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Appendices | Management of Contaminated Remains

Management of Contaminated Remains

1. GENERAL
Contaminated remains require special handling.  This page provides an outline of actions that must be addressed in managing the deceased.

2. PRONOUNCEMENT OF DEATH.
The authority, such as the local coroner, the RTF physician, etc., for pronouncing death needs to be identified.  A procedure to bring the authority into the contaminated area or to extract the remains to a hot line for pronouncement must be accomplished as soon as practical.  If a non-CNWDI cleared authority is used within the NDA, the authority will need to be debriefed by security officials.

3. ACTIONS FOR REMAINS WITHIN THE NDA.

a. Mark and Cover.  EOD personnel should mark a safe path to the remains and cover the remains as soon as practical. 

b. Extraction.  A plan to extract the remains should be developed and implemented.  ASHG shall approve the plan.  RAMT, MRAT, the death pronouncement authority and the RTF Mortuary Affairs Officer are all appropriate parties for advice and coordination.

c. Decontamination and Transport.  A plan to decontaminate the remains (if necessary), package the remains and store or ship the remains should be developed and implemented.  Decontamination with soap and water, if necessary, is likely adequate.  For alpha contamination, containment of contamination can be accomplished with a body bag, whereby, decontamination might not be necessary.  Decontamination on site may be driven by requirements at the receiving facility.  The RTF Mortuary Affairs Officer is the key official for this coordination effort.  A sample BROKEN ARROW Human Remains Special Instructions Form is attached as Figure 1 at the end of the appendix.  Refrigerated vans will likely be needed for storage and transport.

d. Goals for Disposition of Remains.  Human remains should be managed with respect, dignity and timeliness.  In many environments (e.g., hot and humid), removal of remains before decomposition should be a HIGH PRIORITY.  Attempting decontamination after the body begins to decompose will be futile. 

4. EVIDENCE PRESERVATION.
For some accidents, the National Transportation Safety Board (NTSB) may have evidence preservation and documentation requirements.  Likewise for potential terrorist events, the FBI may have special evidence preservation requirements.  If this is the case, early coordination in planning or submittal of waivers should be pursued.  The RTF operations and security staff should expedite and resolve any such issues.

5. TECHNICAL RESOURCES.
The Armed Forces Medical Examiner, the Armed Forces Institute of Pathology and the Army’s 262nd Quartermaster Batallion (with WMD DECON Mortuary Affairs Unit, Fort Lee, VA) are all potential consultants for managing contaminated remains.


Figure 1. SAMPLE BROKEN ARROW HUMAN REMAINS TRANSPORT, AUTOPSY AND MORTUARY AFFAIRS SPECIAL INSTRUCTIONS FORM


Special Instructions for the Remains of ____________________________.
(Name, last 4)

These instructions are to accompany the remains and are intended for autopsy and/or mortuary service staff processing and preparing the body for burial.  The remains of _______________________ are slightly contaminated with radioactive material that emits alpha particles and low energy gamma rays. When following these special instructions, the levels of radiation associated with preparing the remains for burial are safe and will not result in a dose to staff members in excess of 5 mrem (1/1000th of the allowed occupational dose limit). Use normal pathogenic protective clothing (e.g., universal precautions) when handling the remains. Additionally, double glove and wear a surgical mask. Use care to remove the deceased clothing so that any dust is not agitated and resuspended into the air. Place the clothing in a plastic bag and seal it. Then double bag the clothing. During embalming and other processing of the remains, be sure to collect all liquid wastes and any solid wastes in autoclave containers and run them through the autoclave process. Likewise, do the same for all runoff associated with washing autopsy tools or related equipment. Mark all bags and containers with a contamination sticker or tag and save them for retrieval by the US Army Rock Island radioactive waste disposal staff/contractors.  Take care not to cross contaminate items or surfaces in the laboratory. For example, do not make entries on a computer keyboard without first removing the outer layer of gloves.  Double bag the body bags used for transporting the remains to the mortuary facility and mark with a contamination sticker or tag. Likewise, do the same for any gowns, gloves, or other protective clothing used while executing these special instructions. Ensure that no single staff member is in close proximity of the body or collected waste containers for more than a total of 10 hours. Within one meter would be indicative close proximity.  Incineration of the remains is not recommended. If incineration is desired, approval from the state health department may be necessary.  While the remains are in DoD custody, radiological specialists from the US Army Radiological Advisory Team at Walter Reed Army Medical Center are available for on site assistance in implementing these instructions. As well, radiological specialists from the Armed Forces Radiobiology Research Institute are also available for assistance. These special instructions were prepared by COL John Mercier, Ph.D., PE, DABR, Senior Health Physicist, Armed Forces Radiobiology Research Institute, ph. 301-295-1210.


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