MORTUARY SERVICES.pptx

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1. Mortuary Services Rashmi Sreenivasamurthy 21/10/2022 1

2. Introduction It is the responsibility of every hospital to dispose of the dead body in a proper way. Necessary to have a clear guideline regarding the preservation and disposal of the dead body taking into consideration the medico-legal aspects in various situations and circumstances. 21/10/2022 2

3. KEY WORDS MORGUE : The Hospital Morgue Unit is a facility for the viewing and/or identification of a body and the temporary holding / storage of bodies prior to transfer to a Mortuary. MORTUARY : A building where the bodies of deceased persons are held for identification, postmortem examination , and preparation for burial or cremation. 21/10/2022 3

4. KEY WORDS- Contd. Post-mortem examination or autopsy : An examination of a corpse in order to determine cause of death or changes produced by a disease. 21/10/2022 4

5. Purpose/ functions To keep the bodies of the patients dying in the hospital , until the relatives claim them and arrange for their disposal. To keep the unclaimed dead bodies until their disposal is arranged by the hospital authorities. This is done by arranging either for their burial or cremation. To allow viewing and identification by relatives, police and other people. To receive dead bodies requiring pathological post-mortems pending final disposal. To receive dead bodies brought to the hospital for medico-legal post-mortem work and store in the mortuary pending further disposal. For teaching the undergraduates as well as post-graduates. 21/10/2022 5

6. The types of dead body preserved in the mortuary can be classified as from within the hospital/outside and : 1.  Non medico-legal Identified Unknown 2.  Medico-legal Identified Unknown 21/10/2022 6

7. LEVELS OF MORTUARY FACILITY Level 1 Facility (L1): A mortuary without an autopsy suite. Examinations performed in this facility will be limited to external examination, and/or other investigations such as post mortem imaging and percutaneous needle sampling. Level 2 Facility (L2): A mortuary with an autopsy suite without the infrastructure or personnel expertise to perform high risk or specialised autopsies. Level 2 facilities will potentially refer some autopsies to a Level 3 facility. Level 3 Facility (L3): A mortuary with an autopsy suite and with the infrastructure and personnel expertise to perform high risk or specialised autopsies. 21/10/2022 7

8. PLANNING CONSIDERATIONS LOCATION: Separate building near pathology laboratory. Preferably in a place where a dead body can be moved quietly and discreetly, in order that other patients are not upset. It must have a separate entrance and exit, screened from the view of patients and others in the hospital. 21/10/2022 8

9. PLANNING CONSIDERATIONS Size : The actual extent of the mortuary provision will vary according to climate and local custom. Acc. to Mc Gibony , for a hospital with: No. of beds No. of body storage units recommended No. of post mortem rooms recommended 50-100 2 200 3 1 500-600 Need based 2 21/10/2022 9

10. LAYOUT & AREAS Covered access/ portico Relatives waiting area -20 m ² Body store PM examination area Specimen handling area Changing rooms Administrative area 21/10/2022 10

11. Physical facilities Floors: hard, durable, impervious and washable Walls: hard, durable, impervious, washable and with a scope for future expansion. Ceilings: 10 ft min. Doors: sliding/double doors; wide Windows: natural lighting, opaque glass. Corridors: 8 ft wide 21/10/2022 11

12. Physical facilities Lighting : Ventilation : 10 air changes per hour. Hot & cold water supply : elbow operated taps. Communication : internal & external telephone lines. Room Avg. Lumen/ Sq. Ft. Post mortem room 25 Post mortem tables 150 Pathology room 15 Cold storage 10 21/10/2022 12

13. Other considerations Separate arrangements for keeping decomposed and infectious bodies (known HIV/hepatitis death cases) etc. Handing over the dead bodies after post-mortem examination to the relatives/ undertakers through police. Post-mortem viewing gallery for the students /IO /nominees as per court orders etc. 21/10/2022 13

14. Equipment Cold chamber: 2 ⁰C - 5⁰C Post mortem table: stainless steel Sterilizer X ray machine Thin layer chromatography kit Gas liquid chromatography Spectrophotometer Weighing machine SS bone and meat cutting saw. 21/10/2022 14

15. Staffing Round the clock services Depends on size of hospital & complexity of operations. For initial 150 autopsies per year i )  Forensic experts-Two ii)  Post mortem technician- Two. iii)  Record assistant-One. iv) Chowkidar - One. v)  Morgue attendants-5 vi) Three sweepers for shift duty round the clock and one as a reliever. For every additional 100 autopsies per year i )  Specialist- One. ii)  Post mortem assistant - One. iii)  Technician- One (for teaching institutions). iv)  Technical assistant- (300-500 autopsies/ yr )-One,(>500 autopsies/ yr )-Two. v)  Photographer - One. 21/10/2022 15

16. Documentation in mortuary All morticians should keep a mortuary register. Details: Give a number to each body. Name, sex, age of the deceased person. Date and time of death Identification marks of the deceased and finger impressions may also be noted. Details of near relatives e.g. Name, relationship, address and phone number should be noted. Whether or not an autopsy was carried out. If autopsy done, then date and time of autopsy and name of the autopsy surgeon. Date and time when the body is placed in the cold storage. Length of the body and breadth across the shoulder (helps in making coffin of correct size). A list of valuables, which have not been removed from the body such as rings, bangles and others. Signature of the mortuary technician who allows body to be taken away. Date and time when the body is removed. Name of the relatives or police collecting the body. 21/10/2022 16

17. Protective Gear for staff 21/10/2022 17

18. POLICIES & PROCEDURES Protocols for inquest: inquest form duly sealed forwarded by investigating officer with the dead body under police escort to authorised MO. Time of post mortem: MLC/ Non-MLC 21/10/2022 18

19. POLICIES & PROCEDURES MLC: 3 copies, label on the body for identification. The death certificate and the label should be marked "M.L.C." in bold letters for medico-legal cases. The label should have the following information on it: Patient's name, address, the age and sex, hospital registration number, date and time of death and when the body was placed in the mortuary cold storage. The body should also have identity wrist bands, which serves as a ready means of identification. Non-MLC: cold storage on request, consent from kith & kin for PM. Identification of bodies: Wrist band Documentation Hand and foot prints of neonates 21/10/2022 19

20. The Following Category of Cases Should be Made as M.L.C. All injury cases, circumstances of which suggests commission of offence by someone. All burn injuries due to any cause. All vehicular, railway, aeroplane , ship, boat, factory, construction site or other unnatural accidents where there is likelihood of death or grievous hurt. Suspected or evident homicide, suicide including attempted. Suspected or evident poisoning. Suspected or evident sexual assaults. Suspected or evident criminal abortion. Unconscious cases where the cause is not natural or not clear. Cases brought dead with improper history creating suspicion of an offence. Cases referred by Courts or otherwise for age estimation. Dead on arrival cases, or patients who die shortly after being brought to the Casualty and before a definite diagnosis could be made. Any other case not falling under the above mentioned category but has legal implications. Patients dying suddenly after parenteral administration of a drug or medication. Patient falling down or any mishap in the Hospital, sustaining injury in the Hospital. Death on Operation table. Unexplained death after surgery or Interventional procedure. Unexplained ICU death. Patient treated and then referred from a private hospital or other Government hospital with complications of surgery or delivery or bleeding, where the cause of death is unexplained. Relatives of the patient assault the treating doctor or other staff of the hospital. Relatives of the patient create a law and order problem in the hospital 21/10/2022 20

21. POLICIES & PROCEDURES Protocols for unclaimed bodies: 72 hrs PM Unidentified MLCs Clothing & belonging Anatomy Act : 1949 Unclaimed bodies in hospital & death due to natural cause - The hospital authority is lawfully in charge of the body. It should contact at address that is available. If the body is unclaimed after 72 hours, it is legally authorized to dispose of the body bearing its expenditure. As per human transplant act 1994 , the hospital authority is authorized to give permission for removal of any human organ from the unclaimed body after 48 hours. However if the hospital has reason to believe that some near relative might object, the permission to remove the organ must not be given. The unclaimed M.L.C. bodies in hospital should be handed over to the police who shall dispose of the body after postmortem. 21/10/2022 21

22. PM Report Contents of Post-Mortem Report: Name of the deceased, Identification, Place, date and time of post-mortem, External Examination, Internal Examination, Viscera and Samples collected for analysis, Opinion as to cause and manner of death. 21/10/2022 22

23. EMBALMING Embalming is necessary to prevent putrefaction in case the relative wants to keep the body for longer time. In case of anatomical embalming it helps in the preservation and sterilization of the body besides making it suitable for dissection. It is not necessary to keep the embalmed body in the cold storage. 21/10/2022 23