiant 36 oz. Metaflow 36 oz. Metaflow 8 oz. Edemaco 36 oz. Rectifiant 36 oz. Rectifiant head turn green, not the hands. Using a RCI you 8 oz. - 16 oz. Icterine 24 oz. Edemaco 24 oz. Edemaco can inject the head and face only. When finished NO WATER 2 oz. - 16 oz. Icterine 2 oz. - 16 oz. Icterine Regular injecting the head, make sure you tie the left carotid Pre-Inject Head First artery off. Edema is very rarely in head Per gallon solution Cavity: 2-3 bottles Dri Cav DELAYED Aspiration 24 oz. of Freedom Art 2 - 16 oz. bottles of Rectifiant HEAD ONLY!!! Using Freedom Art on Jaundice Cases 2 - 16 oz. bottles of Metaflow Freedom Art is a formaldehyde-free arterial 8 oz. of Restorative chemical which preserves, disinfects, and 4 oz. - 8 oz. of Edemaco, to add firmness deodorizes. You will see clearing of mild jaundice 1 oz. - 16 oz. Dye - use your discretion and superior cosmetic tint even with severe jaundice Enough water to make a 1 gallon solution cases when using Freedom Art. The cosmetic effects It is necessary to file all appropriate embalming of Freedom Art are amazing and I personally think reports and logs. A reminder: in the court’s eyes, if it better than many formaldehyde-based arterial wasn’t documented, it never happened. Please take solutions. Freedom Art can be used with any Dodge this paperwork seriously. It should be a no-brainer! Please remember our main goal is for preser- vation! Embalmers discretion is always advised and Matt Black has been a licensed funeral director treat the worst condition first. Cosmetics can cover and embalmer in the state of Pennsylvania any color change; our concerns need to be on the for over 20 years. He represents The Dodge embalming. The viewing is still the most personal- Company in central and western Pennsylvania. ized event in a funeral. A family only has one chance In addition to being a graduate of the Pittsburgh to say goodbye. Institute of Mortuary Science, Matt also holds References: degrees in Bio-Medical Engineering Technology Embalming: History, Theory, and Practice – Robert G. Mayer and Industrial Management. The Principles and Practice of Embalming – Frederick and Strub Thanatochemistry A Survey of General, Organic, and Biochemistry for Funeral Service Professionals - James M. Dorn and Barbara M. Hopkins

The Dodge Magazine 6 Presenting the Perfect Remains With Waterless Preparation

by Bill Martin

When Don Sawyer started demonstrating and Plasdoform chemical compound because, just developing specific undiluted solutions for different as learning how to improve results with elevated types of human remains, the chemotherapeutic pressure, low rate of flow control and pulsation, drug era had not yet started in full force. Bodies learning how to improve results with low water and were showing signs of extensive chemical waterless embalming is equally important. When treatment and these signs were changing the entire you learn more about sophisticated chemicals and complexion of how we would handle efficient how to use them in undiluted solutions, the results embalming from then on. Don began using slightly will speak for themselves. Your results are better diluted embalming solutions on bodies that were without water. considered “normal” cases, such as bodies that were Webster defines dilute as, “To thin down or dead for one to two hours, were emaciated, had weaken.” If I may quote Dr. Jerome Frederick, low fat content, and thin skin. We know now that our chemist who developed the Plasdoform line the so called “normal” remains are unusual and of chemicals, “In summary, then, the use of water rarely seen in many areas. to dilute the arterial for injection presents many Moderately difficult to difficult remains seem hazards which may lead to embalming failures. If The development to be the norm because of a longer disease treatment “waterless” embalming is tried, it is usually very of the clathrate process, bodies deceased for longer periods of successful. If proper chemicals are selected for molecule was the time, and of course, refrigerated, sometimes even embalming, there is actually no need to dilute these first contribution chemicals with external sources of water. Rather, frozen. The longer time the person has been dead to Dodge’s now creates beginning and advanced putrefaction and the task of dilution will be accomplished by the skin slip. High bodily fluid accumulation in the water constituent of the body itself. Such cases, well-known tissue is common because of the longer disease even though they have been heavily dosed with a Plasdoform- process before death. plethora of chemotherapeutic agents, inevitably based arterial In the mid 60’s, Don Sawyer began turn out better (and with fewer problems) than the and co-injection experimenting with stronger solutions using less same type of cases where water has been used for chemicals. The and less water to increase the solution formaldehyde arterial dilution.” index to overcome the issues created by the To this day the greatest number of embalming clathrate molecule condition of these remains. I think it is safe to say failures are caused by injecting large amounts of is a molecule that 1970 began the chemotherapeutic drug era. weak solutions. By now it should be obvious that within a molecule. Since that time Dodge began changing chemical water is not a preservative and is not even safe to compounds to better counteract the effects of these consider it a vehicle to carry the chemical to the chemotherapeutic drugs and increase efficient tissue. Preservative and co-injection chemicals embalming results. are capable of driving themselves with a little The development of the clathrate molecule help from your injector, using low flow, elevated was the first contribution to Dodge’s now well- pressure, and when possible, pulsation. known Plasdoform-based arterial and co-injection If some of you remember reading articles chemicals. The clathrate molecule is a molecule written by Don Sawyer you may remember the within a molecule. The chemical, when injected, following quote, or one similar to it. “Somehow travels to the cell and releases its preservation many embalmers seem to have come to the illogical and fixation on demand, so the tissue is not conclusion that water has preservative properties.” overwhelmed with preservative. The preservation I have told many customers that when I enter a process is slower but a more thorough tissue preparation room and check the water faucet, I saturation takes place. This may not seem important have never seen any lettering printed on the faucet information to know but if you understand the that says, “The liquid that comes from this faucet process of Plasdoform solutions, your results will preserves tissue.” I think that rather than believing surely be better because you will better understand that an embalmer would consider water to be a mixing waterless, or as it’s sometimes referred to, preservative, Don used his statement to invite us ‘no water added’ solutions, and what type of results to think more about the dangers of a water-based you can reasonably expect to achieve. embalming solution. I think it is important to understand the Considering that the so-called average,

7 Summer 2014 normal, or ideal body is rare anymore, because of chemicals will not dilute the preservation chemicals a number of conditions mentioned previously, we but will help control the fixation of the tissue for should consider that using water in any embalming a more recognizable body, as well as more normal solution should be strongly discouraged. Having feeling tissue, should the family decide to touch When said that, perhaps with careful pre-embalming their loved one. Preservation can be increased by a determining what consideration, and on rare occasions, with remains higher index of embalming solution without over- to use for the recently deceased, perhaps two quarts would be fixing the tissue. Remember over-fixed bodies are undiluted first OK, after careful evaluation of the body condition not necessarily well embalmed. injection solution, and using warm water only. If you choose to add more preservative you we should first Eliminating the use of water to produce a must increase the co-injection (Metaflow) as well. diluted primary solution will, of course, do just You may increase the index to satisfy your judgment consider the that, eliminate the diluted solution, along with for increasing preservation, but increased fixation condition of the most of the dangers of embalming failure. may create too much firming. Use the same amount body in front of It is important to never forget that your of Metaflow, or even twice the amount, and possibly us, not the one undiluted (waterless) solution will remain undiluted add at least 16 ounces of Restorative to help hold you embalmed if there are enough co-injection chemicals injected back fixation. Adding to an undiluted solution is with the original undiluted mixture, specifically reasonable and will help any situation where you yesterday, last Rectifiant. Rectifiant neutralizes the pH of the think you may have incorrectly estimated the month, or the one body fluids that have the capability of rendering results. Conversely, you may want to tone down you remember the preservative ineffective. Bodily fluids carry an undiluted solution that could be considered too that “looked just the same danger as water; enough water mixed “hot” by adding just co-injection chemicals to slow like this one,” with body fluids produce the same results as water the fixation, without compromising preservation. because no two alone: zero preservation. I know that dehydration is always an issue when When determining what to use for the higher indexes are used in embalming solutions, bodies will ever undiluted first injection solution, we should first so please, remember co-injection chemicals, be exactly the consider the condition of the body in front of us, specifically Metaflow and Restorative, control over- same. not the one you embalmed yesterday, last month, fixing and, therefore, control dehydration. Two or the one you remember that “looked just like this things accelerate dehydration and one of them is one,” because no two bodies will ever be exactly NOT formaldehyde. What are they??? WATER and the same. Each case should be evaluated by the REFRIGERATION. embalmer based only on the conditions he or she Metaflow is a vascular conditioner that observes, or reads about in any paperwork which provides both fixation control and assistance to may indicate cause of death or medical treatment. the preservative chemical. Metaflow also disperses For example, you may raise an eyelid during blood clots to aid in better drainage. Rectifiant your original evaluation and observe the whites of is the cell scrubber that removes deposits from the eyes. If the sclera has the “road map” appearance blocking the entrance of the preservative into the (red lines all over the area), it would mean the cell. Restorative aids in dehydration prevention presence of high blood pressure at the time of by rehydrating the cell if it is over-injected with death. This would indicate the person probably was a solution that may be a little too strong and on blood pressure medication and perhaps, blood will set the tissue too firm. Restorative is useful thinners. Therefore, it is safe to assume clotting on emaciated bodies when the skin is tight up would be at a minimum, drainage and chemical against the bone because of low fat or muscle. The distribution to the tissue would likely be very good. Restorative will provide a slight layer between the As you contemplate undiluted (waterless) skin and bone which will allow easier introduction solutions and then consider you cannot eliminate of a hypodermic application of Feature Builder in dilution by retained body fluids, the waterless the face and temporal regions. logic begins to come into focus. You can control Please note that the suggested chemical the injected solution but you cannot control bodily dilutions on the attached chart allow, in some of fluid retention. Therefore, your injected solution the examples, ½ gallon of warm water. If you must handle the body fluid dilution to control the feel a waterless solution is something you are preservation and fixation levels. willing to try, the ½ gallon of water may feel more When you look at this closer, you will better comfortable for you to start with. Working your realize the value of co-injection chemicals, such way up to the waterless by using low water for the as Metaflow, Rectifiant, and Restorative. These various types of bodies listed will help you remain in your comfort zone. In addition to representing The Dodge Also remember as I stated on my waterless Company in Washington, northern Idaho, embalming solution chart, “Not all bodies require western Montana, and Alaska, Bill has been a waterless embalming; however, ALL bodies require regular faculty member of the Dodge Institute’s LESS WATER.” Sunshine Seminars and has conducted I will leave you with one thought. There is only numerous continuing education programs for one reason families bring their dead to you. They need someone to handle the final disposition of state associations across the country, in Mexico that loved one. You cannot spend too much time on and Canada. honoring that trust!!!

The Dodge Magazine 8 LOW WATER & WATERLESS EMBALMING SOLUTIONS As recommended by Bill Martin

All remains should be embalmed with never more Therefore, they both enhance preservation and than ½ gallon of water. For the so called “normal” control excessive fixation. The control of fixation remains, begin with ½ gallon of water. Add allows the operator to completely preserve all tissue accessory chemicals to make a total solution of 2 to while low water prevents excessive dehydration 2 ½ gallons. You will add preservative chemical for and excessive chemical dilution. preservation. Preservation shall be your primary concern, after you have posed the features to create All recommendations may be varied in chemical a recognizable and comfortable appearing remains. content. NEVER use more than ½ gallon of water on any body. The overall condition of the remains Example: will always require the operator to diagnose the 64 oz. H20 (HOT) = ½ gallon actual solutions needed to attain the best results. 4 btls Metaflow = ½ gallon NEVER use water on bodies with edema. 4 btls Rectifiant = ½ gallon 2-3 btls Arterial + l to 2 btls Restorative = ½ Please note that the suggested chemical dilutions gallon = 2 gallon total solution on this chart allow (in some examples) ½ gallon of warm water. **This example should be considered a UNIVERSAL recommendation. If you feel that a waterless solution is something you are willing to try, the ½ gallon of water (low More Metaflow and Rectifiant could be required water) solution, may feel more comfortable for you depending on the type of body being injected. as a starting point until you are comfortable going More or less arterial may be required as well as waterless. Restorative. Not all bodies require waterless embalming; however, ALL Metaflow, Rectifiant and Restorative CONTROL bodies require LESS WATER. the fixation of the tissue. These chemicals also allow for maximum preservation as they only Questions? cause minor dilutions of the preservative chemical. Call Bill at 206-953-0269

NORMAL BODY EMACIATED BODY Emaciated Body ½ gallon H20 ½ gallon H20 4 btls Metaflow 4 btls Metaflow 4 btls Rectifiant 4 btls Rectifiant Approx 2 btls humectant based arterial 2-4 btls Arterial 2 btls Restorative 1 btl Restorative OBESE BODY REFRIGERATED (1or more days) 4 btls Metaflow 4 btls Metaflow 4 btls Rectifiant 4 btls Rectifiant 2 btls 24-30 index arterial 4 btls Arterial **½ gallon of water may be used w/recent death 1-2 btls Restorative and no refrigeration. ½ gallon (warm to hot H2O) or less as required. Repeat as second injection and change solution as needed. Body condition may suggest waterless. WATERLESS JAUNDICE BODY—may be infectious CHEMO BODY Body may be edematous. 5 btls Metaflow 4 btls Metaflow 5 btls Rectifiant 4 btls Rectifiant 2 to 3 btls arterial or as needed 1 btl Restorative (if needed) **For emaciated bodies add 2 btls Restorative. 3 btls Metasyn WATERLESS Add Edemaco as needed (8 to 16 oz) 16 oz Blonde Inr-tone (color additive) EDEMATOUS BODY Second Injection, if needed adjust 6 btls Metaflow solution accordingly 6 btls Rectifiant WATERLESS 4 btls 30 index arterial 8 oz Edemaco per gallon BODY W/TISSUE GAS WATERLESS 5 btls Metaflow 5 btls Rectifiant INFECTIOUS DISEASE 2 btls Dis-Spray (ie: Aids, Hepatitis, T. B., etc.) 5 btls Introfiant Follow refrigerated body procedure WATERLESS WATERLESS

9 Summer 2014 POWER OF THE PLASDO

The Plasdo arterial line imparts a natural flesh-toned appearance. Water soluble Dodge Vasculin contains no emulsified animal fats, and our Plasdoform-based,non-blotching formula produces thorough preservation without the risk of over-embalming.

For Professional Embalming Use Only

Plasdopake Catalog No. 107011 Plasdo-25 Catalog No. 107020

© 2014 THE DODGE COMPANY Embalming CJD Cases: The Facts

by Karl Wenzel, CFSP, MBIE

Continual growth professionally, as well as it does affect approximately one in every million personally, is extremely important for an embalmer people per year. It is important to know the truth or funeral director. Added knowledge will allow regarding CJD, when cases infected with this prion you to make good, educated decisions, and to disease enter your facility. Over the years I have distinguish between fact and fiction. As we grow seen and heard of too many funeral establishments in life and in our chosen profession, we learn that and embalmers leaning on the side of fiction. fear of the unknown is always intimidating. When As a young student I recall entering the faced with something in the preparation room like funeral home in which my friend was doing his Creutzfeldt-Jakob Disease (CJD), it’s best to go apprenticeship, and being told a CJD body was with the facts and educate yourself enough to stay arriving and that it was “highly contagious” and away from fiction. “must not enter the funeral home.” The older Although CJD cases are not overly common, licensed directors perceived this to be a case where

11 Summer 2014 even breathing the air around the remains would important discussion. The misinformation passed on put them in great risk of infection. Embalming by the funeral director had the organizer concerned and handling of these remains were forbidden, and that embalming a CJD case was unlawful. Once certainly no service with viewing could be provided. again, fictional information prevented the factual In fact, the remains were not even allowed to enter information from being passed on. According to any further than the garage of the funeral home. the Creutzfeldt-Jakob Disease Foundation there is The service was to be immediate and the remains no state in the USA that forbids embalming a CJD had to be buried in a sealed container. Employees case, and the World Health Organization states were not allowed to open the body bag to even that unautopsied and autopsied remains can be verify if they had transported the correct remains embalmed safely. Fortunately, the seminar was held Although CJD is from the morgue. Naive and inexperienced in the and important truthful information was shared with world of funeral service, I took this information all in attendance. transmissible, it and treated it as fact. In truth, this was nothing but Let’s take a look at important things to re- is not contagious misinformation and complete fiction. member when embalming these cases. As in any like a common CJD is a rare and fatal form of dementia embalming, we must always weigh in on the side of cold. In 30 years caused by an infectious prion disease that is a personal precautions and safety. We all know these of research, no neurodegenerative disorder. The name comes from precautions can be something of a nuisance in the transmission has the two German physicians who first described flow of our busy schedules. However, it is impor- the condition in the 1920’s. CJD is classified as a tant to you, the embalmer, to protect yourself from ever been found “transmissible spongiform encephalopathy” and it is any potential health risks when embalming. Since in everyday here that the fear and the myths about the disease CJD is only truly confirmed by way of an autopsy living. arise. Often when we hear the diagnoses of CJD following death, we must think of the cases that the thought of Mad Cow Disease comes to mind. may be undiagnosed and their potential risks. This This is, in fact, false, as only cows can acquire Mad is why protective attire and good work practice is so Cow Disease and not people. CJD is generally important to everyday embalming. characterized by symptoms associated with Protective attire should include fluid resistant muscular coordination and personality changes. coveralls, a full facial shield with a disposable This is followed by the rapid progression of memory surgical mask, hair and shoe covers, and good quality loss with severe brain impairment. disposable surgical gloves that you may even “double There are three main types of CJD: sporadic, glove” (cut proof gloves are recommended when familial, and acquired. Sporadic is the most using sharps). The use of disposable embalming common, affecting 85% of all CJD cases, and is instruments is also recommended. If using non- commonly seen in individuals over the age of 50. disposable instruments, disinfection by way of Familial, or inherited, is associated with a gene soaking the instruments in undiluted bleach for a mutation and accounts for 5% to 10% of cases. period of one hour (minimum) is recommended. Acquired CJD cases form less than 5% and are a Dodge also offers a Hi-Risk Disposable Instrument result of medical transmission such as contaminated Kit (Cat. No. 700199) which would work well for human growth hormone, or tissue grafts of dura this situation. mater from cadavers pre-1987. Due to the long It is important to remember when handling incubation of this disease, cases are still seen today remains, both in the transferal from the place of which have been infected in this way. death and in the transferal to the preparation table, Remember that Although CJD is transmissible, it is not that we control and contain the leakage of bodily formaldehyde contagious like a common cold. In 30 years of fluids. These remains should always be transferred and other research, no transmission has ever been found in in a sealed body bag with absorbent material placed embalming everyday living. Family members, nurses, doctors, around the head of the individual to contain any chemicals will coroners, funeral directors, or embalmers are at possible leakage. It has even been recommended not kill the CJD no greater risk of contracting the disease than the by some that if the remains have been autopsied general public. The truth is, no pathologist has then a plastic bag be sealed around the head before prion and should ever contracted CJD through research or autopsy. transferal. be considered “Although it is a transmissible disease, it is not, in the When positioning the remains on the prepa- a preservation commonly accepted sense of the word, an infectious ration table, the surrounding floor area should be method ONLY, disease. And that is an important distinction,” states lined with plastic with absorbent sheets to collect and not a expert Dr. Paul Brown of the National Institute of any possible spillage. The body bag and other soiled Health. The fear of the unknown is powerful, and, material should carefully be removed and placed disinfection. unfortunately, poor and misleading information on into a biohazard bag for incineration. caring for CJD cases is even more powerful. The entire body should be disinfected using a Many years ago I took part in the formation liberal amount of Dis-Spray. If the body is autopsied, of a seminar that spoke to embalmers on “How the entire area should also be wiped down with to Prepare CJD Cases.” It was an informative and undiluted bleach soaked towels and allowed to helpful seminar that shared valuable information stand for a 15 minute period. on the proper handling of these cases. What was When the embalming site has been selected, unfortunate about the seminar was that it almost the appropriate vessels should be injected with a never happened. A call from a misinformed waterless solution of equal parts of Introfiant, Rec- funeral director to the organizer nearly halted this tifiant, and Metaflow. A waterless solution is rec-

The Dodge Magazine 12 ommended to achieve maximum preservation with may then be washed using a disinfecting soap. minimal drainage. Remember that formaldehyde The causative agent that surrounds CJD is and other embalming chemicals will not kill the difficult to kill, therefore the entire work area must CJD prion and should be considered a preservation be washed and wiped down with undiluted bleach method ONLY, and not a disinfection. All blood and left for a minimum of an hour before rinsing drainage should be drained using a drainage tube. with water. Here is where I have found the greatest As an embalmer we face a lot of diverse controversy in my research of handling CJD cases. problems and unknowns in our daily mission What do we do with the waste from both arterial to assist the families who have lost a loved one. drainage and aspiration? Do we even aspirate these In deaths caused by CJD we know that good cases? If we look at what goes into our local sewer techniques and good practice is required to keep us systems on a daily basis and the large amounts of safe. All embalmings hold potential dangers for us, dangerous pathogens and human waste containing E. the embalmers. Good, factual information is the key coli, the small amount of known CJD cases fails to to our personal safety. even compare. Funeral homes have been disposing waste into the sewer systems for generations, Here are some facts regarding CJD: and that would include undiagnosed CJD • Diagnosis may not be made before death. The causative cases. “Although physicians are certainly suspecting • Autopsy is the only true way of confirming the disease (CJD) more frequently, they are not CJD. agent that taking the steps necessary to confirm it. Therefore, surrounds CJD • There is no treatment/cure – the disease is they are not communicating their suspicions to you, is difficult to kill, the embalmer. The large majority of CJD cases are 100% fatal. therefore the unconfirmed,” states Kim Collison, clinical manager • Embalming an autopsy CJD case is possible. of the Immunochemistry and Advanced Technology entire work area Laboratories at Spectrum Health in Grand Rapids. • Embalming CJD cases is not against the law. must be washed Let’s look at two possible options for disposing In some states it is required unless religious and wiped down reasons say not to embalm. bodily waste during embalming CJD cases. with undiluted First, we could collect the arterial drainage • Open casket viewing is possible. into a separate container, like a pail or a sink, then bleach and left treat it with a volume of undiluted bleach and • Effective Disinfectants against CJD prion are: for a minimum allow it to sit for a period of no less than one hour -Sodium Hydroxide (1N for 1 hr – viable of an hour before before disposal. The second method would be to results) rinsing with -Sodium Hypochrite (5000ppm for 15 mins) simply allow your drain tube to enter the drain water. immediately. This method is more practical and -Guandine thiocynante (4 mins) would certainly reduce the embalmer’s exposure -Phenolic (LPH) (0.9% for 30 mins) level and risk. • There is no evidence of transmission from When we discuss aspiration of CJD cases I environmental surfaces if contaminated with think we should emphasize precaution. Aspiration blood or body fluids. can be done, if care is used to avoid the spinal area, and a disposable trocar is used. I would recommend For further information on CJD, please contact that you forgo aspiration and orally pack the nasal the CJD Foundation at http://www.cjdfoundation.org and throat passages with cotton soaked in bleach, followed by the use of DodgeSeal to seal the nasal and throat passages. This product will harden References Used: CJD Information For Funeral Directors and Embalmers – CJD and reduce the risk of unwanted purge. Another Foundation Inc. option would be to introduce a cavity chemical Creutzfeldt-Jakob Disease - Fact and Fiction: Pts 1 & 2 – Kim Collison 9-01 like PermaCav 50 orally, using a nasal tube into the Dodge Magazine Creutzfeldt-Jakob Disease (CJD) and the Importance of Infection Prevention esophagus and bronchi to assist in slowing down the – Beau Ances, MD, PHD,MSc, Washington University Saint Louis; migration of bacteria. DodgeSeal would again be Deana M. Simpson, RN, St. John Providence Health System and used to close off the throat and nasal openings. Founder/Director CJD Insight In autopsied cases the viscera should be treated CDC – Centers for Disease Control and Prevention – www.cdc.gov with 32 oz. of Dri Cav and double bagged. Dry packing of viscera is forbidden. Upon completion of the arterial injection, the cavity should be dried Karl is the Coordinator of Technical Education and the viscera bag placed inside the cavity, along and Training for Dodge as of September 2013. with embalming powders, and sutured closed. He worked for the Arbor Group (largest The cranium may be treated using Syn Gel, and independent funeral service chain in Canada) the cranial floor sealed with Inr-Seel and closed. for six years as their Manager of Decedent Caution should always be used to avoid sharps (bone Care and Preparational Development. Karl fragments, needles) and punctures when closing the has been a licensed embalmer since 1997 and incisions and the use of cyanoacrylates is preferred. is licensed in Ontario. He is the Fountain Upon completion, the entire body should again be National Academy Canadian Ambassador. wiped down using undiluted bleach and allowed to Karl Wenzel, CFSP, MBIE stand for a minimum of 15 minutes. The remains

13 Summer 2014 Disease of the Month:

MERS-CoV by Kim Collison MSA, M.T. (ASCP)

From medical journals to news magazines to local those infections have been mild, they prove that newspapers, MERS-CoV is in the headlines. Middle this virus has the ability to spread from person-to- East Respiratory Syndrome (MERS) is caused by person when there is extended close face-to-face a coronavirus (CoV). The first case was reported contact. There is not enough evidence at this point in September 2012 in the Arabian Peninsula. to suggest that the virus is spread through limited Since mid-March 2014, the frequency of reported casual contact. infections has increased. The first case of MERS in A spike in the number of MERS cases in Saudi the United States was reported in Indiana on May Arabia since March of this year has prompted 2, 2014, and a second case was reported in Florida concern that the virus may be mutating to a more on May 11, 2014. To date, all reported cases have easily transmittable form. Genetic sequencing has been linked to the Arabian Peninsula. As of May 12, proven that this is not the case.3 While this is good 2014, the CDC reports 536 laboratory confirmed news, the fact remains that currently there is no cases of MERS-CoV and 145 deaths. Those infected treatment for MERS. The number of healthcare with MERS-CoV range in age from 2 years to 94 workers being infected is of serious concern. The years.1 transmission in healthcare settings illustrates that Currently, 65% of cases are in males and 19% infection control remains the primary means of of cases have involved healthcare workers. MERS preventing and controlling MERS-CoV. Prior to is a respiratory illness that includes symptoms of SARS, there had not been many studies on their fever, cough, and shortness of breath. When the first modes of transmission because coronaviruses This virus has the cases of MERS were diagnosed, it was immediately usually cause mild upper respiratory tract illnesses. compared to SARS. Severe Acute Respiratory During the SARS outbreak, scientists determined ability to spread Syndrome (SARS) first appeared in China in late that coronaviruses spread from person-to-person from person-to- 2002 and developed into a deadly international through the air by coughing, sneezing, and close person when outbreak in 2003. MERS and SARS are both caused personal contact, as well as through indirect there is extended by coronaviruses. Coronaviruses are also the cause contact by touching contaminated surfaces and close face-to-face of the common cold and other mild respiratory then touching the mouth, eyes, or nose. Based on the known modes of transmission of MERS-CoV, contact. There illnesses. Until a decade ago, coronaviruses had only caused non-life-threatening colds and mild upper standard precautions must be followed consistently is not enough respiratory infections in humans. In 2003, the SARS- and personal protective equipment (PPE) must be evidence at this CoV emerged and killed nearly 10% of the people appropriately used. point to suggest it infected. Now MERS-CoV is traveling around the Standard, contact, and airborne precautions, that the virus is world killing 30% of the people it infects.2 While PPE, and environmental infection control measures spread through MERS has several clinical features which resemble are recommended when handling MERS-CoV those caused by SARS, scientists have determined cases. The need for these precautions is easily limited casual that the MERS coronavirus is distinctly different. understandable when looking at the clinical contact. However, like SARS, MERS has a high death rate symptoms and specimens used for laboratory and it has the potential to cause a pandemic. testing. A wide clinical spectrum of MERS- Both SARS and MERS present similar symptoms CoV infection has been reported ranging from including a cough, fever, shortness of breath, asymptomatic infection to acute upper respiratory myalgia, vomiting, and diarrhea. Both have the ability illness, rapidly progressive pneumonitis, respiratory to progress to respiratory failure; however, MERS failure, septic shock, and multiple organ failure has shown a much more rapid progression. SARS resulting in death.4 The laboratory specimens of affected young, healthy individuals and appeared choice when testing for MERS-CoV include sputum to be much more infectious. To date, the median (lower respiratory tract), nasopharyngeal or age of those with laboratory confirmed MERS-CoV oropharyngeal swabs, and blood. This information infections is 49 years, and a large percentage of those indicates that any aerosol generating procedure can infected are males. The majority of serious and fatal pose a risk to the embalmer. PPE should include infections have occurred in people with underlying gloves, impervious gown, eye protection or full face comorbid medical conditions such as diabetes, shield, and an N95 respirator. All environmental hypertension, chronic cardiac disease, and chronic surfaces must be properly cleaned using an EPA- renal disease. Approximately a quarter of those registered disinfectant. As always, hands should be infected with MERS-CoV are healthcare workers. washed frequently, especially after removing gloves. These infections have been milder or asymptomatic. These are the basic steps of infection prevention Some family members of those with serious or fatal that anyone in funeral service can extrapolate from infections have tested positive for MERS. While healthcare guidelines.

The Dodge Magazine 14 In April 2014, the World Health Organization Disinfection of the skin surfaces was not issued the Infection Prevention and Control of Epidemic- specifically covered in the WHO Guidelines. As with and Pandemic-Prone Acute Respiratory Infections in environmental surfaces, clean the body with soap Health Care Guidelines. Although the majority of these and water to remove any body fluids contaminating guidelines focus on the healthcare setting, there are the skin surfaces. The coronavirus is inactivated by some specific recommendations for the care of the disinfectants such as alcohol, sodium hypochlorite, deceased. The major points are as follows: quaternary and phenolic compounds. Disinfection • Removal of the deceased requires adherence to of the skin surfaces can be accomplished using a standard precautions and the use of proper PPE quaternary disinfectant such as Dis-Spray. Avoid production to protect against exposure to body fluids. The The deadly Middle East Respiratory Syndrome of aerosols at all deceased should be transported in an imperme- began less than two years ago in the Arabian times. Aerosols able body bag to avoid leakage of body fluids. Peninsula and has spread across Europe, into Asia can be produced • Standard precautions, appropriate PPE, and and now the United States. Similar to SARS in through the proper hand hygiene must be used for all early 2003, this virus has traveled the globe on activities in the prep room. This applies to the airplanes, buses, and trains. MERS illustrates two expulsion of tidal initial intake functions upon arrival in the prep important points: (1) a new respiratory virus can air when moving room including washing the body, shaving, easily spread because the human population will or repositioning washing the hair, to the embalming process. have no immunity against the virus and (2) new the remains. The • Avoid production of aerosols at all times. diseases are just a plane ride away. Although MERS production of Aerosols can be produced through the expulsion has not reached pandemic levels, it is important to of tidal air when moving or repositioning the recognize that 30% of those infected with the virus purge can also remains. The production of purge can also have died. The CDC reports 16 countries as having release aerosols. release aerosols. Also, any function resulting confirmed cases. MERS is spread through direct in splashing can produce aerosols. Care person-to-person contact as evidenced by the spread should be taken to insure no splashing occurs from patient to healthcare worker. The message as drainage enters the sanitary sink. Covering MERS-CoV sends to healthcare and funeral service the sanitary sink or extending the drain tube is that all of the infection control and prevention below the water surface in the sink can help strategies reduce but do not totally eliminate the avoid splashing. If a patient infected with an possibility of exposure. It is up to each individual to acute respiratory infection dies during the strictly adhere to current safety guidelines including infectious period, the lungs and other organs the use of proper PPE and frequent hand washing to may still contain live virus. In these cases, reduce the risk of occupational exposure. anytime the embalmer aspirates the lungs and The coronavirus is inactivated internal organs, the live virus is released into Works Cited any drainage produced. 1 About MERS. http://www.cdc.gov/coronavirus/mers/about/index. by disinfectants html. Accessed 5/20/14 • Hand washing is probably the easiest yet most 2 Williams, R. Combating Coronaviruses. http://www.the-scientist. such as important process in infection prevention. com//?articles.view/articleNo/40099/title/Combating- alcohol, sodium Hands should be washed after any direct Coronavirus. Accessed 5/30/14 3 MERS Cases Highlight Risk to Healthcare Workers. Medscape. May 13, hypochlorite, contact with the remains, immediately after 2014. glove removal, and any time you exit the prep 4 Interim Guidance for Health Professionals. http://www.cdc.gov/ quaternary corovirus/mers/interim-guidance.html. Accessed 5/20/14. room. 5 Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute and phenolic • Properly cleaning and disinfecting the prep Respiratory Infections in Health Care. WHO Guidelines. April 2014. compounds. room environment will significantly reduce References Disinfection of the or remove the infectious particles, therefore Assiri, A., McGeer, A., Perl, TM., et al. Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus. New England Journal of skin surfaces can reducing the risk of infection. The viruses Medicine 2013;19:19. that cause acute respiratory infections such Barclay, L. MERS-CoV: Different From SARS, Comorbidities May Be Key. be accomplished Medscape. July 25, 2013. using a as MERS-CoV can survive on countertops Health Workers Catch SARS-Like Virus from Patients. Available at: http:// and contaminated equipment for hours to www.laboratoryequipment.com. Accessed 10/23/13. quaternary Morbidity and Mortality Weekly Report. 2014; 63(19): 431-436. C2014. days. Any surface or equipment that has been Centers for Disease Control and Prevention. disinfectant such contaminated by tissue or body fluid must be Officials Confirm Reports of Second US MERS Case. http://www. bioscience technology.com/news/2014/05/officials-confirm- as Dis-Spray. cleaned before it can be disinfected. Excess reports-second-us-mers-case?type=cta. Accessed 5/12/14. organic matter can impede the effectiveness of Interim Infection Prevention and Control Recommendations for Hospitalized the disinfectants. Use absorbent material and Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). http://www.cdc.gov/coronavirus/mers/infection-prevention- soap and water to remove any visible tissue or control.html. Accessed 5/20/14. body fluid. After cleaning, the surfaces should be disinfected using standard hospital grade disinfectants. The coronaviruses are inactivated by the disinfectants as long as manufacturer Kim is the manager of the Immunochemistry recommendations for use and contact time and Advanced Technology Laboratories for the are followed. It is important to avoid the Division of Pathology and Laboratory Medicine generation of aerosols during environmental at Spectrum Health in Grand Rapids, Michigan. cleaning and disinfection. This can be achieved She is a Clinical Laboratory Scientist with a by pouring the detergent or disinfectant onto master’s degree in health care administration. the surface rather than using a spray bottle.5

15 Summer 2014 Long-term Embalming

Steven Labrash, CFSP

When we think about embalming, most of the setting, such as carbolic acid (phenol) and high time we are referring to a process that I will call percentage alcohols. These chemicals are needed (for purposes of this article) “mortuary style for anatomical embalming but not desirable for embalming.” The goal of mortuary style embalming mortuary use. is temporary preservation, with the appearance The process I’m referring to as “long-term of the deceased being equally important. It is embalming” is a combination of these two styles. generally accepted that the preservation is short This technique should be considered when you are term with no promise of long-term preservation. presented with a case that will be at your mortuary Many mortuaries have even put that wording into for several months or longer. For purposes of this their embalming authorization forms (embalming article, long term is 2-12 months. I have used this is temporary preservation). The goal of mortuary technique on 21 cases and have had good results style embalming is to provide a lasting memory with each. The 21 cases had delays between 3 and 14 picture that is pleasant and recognizable. months with the average being 5 months. I wanted The second type of embalming that I am going to present this process in a way that every embalmer to discuss is called “anatomical embalming.” This is could easily follow. I will also refer to the class of the type of embalming commonly done at medical chemicals for easy substitution (humectants, co- schools and research facilities. The goal of anatomical injectant, etc). I refer to some specialty fluids and embalming is long-term preservation with little or I hope that these are already part of your standard no regard given to the appearance of the deceased. prep room supply. If they are not, I hope that you The cadavers are held at room temperature from will give serious consideration to including them. several months to several years. With anatomical Embalming Basics embalming, I’ve preserved cadavers that have Embalming chemically inhibits or arrests been around for 3-4 years with little or no signs of decomposition. It does not reverse decomposition, it decomposition. In general, anatomical embalming only retards it. For this reason, it is important that uses chemicals in their raw form (formaldehyde, the embalming be done in a timely fashion. The isopropyl alcohol, propylene glycol). There are longer we wait to embalm, the more decomposition also some additional chemicals used in anatomical will occur and less tissue will be available for embalming that you would not use in a mortuary preservation. The process of decomposition begins

The Dodge Magazine 16 Want to brush up on your embalming skills? Need some CEUs? Would you like to compare notes with embalmers from all over North America?

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