Workplace safety concerns in medico-legal death investigations related to COVID-19.

The personnel involved in the management of COVID-19 affected dead bodies, including law enforcement personnel at the scene of crime, personnel involved in transportation of the dead bodies, forensic practitioners, autopsy pathologists, mortuary personnel, as well as the family members of the dead, etc. are at risk of exposure to SARS-CoV-2 infection. Post-mortem examination is a high-risk procedure, considering that it involves aerosol generating procedures, and exposure to body fluids. The safety of the forensic practitioners and support staff in the management of suspected or confirmed COVID-19 deaths hence, is of extreme importance, especially in the absence of pre-autopsy testing for COVID-19 and due to non-availability of adequate first-hand medical history of the deceased. This communication aims to highlight the current practices and advises certain guidelines in ensuring occupational health and safety in view of these risks in medico-legal death investigations.

Nursing recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes.

OBJECTIVE: to develop a protocol of recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes. METHOD: a study of experts' recommendations using a structured form applied through the Delphi Technique, obtaining 100% agreement among professionals after four rounds of analysis. The population comprised six nurses members of the Scientific Department of Gerontological Nursing of the Brazilian Association of Nursing (Associação Brasileira de Enfermagem). RESULTS: the protocol was structured in a nucleus of nursing interventions to face the spread of COVID-19 in Nursing Homes, consisting of 8 actions. FINAL CONSIDERATIONS: the protocol can help nurse managers to organize assistance to face the pandemic, which can be adaptable to each reality, making training nurses and health teams easier.

Review: The safe handling of a corpse (suspected) with COVID-19.

INTRODUCTION: Countries around the world are confronted with a rising count of patients that die from COVID-19. Up to this date, there is no scientific evidence that proves that a COVID-19 corpse is still infectious. Different guidelines are being followed worldwide on how to deal with a COVID-19 positive corpse. The aim of this review is to compare different guidelines and literature on best practice for handling a COVID-19 positive corpse. RESULTS: The guidelines vary greatly in the use of PPE's and other safety measures especially during autopsy. There is great variation in the use of disinfectant and its concentration. Also recommended funeral services and contact with relatives vary greatly. CONCLUSION: In conclusion, there is very limited scientific evidence on which the researched guidelines are based. It is unclear why some guidelines propose a "business as usual" attitude and others a "code-red" attitude. More scientific evidence is needed to substantiate the handling of COVID-19 positive corpses to make an educated decision on how to safely handle a COVID-19 positive corpse.

Autopsy Services and Emergency Preparedness of a Tertiary Academic Hospital Mortuary for the COVID-19 Public Health Emergency: The Yale Plan.

Pathology Autopsy and Mortuary Services have been front and center in the severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) pandemic. The sheer number of fatalities from the pandemic have been unlike any other in recent memory and needed the rapid creation of new protocols and paradigms to manage the situation. This required rapidly escalating mortuary capacity to manage the increased fatalities from the pandemic with the establishment of lines of communication and networking with governmental entities, institution of new policies for patient flow, and implementation of worker infection control and well-being plans. Autopsies also assumed a crucial role, both to provide insight into the pathomechanisms of a novel disease and to allow tissue retrieval necessary to power research directed towards finding a vaccine. We here outline the plan adopted by the Yale Autopsy and Mortuary Services, in alignment with the institutional mission of high-quality patient care, education, research and health care worker safety and well-being, as the Corona Virus Disease of 2019 (COVID-19) pandemic surged in Connecticut. In the early response phase, ensuring sufficient mortuary capacity necessarily took center stage. As we enter the recovery and plateau phase of the pandemic, setting up a process for a rapid and safe autopsy, that will meet educational and research needs while ensuring the safety of our workforce is being implemented.

COVID-19: Postmortem Diagnostic and Biosafety Considerations.

As a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19-infected decedents at autopsy. While in some cases a history of fever and/or respiratory distress (eg, cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with-but not of-COVID-19 may still be infectious, however. While multiple guidelines have been issued regarding autopsy protocol in cases of suspected COVID-19 deaths, there is some variability in the recommendations. Additionally, limited recommendations to date have been issued regarding scene investigative protocol, and there is a paucity of publications characterizing COVID-19 postmortem gross and histologic findings. A case of sudden unexpected death due to COVID-19 is presented as a means of illustrating common autopsy findings, as well as diagnostic and biosafety considerations. We also review and summarize the current COVID-19 literature in an effort to provide practical evidence-based biosafety guidance for medical examiner-coroner offices encountering COVID-19 at autopsy.

Nursing recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes / Recomendaciones para abordar la propagación de COVID-19 en Hogares para Ancianos / Recomendações para o enfrentamento da disseminação da COVID-19 em Instituições de Longa Permanência para Idosos

ABSTRACT Objective: to develop a protocol of recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes. Method: a study of experts' recommendations using a structured form applied through the Delphi Technique, obtaining 100% agreement among professionals after four rounds of analysis. The population comprised six nurses members of the Scientific Department of Gerontological Nursing of the Brazilian Association of Nursing (Associação Brasileira de Enfermagem) Results: the protocol was structured in a nucleus of nursing interventions to face the spread of COVID-19 in Nursing Homes, consisting of 8 actions. Final considerations: the protocol can help nurse managers to organize assistance to face the pandemic, which can be adaptable to each reality, making training nurses and health teams easier.

RESUMEN Objetivo: desarrollar un protocolo de recomendaciones para abordar la propagación de COVID-19 en hogares para ancianos. Método: estudio de recomendaciones de expertos utilizando una forma estructurada aplicada utilizando la técnica Delphi, obteniendo un 100% de acuerdo entre profesionales después de cuatro rondas de análisis. La población estaba compuesta por seis enfermeras que son miembros del departamento científico de enfermería gerontológica de la Asociación Brasileña de Enfermería (Associação Brasileira de Enfermagem). Resultados: el protocolo se estructuró en un núcleo de intervenciones de enfermería para enfrentar la difusión de COVID-19 en Hogares para Ancianos y consta de 8 acciones. Consideraciones finales: el protocolo puede ayudar a los gerentes de enfermería a organizar la asistencia para enfrentar la pandemia, que puede adaptarse a cada realidad, facilitando la capacitación de los equipos de enfermería y salud.

RESUMO Objetivo: elaborar um protocolo de recomendações para o enfrentamento da disseminação da COVID-19 em Instituições de Longa Permanência para Idosos. Método: estudo de recomendações de especialistas utilizando-se um formulário estruturado aplicado por meio da Técnica Delphi, obtendo-se 100% de concordância entre os profissionais após quatro rodadas de análise. A população foi constituída por seis enfermeiros membros do Departamento Científico de Enfermagem Gerontológica da Associação Brasileira de Enfermagem. Resultados: o protocolo foi estruturado em um núcleo de intervenções de enfermagem para o enfrentamento da disseminação da COVID-19 em Instituições de Longa Permanência para Idosos, consistindo em 8 ações. Considerações finais: o protocolo poderá auxiliar os enfermeiros gestores a organizar a assistência para enfrentar a pandemia, que pode ser adaptável a cada realidade, facilitando o treinamento das equipes de enfermagem e saúde.

[Comparative normative on sanitary practices of cadaveric preservation in Spain]. / Normativa comparada sobre prácticas sanitarias de conservación cadavérica en Españ.

In this paper the current regulations on cadaveric preservation practices required for the transfer of corpses in the different Autonomous Communities -Reglamentos de Policía Sanitaria Mortuoria- and national legislation are compared. The criteria taken into account have been: a) which sanitary practices are included in the regulations, b) which ones can be carried out in corpses posing a health risk, c) when they are compulsory to be carried out, d) when they can be carried out after death, and e) what professionals can carry them out and/or take responsibility for them. At the time of finishing the paper, a new mortuary regulation is being passed in Andalusia, as well as a decree from the Ministry of Health on technical and sanitary requirements concerning international transfer of corpses and human remains.

Se comparan las normativas vigentes sobre prácticas sanitarias de conservación cadavérica requeridas para el traslado de cadáveres, en las diferentes Comunidades autónomas y la legislación estatal. Los criterios tenidos en cuenta han sido: qué prácticas sanitarias se incluyen en la normativa, cuáles pueden llevarse a cabo en cadáveres de riesgo sanitario, cuándo se requiere su realización, en qué momento tras el fallecimiento pueden realizarse y qué profesionales las pueden llevarlas a cabo y/o responsabilizarse de las mismas. En el momento de finalizar el artículo se está tramitando la publicación del nuevo decreto de sanidad mortuoria de Andalucía, así mismo se está elaborando, por parte del Ministerio de Sanidad, Consumo y Bienestar Social, un Real Decreto sobre "Condiciones técnico sanitarias básicas en materia de traslado internacional de cadáveres, restos humanos y restos cadavéricos".

Normativa comparada sobre prácticas sanitarias de conservación cadavérica en España / Comparative normative on sanitary practices of cadaveric preservation in Spain

Se comparan las normativas vigentes sobre prácticas sanitarias de conservación cadavérica requeridas para el traslado de cadáveres, en las diferentes Comunidades autónomas y la legislación estatal. Los criterios tenidos en cuenta han sido: qué prácticas sanitarias se incluyen en la normativa, cuáles pueden llevarse a cabo en cadáveres de riesgo sanitario, cuándo se requiere su realización, en qué momento tras el fallecimiento pueden realizarse y qué profesionales las pueden llevarlas a cabo y/o responsabilizarse de las mismas. En el momento de finalizar el artículo se está tramitando la publicación del nuevo decreto de sanidad mortuoria de Andalucía, así mismo se está elaborando, por parte del Ministerio de Sanidad, Consumo y Bienestar Social, un Real Decreto sobre "Condiciones técnico sanitarias básicas en materia de traslado internacional de cadáveres, restos humanos y restos cadavéricos"

In this paper the current regulations on cadaveric preservation practices required for the transfer of corpses in the different Autonomous Communities -Reglamentos de Policía Sanitaria Mortuoria- and national legislation are compared. The criteria taken into account have been: a) which sanitary practices are included in the regulations, b) which ones can be carried out in corpses posing a health risk, c) when they are compulsory to be carried out, d) when they can be carried out after death, and e) what professionals can carry them out and/or take responsibility for them. At the time of finishing the paper, a new mortuary regulation is being passed in Andalusia, as well as a decree from the Ministry of Health on technical and sanitary requirements concerning international transfer of corpses and human remains

Rito funerario inverso. Terapia y valores / Inverse funeral rite. Therapy and values / Exéquias revertida. Terapia e valores

El rito funerario tiene un claro componente terapéutico para las personas que lo realizan, pero cuando la muerte es anunciada, la persona que va a morir puede realizar lo que he dado en llamar un "rito funerario inverso". En ese rito se produciría una doble acción terapéutica: Primera para sus seres queridos ayudándoles a superar su pérdida y segunda para el propio individuo al poder enfrentarse a su propia muerte. Cuál puede ser el posible origen de este rito y la influencia de la cultura y los valores personales y comunitarios en él

The funeral rite has a clear therapeutic component for the people who perform it, but when death is announced, the person who is going to die can perform what I have called a "reverse funeral rite." In this rite would produce a double therapeutic action: First for their loved ones helping them to overcome their loss and second for the individual himself to be able to face his own death. What may be the possible origin of this rite and the influence of culture and personal and community values on it

O rito funeral tem um componente terapêutico claro para as pessoas que fazem isso, mas quando a morte é anunciada, a pessoa que vai morrer pode fazer o que tenho chamado de "reverse rito funeral." Neste rito iria ocorrer uma acção terapêutica dupla: em primeiro lugar para os seus entes queridos ajudá-los a superar sua perda e segunda para o indivíduo a ser capaz de enfrentar sua própria morte em si. O que pode ser a possível origem deste rito ea influência da cultura e dos valores pessoais e comunitários na mesma

Comparación de los efectos tafonómicos observados en dos estructuras funerarias de espacio vacío / The taphonomic effects comparison in two empty space burial structures

Introducción. La tafonomía ayuda a entender las cuestiones relacionadas con las modificaciones post mortem de los restos cadavéricos en los campos de la paleontología, la arqueología y la antropología forense. Por ello, el objetivo principal del proyecto experimental Taphos-m es generar un corpus en tafonomía que permita comprender qué agentes y procesos tafonómicos son los responsables de los efectos observados en diferentes contextos. Material y métodos. Pasados 3 años y medio desde su inhumación, se ha valorado el estado cadavérico de 2 cuerpos de Sus scrofa domestica enterrados en 2 estructuras vacías de características constructivas distintas, así como la distribución espacial que presentaban los elementos anatómicos. En caso de esqueletización, también se describe el estado de la superficie cortical de los huesos y la eventual fragmentación ósea. También se han llevado a cabo analíticas complementarias, como análisis histológico y patológico. Resultados. Los restos del animal enterrado en la tumba de piedra se encontraron en estado desecado, mientras que los restos inhumados en la tumba de tejas planas estaban prácticamente esqueletizados. Se observaron diferencias en el análisis de los efectos tafonómicos, sobre todo en relación con la distribución espacial de los elementos anatómicos, vinculados con la presencia de sedimento y el estado cadavérico. La lesión que presentaba uno de los animales en la extremidad trasera podría influir en el mantenimiento de la articulación anatómica. Conclusiones. Los datos meteorológicos del momento de la inhumación y las características de la tumba son variables que determinan la evolución y el estado cadavérico de los restos, pero no son las únicas, ya que las lesiones pueden suponer diferencias en la distribución espacial de los restos óseos y articulaciones anatómicas (AU)

Introduction. Taphonomy helps to understand the issues related to changes of the cadaveric remains in the frame of palaeontology and archaeology as well as in the frame of forensic anthropology. The first objective of the experimental project Taphos-m was to generate a corpus of information on taphonomy to know what taphonomic agents and process could be responsible for the observable effects in field. Materials and methods. The cadaveric state of Sus scrofa domestica remains and the spatial distribution of the anatomical elements has been described. In the case of skeletonization, the state of the cortical surface and fragmentation of the bones was evaluated too. Also the pathological and histological analysis has been observed. Results. The animal remains buried in the stone tomb were in dried state, while the remains buried in the tile tomb were skeletonized. There were differences in the observable taphonomic effects, particularly in the spatial distribution of the anatomical elements. The lesion in the leg of one animal could be responsible of the maintenance of anatomic articulation. Conclusions. Meteorological data during inhumation and the tomb characteristics are variables that determine the evolution and condition of the remains, but they are not the only ones: the pathological lesions may involve differences in the spatial distribution of the bones and anatomical articulations (AU)

Identification of the earliest collagen- and plant-based coatings from Neolithic artefacts (Nahal Hemar cave, Israel).

Mortuary practices in human evolution record cognitive, social changes and technological innovations. The Neolithic Revolution in the Levant was a watershed in this domain that has long fascinated the archaeological community. Plaster modelled skulls are well known at Jericho and several other Neolithic sites, and in Nahal Hemar cave (Israel, ca. 8200 -7300 cal. BC) excavations yielded six unique human skulls covered with a black organic coating applied in a net pattern evoking a headdress. This small cave was used as storage for paraphernalia in the semi-arid area of the Judean desert and the dry conditions preserved other artefacts such as baskets coated with a similar dark substance. While previous analysis had revealed the presence of amino acids consistent with a collagen signature, in the present report, specific biomarkers were characterised using combined proteomic and lipid approaches. Basket samples yielded collagen and blood proteins of bovine origin (Bos genus) and a large sequence coverage of a plant protein charybdin (Charybdis genus). The skull residue samples were dominated by benzoate and cinnamate derivatives and triterpenes consistent with a styrax-type resin (Styrax officinalis), thus providing the earliest known evidence of an odoriferous plant resin used in combination with an animal product.

Stress and resilience in military mortuary workers: care of the dead from battlefield to home.

The death of a military service member in war provokes feelings of distress and pride in mortuary workers who process the remains. To further understand their reactions, the authors interviewed 34 military and civilian personnel to learn more about their work stresses and rewards. They review stresses of anticipation, exposure, and experience in handling the dead and explore the personal, supervisory, and leadership strategies to reduce negative effects and promote personal growth. These results can be applied to many other situations requiring planning, implementing, and supervising mortuary operations involving mass death.

Collective secondary cremation in a pit grave: a unique funerary context in Portuguese Chalcolithic burial practices.

Perdigões is a large site with a set of ditched enclosures located at Reguengos de Monsaraz, Alentejo, South Portugal. Recently at the central area of this site burnt human remains were found in a pit (#16). This structure had inside human remains, animal bones (namely pig, sheep or goat, cattle, dog, deer and rabbit), shards, ivory idols and arrowheads. All have been subjected to fire and later deposited in that pit, resulting in a secondary disposal of human bones. The recovered fragmented human bones (4845.18 g) correspond to a minimal number of 9 individuals: 6 adults and 3 sub-adults. The aim of this work is to document and interpret this funerary context based on the study of the recovered human remains. For that purpose, observations of all alterations due to fire, such as colour change and type of bone distortion, as well as anthropological data were collected. The data obtained suggest that these human remains were probably intentionally cremated, carefully collected and finally deposited in this pit. The cremation was conducted on probably complete corpses, some of them still fairly fresh and fleshed, as some bones presented thumbnail fractures. The collective cremation of the pit 16 represents an unprecedented funerary context for Portuguese, and Iberian Peninsula, Chalcolithic burial practices. Moreover, it is an example of the increasing diversity of mortuary practices of Chalcolithic human populations described in present Portuguese territory, as well as, in the Iberian Peninsula.

Deaths within 12 months after (125)I implantation for brachytherapy of prostate cancer: an investigation of radiation safety issues in Japan (2003-2010).

PURPOSE: The International Commission on Radiological Protection recommends removing the prostate before cremation if death occurs within 12 months after (125)I brachytherapy. However, the incidence of death within this time frame has not been robustly investigated in any country. The purpose this study was to investigate the incidence and cause of death and actions taken when death has occurred within 12 months after (125)I brachytherapy for prostate cancer in Japan. METHODS AND MATERIALS: Data were extracted from the Japan Radioisotope Association database to investigate the total number of implantation cases, number of early deaths after implantation, cause of death, and postmortem actions between September 2003 and the end of June 2010 in Japan. Early death was defined as occurring within 12 months after (125)I brachytherapy for prostate cancer. RESULTS: During the study period, 15,427 patients underwent (125)I brachytherapy and 43 (0.28%) died within 12 months after implantation. For 37 of the 43 patients (86%), the brachytherapy source was retrieved together with the prostate gland at autopsy; however, autopsy could not be performed in six (14%) of the deceased patients. The largest proportion of early deaths was because of cerebrovascular or cardiovascular disease (17/43, 40%), followed by malignant tumor (15/43, 35%), and respiratory disease or infection (7/43, 16%). CONCLUSIONS: The incidence of early deaths within 12 months after (125)I brachytherapy in Japan was 0.28%. In almost all cases, the brachytherapy sources were removed in the intact prostate before the body was cremated and stored appropriately.

[Care in the mortuary: a duty of humanity]. / Le soin en chambre mortuaire, un devoir d'humanité.

Caring for the dead and their loved ones is something human beings have always done. It acknowledges the deceased person's place as an individual within a social group. It begins with preparation of the corpse--the first stage of a religious or cultural rite. These rites are essential to separate the dead from the living and to allow the latter to mourn.

Technologies of the HIV/AIDS corpse.

In the early 1980s, unprecedented numbers of gay men and intravenous drug users began dying of what would later become known as HIV/AIDS. What the HIV/AIDS corpse posed was a direct challenge to the institutional controls developed by funeral directors to normalize and transform the dead body. How the funeral service industry reacted and changed in response to the emergence of the HIV/AIDS corpse offers an opportunity to re-examine the productive potential of the dead human body. My article examines the epidemic's production of what I call the HIV/AIDS corpse, and the institutional affects those corpses had on the US funeral service industry. The theoretical concept I use to analyze the productive qualities of the HIV/AIDS corpse is the technologies of the corpse. These technologies are the machines, laws, and institutions that control the corpse by classifying, organizing, and physically transforming it. What emerges from the institutional challenges posed by the HIV/AIDS corpse is a specific kind of dead body that offers political possibilities for both the concept of a queer body and the broader subject of human death.

Simple hand-held metal detectors are an effective means of detecting cardiac pacemakers in the deceased prior to cremation.

The hazard of undetected cardiac pacemakers exploding in crematoria is well described. This short report describes the use of an affordable hand-held metal detector to detect cardiac pacemakers. Over the course of a year, the metal detector located 100% of cardiac pacemakers in a district general hospital mortuary. A simple model using pigskin and fat is also used to demonstrate the effectiveness in vitro. Commercially purchased hand-held metal detectors should be used in all mortuaries responsible for detection and removal of cardiac pacemakers prior to cremation.

"No one has ever asked for it back!" A survey assessing the fate of reusable external fixation equipment in mortuaries.

Technicians from one hundred and eighteen Human Tissue Authority (HTA) approved mortuaries licensed to perform post-mortems in England completed a telephone interview. All were questioned on whether they had contact with reusable external fixators, who was responsible for the removal, the number removed annually, and the destination of the fixator post-removal. Opinion was sought on how the return of the equipment could be better facilitated. Seventy-four of the technicians interviewed could remember seeing external fixation devices, but were unable to quantify how many were removed annually. Sixty-one of those questioned stated that they personally removed the fixator, three always requested an Orthopaedic surgeon to remove the device and five contacted a Nurse Specialist. Forty-eight stated that they returned the devices to their local Sterile Services Department or Orthopaedic department. Nine technicians always discarded the fixators, eight always left them with the body and two stored them in the mortuary. Many reusable external fixation devices are inappropriately disposed of each year due to a lack of knowledge and communication with Orthopaedic departments. Confusion also exists among some technicians over whether external fixation components should be treated as 'implants'. There is a need for clear guidelines to raise awareness and ensure the appropriate return of these high cost devices.

Information on practical procedures following death.

This article outlines the procedures following a death and examines funeral arrangements, including the different types of burial and the cremation process.