Moving The Deceased: Hospital Protocol For Body Transportation

The movement of dead bodies in hospitals is a delicate and discreet process, as witnessing a lifeless body being wheeled down the hallway can be unsettling for other patients. Hospitals aim to minimise the visibility of this transition from life to death, which can be challenging due to the rare occurrence of post-mortem body movements caused by residual gases and nerve impulses. When it comes to the practicalities of moving a deceased person, hospitals follow specific procedures, such as using body bags, gurneys, and established routes to ensure safe and respectful transportation to the morgue or out of the hospital.

Moving bodies discreetly

When a patient passes away in a hospital, staff must move the body without causing alarm to other patients. This can be challenging, as residual gases escaping the body can cause it to make moaning or breathing sounds, and leftover nerve impulses can cause the limbs to twitch or move.

In the case of patients with viral hemorrhagic fevers (VHF), hospitals must follow specific procedures for handling human remains. These procedures include establishing contaminated, decontamination, and clean areas. Only workers wearing proper personal protective equipment (PPE) are allowed in the contaminated area, and they must perform final decontamination in the decontamination area before passing the remains to the clean area. The body is then placed in a leakproof body bag, which is sealed to contain all contents and prevent fluid leakage. The bagged body is then transported to the morgue or out of the hospital via a pre-identified route that minimises patient and personnel traffic.

For non-VHF cases, hospitals typically use a hospital gurney with cremation-compatible body bags. The body is first placed in a vinyl or chlorine-free bag, which is heat-sealed to prevent fluid leakage. It is then placed in a second, middle-layer bag, specifically designed for the transport of infectious human remains. Finally, the body is placed in a third bag made of laminated vinyl or other chlorine-free material, with handles for easy transport.

While these procedures ensure the safe and sanitary handling of human remains, they also serve to maintain discretion and minimise disturbance to other patients. The trip from the patient's room to the elevator is typically very quick, and most patients are likely to be preoccupied with their own health concerns. As such, hospitals can usually move deceased patients without causing undue distress to others.

Preparing bodies for cremation

Death and Transportation:

When a person passes away in a hospital, their body is first respectfully washed and cleaned by hospital staff, ensuring the removal of any blood or bodily fluids. If the deceased is a registered organ donor, the relevant organs are carefully extracted. The body is then placed in a body bag or waterproof sheet and transported to the hospital morgue, with discretion, to avoid causing distress to other patients.

Identification and Preparation:

Funeral directors are responsible for collecting the deceased from the hospital morgue or another place of death. They ensure proper identification through tags placed on the person's toe or ankle. The body is then transported to a cool storage space at the crematorium, preserving it until cremation. If the family wishes to view the body, embalming may be performed to improve the appearance of the deceased and slow decomposition. This process involves replacing the blood with fluids, preservatives, and colourants.

Clothing and Belongings:

The family of the deceased may choose to dress their loved one in their favourite outfit, a simple garment, or religious robes. Crematorium staff will dress the deceased before cremation. Jewellery and other valuables are removed, logged, and securely stored. Any mechanical prosthetics or medical devices, such as pacemakers, are also deactivated or removed to prevent hazards during cremation.

Cremation Process:

The body is then respectfully transported to the cremation chamber. The cremation chamber, or retort, is an industrial furnace lined with fire-resistant bricks capable of withstanding extremely high temperatures. The body is placed within the chamber, where heat reduces it to cremated remains, often referred to as "ashes." These remains are then cooled and inspected for any metal remnants, which are removed and recycled or disposed of appropriately. Finally, the ashes are transferred to a temporary container or an urn provided by the family.

Safe handling of bodies with VHF

When it comes to moving deceased patients out of their rooms and into the morgue, hospitals face the challenge of doing so discreetly and without causing alarm to other patients. This task is even more critical when dealing with patients who have died from viral hemorrhagic fevers (VHF), as the viruses that cause VHF can remain in the body post-mortem and be transmitted through various means during the handling process. Here are some detailed instructions for the safe handling of bodies with VHF:

Safe Handling Instructions for Healthcare Workers:

Firstly, ensure that all workers handling the body and any observers wear the recommended personal protective equipment (PPE) as outlined by the CDC's PPE guidance. This is crucial to minimize the risk of exposure to the virus.

Body Bagging Process:

The body should be placed in a multi-layered bagging system. The first bag, or inner layer, should be made of chlorine-free material that is impervious to fluids. This bag should be large enough to envelop the body completely. The second bag, or middle layer, is also chlorine-free and should be heat-sealed around the body to form a leakproof barrier. It should be specifically designed for the containment and transport of infectious human remains. The third bag, or bottom layer, is made of laminated vinyl or other chlorine-free material with a minimum thickness of 18 mil (457 micrometers). It should have reinforced handles that are not sewn on, such as riveted handles with handle straps for secure transport. All seams should be factory heat-sealed or welded to prevent leakage, and the zipper should be on top for easy access.

Waste Management:

Any waste produced during the postmortem preparation and decontamination process should be placed in red biohazard bags following CDC guidelines for handling VHF-associated waste. This includes soiled PPE surfaces, equipment, and patient care area surfaces, which should be decontaminated immediately using an EPA-registered hospital disinfectant effective against non-enveloped viruses.

Burial and Cremation:

The CDC recommends cremation as the preferred method for disposing of the remains of VHF patients. However, in cases where cremation cannot be safely performed, such as with implanted electronic medical devices, burial in a standard metal casket or other comparable method in accordance with local regulations is acceptable.

Collaboration and Training:

Safe handling of VHF patients requires close collaboration with public health officials, funeral directors, and mortuary workers. Healthcare facilities should also provide training and guidance to their staff on the proper procedures for handling human remains of VHF patients, including the use of PPE and infection control measures.

By following these comprehensive safety measures, hospitals can effectively minimize the risk of virus transmission and ensure the safe handling and disposal of bodies with VHF.

Using body bags

Body bags are used to move deceased patients with viral haemorrhagic fevers (VHFs). Hospitals with VHF-related deaths should establish contaminated and clean zones. Only workers wearing PPE that conforms to CDC guidance are allowed in the contaminated area, where the patient was treated. The decontamination area is directly accessible from the contaminated area, where workers perform final decontamination before passing the human remains to the clean area.

In the clean area, workers put on clean PPE under the direction of a trained observer. The body is then placed in a leakproof body bag that is puncture-resistant and sealed to contain all contents and prevent leakage of fluids during handling, transport, or shipping. The bag should be chlorine-free with a minimum thickness of 6 mil (152 micrometers). To prevent any leakage of fluids, all seams should be factory heat-sealed or welded, not sewn, and the zipper should be on top.

The bagged body is then transported to the morgue or out of the hospital. A plan should be in place to transport the body safely, including a pre-identified route through the hospital with minimal patient and personnel traffic. The body is then transported to a pre-identified place of final disposition using a pre-identified route.

If cremation cannot be done because of safety concerns, the body should be buried in a standard metal casket or using another comparable burial method.

Transporting bodies out of the hospital

When a person passes away in a hospital, their body needs to be moved out discreetly and safely, especially if the cause of death was a viral hemorrhagic fever (VHF). Here are the steps involved in transporting a body out of the hospital:

Preparing the Body:

Firstly, the body is placed in a leakproof body bag, which is typically made of vinyl or other chlorine-free material. This bag is sealed to prevent any leakage of fluids during handling and transport. In the case of a VHF patient, the body is prepared in the contaminated area, and then it moves to the decontamination area before reaching the clean area. Workers handling the body in the contaminated area must wear personal protective equipment (PPE) as directed by the CDC.

Transporting Within the Hospital:

The body is then transported within the hospital, preferably using a discreet route with minimal patient and personnel traffic. This ensures privacy and reduces the potential for disturbance among patients. The body is moved directly to the vehicle that will be used for transportation out of the hospital, such as a hearse.

Transporting Out of the Hospital:

Before placing the body in the hearse or other transport vehicle, ensure that any implanted electronic medical devices are removed or deactivated. Additionally, affix the necessary infectious substance labels to the body bag. The vehicle used for transportation should follow a pre-identified route to the place of final disposition, such as a crematorium or burial site.

Notification and Documentation:

It is important to notify the mortuary or relevant authorities about the transportation of the body. This includes providing information about any medical devices and the final destination of the body. Proper documentation and adherence to procedures are crucial to ensure the respectful and safe handling of the deceased.

While witnessing a body being transported in a hospital can be unsettling, these procedures are in place to handle such situations with discretion and respect for the deceased individual and their family.

Frequently asked questions