The winter season extends from December through February and will be here before you know it bringing the potential hazards associated with winter with them. According to the National Oceanic and Atmospheric Administration (NOAA), snow forecasts are generally not predictable more than a week in advance. So, it is not too early to prepare your business for winter weather events – even if you currently see blue skies and not a snowflake in sight.

“BUT WAIT!” you may think, “Aren’t I on the CANA blog? Why are they talking about the weather?” My response is – to keep your employees safe and your business protected from the cost of safety violations. Because that is what we do at Regulatory Support Services for CANA Members and the funeral profession. We want to remind you to be prepared for the effects of winter, particularly as NOAA predicts some areas of the hemisphere to feel colder and snowier than last year. Read on.

Although the Occupational Safety and Health Administration (OSHA) does not have specific standards which cover working in cold temperatures, employers have a responsibility to provide employees with a working environment which is free from recognized hazards, including winter weather related hazards, which are likely to cause death or serious physical harm to them (Section 5(a)(1) of the Occupational Safety and Health Act of 1970). Here are 8 ways you can prepare your employees for the winter weather ahead:

Cold stress refers to environmental conditions (e.g., air temperature/humidity, windchill temperature, rain, and inadequate clothing for protection) in which body heat is lost to the environment at a rate that is faster than the body can produce heat. When the body is unable to warm itself, serious cold-related illnesses and injuries may occur, and permanent tissue damage or even death may result. Examples of cold stress include trench foot, frostbite, and hypothermia.

Cold stress and its effects can vary across different areas of the country. In regions that are not used to winter weather, near freezing temperatures are considered factors for “cold stress.” Increased wind speed also causes heat to leave the body more rapidly (wind chill effect). Wetness or dampness, even from body sweat, also facilitates heat loss from the body. OSHA provides a guide – Cold Stress Safety and Health Guide – which expands upon these topics and can assist in the recognition of cold stress and actions that can be taken to address it.

Use the resources made available to you to train your employees to respond effectively to the onset of cold stress including topics outlined below:

• How to recognize the symptoms of cold stress, prevent cold stress injuries and illnesses
• The importance of self-monitoring and monitoring coworkers for symptoms
• First aid and how to call for additional medical assistance in an emergency
• How to select proper clothing for cold, wet, and windy conditions
• How to navigate winter weather related hazards such as slippery roads and surfaces, windy conditions, and downed power lines
  

Safe work practices which can be implemented by employers to protect employees from injuries, illnesses and fatalities include:

• Providing employees with the proper tools and equipment to do their jobs
• Developing work plans that identify potential hazards and the safety measures that will be used to protect employees
• Scheduling maintenance and repair jobs for warmer months
• Scheduling jobs that expose employees to the cold weather in the warmer part of the day
• Avoiding exposure to extremely cold temperatures when possible
• Limiting the amount of time spent outdoors on extremely cold days
• Using relief employees to assign extra employees for long, demanding jobs
• Providing warm areas for use during break periods
• Providing warm liquids to employees
• Monitoring employees who are at risk of cold stress
• Monitoring the weather conditions during a winter storm, having a reliable means of communicating with employees and being able to stop work or evacuate when necessary
• Having a means of communicating with employees, especially in remote areas
• Knowing how the community warns the public about severe weather: outdoor sirens, radio, and television
• The National Oceanic and Atmospheric Administration (NOAA) provides multiple ways to stay informed about winter storms. If you are notified of a winter storm watch, advisory or warning, follow instructions from your local authorities: NOAA Weather Radio
  

Dressing properly is extremely important to preventing cold stress. An employee should wear:

• At least three layers of loose-fitting clothing
• An inner layer of wool, silk or synthetic (polypropylene) to keep moisture away from the body
• A middle layer of wool or synthetic to provide insulation even when wet
• An outer wind and rain protection layer that allows some ventilation to prevent overheating
• A Knit mask to cover face and mouth as is appropriate for the situation
• A Hat that will cover both ears and will help reduce the loss of body heat
• Insulated gloves to protect the hands
• Insulated and waterproof boots to protect the feet
  

Employers must provide personal protective equipment (PPE), for example, fall protection, when required by OSHA standards to protect employees’ safety, and health. However, in limited cases specified in the standard, there are exceptions to the requirement for employers to provide PPE to employees. For instance, there is no OSHA requirement for employers to provide employees with ordinary clothing, skin creams, or other items, used solely for protection from weather, such as winter coats, jackets, gloves, parkas, rubber boots, hats, raincoats, ordinary sunglasses, and sunscreen. However, depending on the employee’s assigned responsibilities, many employers provide their employees with winter weather gear such as winter coats/jackets and gloves.

Learn more about PPE requirements and how to design an effective PPE program: Personal Protective Equipment.

This may seem obvious, but it must be mentioned. To prevent slips, trips, and falls, employers should clear walking surfaces of snow and ice, and spread deicer, as quickly as possible after a winter storm. In addition, the following precautions will help reduce the likelihood of injuries:

• Wear proper footwear when walking on snow or ice is unavoidable because it is especially treacherous
• Wear a pair of insulated and water-resistant boots with good rubber treads should be worn for walking during or after a winter storm
• Take short steps and walk at a slower pace to optimize reaction time when it is necessary to quickly respond to a change in traction while walking on an icy or snow-covered walkway
  

OSHA has prepared a guide to safe snow removal. You can find it here: Snow Removal: Know the Hazards (osha.gov)

Regulatory Support Services encourages you, at this time, to review your winter weather plans, assure your employees are properly trained, and determine whether the supplies and equipment needed to protect against winter hazards are available to you and your employees. Contact us if you need assistance in reviewing your winter hazards plan or would like additional information to assist you in enhancing your plan for protection. Stay warm. Stay safe.

Suppose you run a small business that handles personal health information (PHI), personally identifiable information (PII), or payment card information (PCI). In that case, you need to be aware of the cybersecurity risks that you face. Cybercriminals are constantly looking for ways to steal, compromise, or destroy your data, and they often target small businesses that have fewer resources and security measures than larger organizations.

The cost of a data breach for a small to midsize business (SMB) can be substantial. On average, a data breach costs an SMB around $217,000 per incident per the Garter® Top Trends in Cybersecurity for 2024. This figure includes immediate financial impacts such as legal fees, fines, and remediation costs.

However, the hidden costs can be even more significant. For example, the average cost of lost business due to a data breach is $1.52 million. This loss stems from eroded customer trust and the potential exodus of clients, which can be catastrophic for businesses that rely on a loyal customer base.

Additionally, operational disruptions, productivity losses, and data restoration costs add to the financial burden. For instance, downtime can cost SMBs an average of $8,000 per hour.

Given these high stakes, investing in comprehensive cybersecurity measures is crucial for protecting against the costs and disruptions of a cyberattack.

Some of the most common cyber threats that small businesses face are:

To reduce the cybersecurity risk for your small business, you should follow these best practices:

During the multiple heat-related illness cases relating to the United States Postal Service (USPS), the Occupational Safety and Health Administration (OSHA) was able to establish extreme heat being a major workplace hazard. However, the agency neglected to provide effective abatement techniques in the case.

Due to this, the Occupational Safety and Health Administration Review Commission (OSHRC) supported the decision made by the administrative law judge to vacate citations in all but one case.

These citations were related to seven employees working during the summer of 2016 in five cities. Every letter carrier experienced illness when they were out delivering mail in the extreme heat and had to get medical treatment. OSHA claimed that six of these workers became ill due to excessive heat. Five citations were filed against USPS for these alleged violations.

The Administrative Law Judge (ALJ) vacated the five citations after finding that OSHA neglected to prove the workplace conditions were hazardous and that effective and feasible measures were accessible to abate the conditions.

In four cases, the OSHRC agreed the agency established that the extreme heat conditions posed a hazard for the workers under the general duty clause but found the abatement suggestions OSHA made for the hazardous conditions for these cases fell short.

For the fifth one, the OSHRC found that USPS indeed neglected to offer proper heat-related illness training to the supervisors. Therefore, this case was remanded for additional review.

According to OSHA, the USPS was in violation of the general duty clause as it failed to implement a proper program to manage exposure to extreme heat. Thus, OSHA suggested the following measures:

• Rest and work cycles
• Employee monitoring and emergency response plans
• Monitoring USPS data on heat-related illnesses among employees
• Decreasing the outdoor time of employees
• Equipping delivery vehicles with air-conditioning
• Acclimatization
• Providing heat-related illnesses training

However, the USPS proved that it was already following most of these measures or was already in the process of implementing them.

This recent incident highlights the significance of a detailed heat illness prevention plan. Employers must not only have a written plan implemented but also provide sufficient training to their workers. Based on guidance provided by OSHA, supervisors must be trained to:

• Identify heat hazards and control them
• Spot early signs of heat illness or stress
• Provide appropriate first aid
• Quickly initiate emergency medical services

Aside from this, the guidance also recommends employers create a heat illness prevention plan that:

• Those employees returning from a break or new employees are acclimatized and gradually build up to work a full day in the heat
• Temperature and work exertion levels are monitored, classifying levels of physical exertion as heavy, moderate, and low
• Employees are provided easy access to water and have sufficient water to stay hydrated, along with proper breaks to rest
• Shades are installed to ensure employees can rest, or cooling systems or air conditioning is provided if feasible
• The buddy system should be implemented to encourage workers to monitor each other for heat-related illness symptoms
  

Training must be provided to workers to spot stages and signs of heat illness, steps to report them, provide appropriate first aid when needed, and understand how and when to get emergency medical assistance.

Disasters happen, often without warning, and businesses must be prepared to deal with them. A natural or manmade catastrophe could threaten your employees or customers and shut down or interrupt your operations for an indeterminate period of time. While no one wants to think about a catastrophic event impacting their workplace, planning for various disasters is the best way to be prepared to respond if they do happen.

A fire is the most common type of emergency for which employers must prepare. The emergency action plan must detail how employees will be alerted to a fire or other emergency so that they can evacuate or take other actions. In addition to alarms, which should have both a sound and visual element, companies could use an emergency communications system such as a public address system or portable radio unit to provide additional information. Employees must also be trained in how to report emergencies, both to other employees and to fire, medical, and rescue services.

Employees should be educated about the threats and hazards that could occur in your workplace, and they need to be trained in their individual roles and responsibilities in an emergency. Training should be repeated at least annually, and new employees should be brought up to speed in the procedures soon after hire. If there are changes to the workplace that impact your plan – for instance, a redesign of the layout or the introduction of new hazardous materials – the plan should be altered, and employees retrained accordingly.

Most people find it difficult to think clearly and logically in a crisis.  A well-considered plan to guide their actions can go a long way in keeping them safe.

​Regardless of your role in the industry, it is important to understand the current laws and regulations that govern your work. The COVID-19 pandemic has led to the implementation of many new laws and regulations which may impact your business. Put aside the necessary time to review the federal, state, and local laws and regulations which affect your daily operations.
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While right to control final disposition and cremation authorization issues continue to dominate legal complaints against people and businesses in this industry, there have been many new developments in the area of labor and employment, employee safety, and non-discrimination laws which may impact your business. If you have difficulty finding the statutes and regulations governing you and your business, try searching the web sites for your state association or licensing board – they often have links available. Federal OSHA and EEOC web sites, and their state counterparts, also provide significant information and updates.

Employment issues are a prevalent headache across all industries and business models. Address common concerns in your employee handbook, so that everyone is on notice of the standards to which they will be held accountable, including:

• Implement clear, unambiguous policies on work hours, time off, sick leave, and vacation time.
• Be mindful that there have been changes in the law and agency guidance on dress codes and make the necessary changes.
• Have appropriate sexual harassment policies in place.
• Communicate your expectations regarding social media use and restrictions on employee posts on business matters.
• Make sure employees are aware that social media is not for airing workplace grievances or complaints.

Make sure your insurance agent or broker understands your business. Make time for these critical discussions. Do not assume that your insurance agent or broker “just knows” because he or she has worked with you in the past. Too often there are gaps in coverage discovered when you need insurance assistance or defense to a legal claim, when it is too late to put the protections you need in place.

Many gaps in coverage result from your agent or broker not understanding your daily work and operations sufficiently to make sure that what you actually do is covered. Just because you have “professional liability” insurance, you have no guarantee that all of your professional services are covered. Proactive insurance strategies will serve you best.

Take some time to think about the education and assistance which will benefit you and your business most in the upcoming year. Then, search for continuing education opportunities that will assist in meeting your goals. There are in person and online resources available to address almost any concern as an industry professional or business owner. Some jurisdictions even allow you to get your crematory operator certification online.
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While this might be challenging as we all face the realities of a continuing pandemic, it is important to find those educational opportunities that will provide the insight and knowledge you need for success now and in the future.

Getting your new year off to a good start can jumpstart accomplishing your business’s New Year’s resolutions. Best wishes for your success in 2022!
CANA Members: Your association is here to help! If you ever need these resources or anything else offered by CANA, reach out.

Hello, my name is Michael Dixon. I am the president and founder of Funeral Professionals Peer Support. Before I tell you why that date is so important, let’s go back a bit. I was born 57 years ago in Transcona, Manitoba to two amazing, successful parents. I was the youngest – and only – boy in a family of girls.

Growing up I had a lot of things stacked against me: I was born with a serious heart defect and a stutter, and in childhood I was sexually abused. The heart defect was cured and with a lot of work my stutter was overcome, but the scars of abuse stay with you forever. I hid it well. I buried it away by playing football and baseball, and, sadly, with alcohol. Upon graduating from high school and college, I started working in the hotel industry. After almost 10 years of that, I discovered that hotels just were not for me.

Funeral service was always my second choice out of high school, so I decided that I would give it a try. After finishing my 40 hours observation, I felt like I belonged for the first time. I was with people who were like me: kind, compassionate, and caring. I started working for a large funeral home and I was loving it. I was a sponge: I soaked in everything I was being taught, both by new directors and seasoned directors. Some are still my role models to this day.

Four years into my new profession, I began to work for a removal service that this funeral home owned. There I saw firsthand how truly cruel humans can be to each other. In a three-year period, I attended over 38 murders—scenes where people were shot, stabbed, and tortured—and some of them were just children. Car accidents, train accidents, and suicides were too numerous to mention. Some calls you will never forget, even though they happened over 20 years ago. I can still picture the Christmas gifts all over the road that came from a car that flipped over on Christmas Eve. I can remember the song that was playing on the radio at a murder scene, or the smell of blood, gas, or anti-freeze.
I know I am preaching to the choir, but things like this never leave your memory. They make you turn the radio off when you hear “Welcome to the Jungle“ or take another route in order to avoid the site of that accident, suicide, or murder scene that is embedded in your memory. Otherwise you get triggered. Or you stand in the doorway of your kids’ rooms watching them because your memory just won’t let you fall asleep. When you do sleep, it’s not a sound sleep for the recommended eight hours, because death does not just happen from Monday to Friday, 8 a.m. to 5 p.m.

But with all these negative things, I never wanted to leave the profession. I tried to do my job well, hiding my feelings of failure, my low self-esteem and loneliness. I always put on a brave face, using comedy and humour to hide the depression that was slowly taking over my life. I, like most people in funeral service, felt that I had no one to go to. I didn’t want to talk to my wife about what I was feeling. The people I worked with at the time did not offer a safe place to talk about your feelings. There were no organized debrief or talk-down sessions, and the ones we did have were usually at a bar with alcohol, which is not a positive healing environment. In that time, the feeling around our profession was “You knew what you were getting into.”
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So, like everyone else, I went ahead and did my job well. I made good work friends and worked hard, but, due to my depression, I was never myself. I was always putting on an act—which often got me in trouble at work and especially at home. I always felt that I never fit in at either place. I didn’t think of myself as a good person, especially not a good father and husband. I thought many times that everyone’s life would be better if I was not around.

One thing about depression, it’s a slow killer. The year 2015 should have been a great year: I had a beautiful home on a nice piece of land, my three amazing kids were successful and taking on the world; my wife was in a good job and an active, well-respective member of our community; I was in a job that I loved, and for the first time I felt loved and respected.
But things were starting to unravel for me. I had terrible anxiety. I hated to be away from home, and when I was at home, I was usually in my room, cut off from everyone. I was not sleeping well, I was having terrible anxiety attacks where it felt like a heart attack—trouble catching my breath, chest pains, etc. I was using alcohol now as a crutch more than I had done in the past, using it to give me confidence to go out, to make speeches, and to meet people.

A month before Christmas in 2015, I decided I’d had enough. I was tired. I was tired of going on. So, I planned this suicide attempt. I scouted out locations, bought a good insurance policy, even did a practice run. January 7th was the day. That Christmas, we went overboard on gifts and had a lot of parties. January 7th came and I got up at my normal time. I was not sad or upset. I was totally at peace. I kissed my wife goodbye, drove my son to school, and off I went, pulling into the parking lot at a park. I sat there having my last cigarette and thought “Okay, let’s do this.”

I opened the car door but for some reason I could not get out of the car. I could hear this voice in my head saying “It’s okay, I got you, make that call!” and I could feel these hands on my shoulder. I started to cry because I was thinking “Who would walk my daughter down the aisle or be there for my two sons and my wife?”
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In my despair, I made a deal with myself. I was going to call my doctor and, if someone answered the phone, I would go for help. If I must leave a message, I would walk in the forest. The phone rang once and a nurse picked up, and I thought “When does that happen? When do you ever call your doctor and they pick up the phone?” After telling the nurse that I was suicidal, my doctor came on the phone and told me to come to his office right away. After an hour of talking, I went for tests and I was diagnosed with severe depression and PTSD.

From that point on, I decided to not be quiet, but to be very open about my diagnosis. When I told my colleagues what I was dealing with, many of them said “Man, I am going through the same thing. I am tired, frustrated, and burnt out and I am thinking of leaving.” So, instead of staying quiet and only worrying about me, I reached out to a few friends and we decided to come together and organize the very first funeral service peer support group in the world.

Ottawa Funeral Peer Support was born. Our profession finally had a place where people could meet and share their personal struggles and get the support and encouragement to get help. In January of the following year, we started to get press coverage from local newspapers, which other news outlets from across Canada picked up. We then started to get requests to do radio and TV interviews both locally and internationally.

Once that happened, we started to hear from funeral directors across Canada saying “We need this in our communities. We need support.” We realized quickly that our long-term goal had to be our right now goal, and Canadian Funeral Peer Support was born. Within a year, support groups have come up in New Brunswick, Nova Scotia, not to mention Ottawa, Hamilton, and Winnipeg all in Ontario. There is also serious interest in Alberta, British Columbia, Toronto, and Windsor.

Then COVID hit. Our peer support groups met in person so, when everything shut down, we had to come up with a plan to stay connected with our people. It was then decided that each group would host Zoom meetings, which opened us up to funeral professionals from around the world. We started to have people connect with us from throughout the United States as well as England, Italy, Australia, and Kenya. We started to hear from people everywhere that this is something they needed and wanted to be part of.

Our management team got together and we realized we are no longer just a Canadian company. We had to go international. In February of 2021 we started an international support line for licenced and non-licenced funeral staff, along with their families. With a phone call or text, you can speak to a counselor with funeral service experience that will listen and help guide you through any issue you have—for both work or non-work-related issues. We became Funeral Professionals Peer Support (FPPS).

One thing that has made us successful is we have always responded to a need. This year, we brought Peer Support groups into the United States. We are reaching funeral professionals from across the United States and Canada with online support meetings and educational webinars.

FPPS has learned is that there is no “extra money“ from our governments for mental health care. That’s why it is now the responsibility that all businesses make positive mental health care a priority in our workplaces. It is our belief that funeral service can be the leader in the goal of a positive workplace.

Stats tell the story of where we are now:

• In a Work and Well-Being Survey less than half of working Americans reported that their organization supports the well being of its employees.
• In 2014, $186 billion was spent on Health care services to treat mental health issues in the US
• 44.7 million adults 18 or older reported mental illness and burnout in 2016
• 8.8 million adults reported visiting a mental health provider in the past 12 months

Poor mental health and stress can negatively affect employees:

1. Job performance
2. Engagement at work
3. Physical capability and daily functioning
4. Absenteeism

We can’t go on doing the same thing and expecting different results. We have lost too many amazing, talented people in our profession to suicide and burnout. That’s why, as a profession, we can be the leaders. We joined this profession because we care about people. Now it’s time to care for one another.

Peer Support is now being looked at and valued as a positive first step in mental health care around the world. In Canada, federal government departments are now instituting peer support groups for their employees. In Canada and the United States, first responders and the military are starting peer groups as well.

Peer Support helps you meet with people that speak your language, learn from people who have been where you are, and support each other. We provide tools that are applicable to the job, make no judgement, ensure confidentiality and offer the opportunity to give back. Our groups have had speakers talk about burnout, stress, compassion fatigue, yoga, healthy eating and—my favorite—personal support animals. All valuable insight into a healthy work and home life.
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If you are interested in a Peer group in your community or you have any questions please visit us at www.funeralpeersupport.com or call 343-961-2470.


Funeral Professionals Peer Support is committed to the improvement of our brothers and sisters’ mental health. My hope is that no one else in our profession is ever sitting in a park alone in their car playing roulette with their life.

Bereavement professionals such as funeral directors, embalmers, cemetery workers, crematorium operators, and their support staff may regularly engage with diverse, potentially psychologically traumatic events. These exposures can lead to a variety of mental health injuries, including post-traumatic stress disorder, major depressive disorder, panic disorder, and alcohol use disorder. Recent research has provided important information about those experiences, such as the scope of the challenges, the potential impacts on mental health, factors impacting health, and some of the opportunities to help protect mental health and provide support.
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Dr. R. Nicholas Carleton, a professor of psychology at the University of Regina and a registered clinical psychologist in Saskatchewan, introduced his discussion on challenges, strategies, and coping by emphasizing that it was really an introduction to mental health.

“There’s a long-standing notion that we are either mentally healthy or mentally unhealthy and none of the data bears that out,” Dr. Carleton explained. “It’s simply not the case. Most of us, throughout the course of a day—and certainly throughout the courses of weeks or months on end—we shift along a continuum from healthy, to having reactions, to possibly being injured, to being ill or meeting diagnostic criteria for one or more mental health disorders. And this is normal.”
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Odds are that people probably experience changes in their mental health throughout the entire day. Dr. Carleton described a scenario where someone wakes up in the morning and everything is fine and that’s terrific, only to move on and have somebody cut them off in traffic, and for a few minutes, they might be reacting—might even be “injured” for a few moments—but they recover very quickly and then they’re at work and moving on with their day.

Right now, all of us are sharing a massive significant environmental variable that’s impacting our mental health—and that’s COVID-19. The impact of the pandemic is underlying all of the other things that impact us, including our biology. If we’re sick, if we have a flu, if we have a cold, that impacts our mental health. If we’re healthy and we’re exercising regularly, we’re active, that impacts our mental health and our mental health impacts our physical health as well.
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If we’re not feeling very happy about something, if we’re worried, if we’re depressed or down, that has a reflection in our physical capacities. We also see those same kinds of challenges with respect to our social environment. If everything is going well with our friends and our family and we’re regularly engaged, that also serves a protective function so that we’re more likely to feel physically healthy and we’re also more likely to feel psychologically healthy. Our biology, our psychology, and our social environment all come together on an overlapping Venn diagram that sits on top of our environmental stressors.

Dr. Carleton informed listeners that it’s also important to remember that mental health has nothing to do with inherent weakness. “We have no evidence that says that there’s one gene or one feeling or one thought or one behavior or one experience that is solely responsible for our mental health or mental state. And certainly not for having difficulties with mental health,” he said. “When we talk about people who are having difficulties with mental health in most cases it’s a function of high stress or chronic strain or physical exhaustion and maladaptive coping all coming together to challenge an individual’s experience.”

He pointed out that anyone can develop symptoms, saying, “At the end of the day, even the most resilient of us is still human. We still experience all kinds of highs and lows in our lives.”

Moving on to talk about potentially psychologically traumatic events that might apply specifically to some of the work that deathcare professionals perform, Dr. Carleton spoke of experiencing, witnessing, or learning about something potentially injurious to a close relative or a friend that may cause mental health injury. He said that other potential events include repeated exposures to distressing details of significant threats such as exposure to war, threatened or actual physical assault or sexual violence, kidnapping, hostage-taking, torture, and mechanisms of severe physical injuries, like motor vehicle accidents and industrial accidents.

“You’re exposed to these things because if someone dies as the function of one of these events, the last responder is you and so you are exposed to these on a regular basis,” he said. “As a species humans are generally resilient and adaptable. So even these kinds of events, when we’re exposed to them, we can bounce back, we can recover. Most stressors—even repeated exposures to these kinds of events—are not typically overwhelming. But you have to remember that our experience of whether something is overwhelming is influenced by our biology, our psychology, and our social environment, as well as what’s happening behind the scenes in our broader environmental variables.”

Dr. Carleton was talking specifically about events that are potentially psychologically traumatic. He said that the most common thing we think of is post-traumatic stress disorder (PTSD) when we think about a mental health injury. PTSD can be one thing that happens following exposure to one or more potentially psychologically traumatic events where we don’t bounce back, where we aren’t able to be as resilient in that moment because of any number of things that have come together. It’s a mental health injury for which there are effective treatments that can provide symptom relief for a great many people and it’s one of the disorders that can follow exposure to the kinds of traumatic events Dr. Carleton listed. It’s also not the only mental health injury or disorder.

Major depressive disorder is actually more common, even among people exposed to these ongoing potentially psychologically traumatic events. “There are also difficulties with substance abuse and dependence disorder,” Dr. Carleton explained. “You’re taking the substance for longer than you expected. You’re taking the substance in order to avoid or manage symptoms that you’re having or to change your emotional status. The problem isn’t necessarily volume. It can be the amount that someone’s consuming. But more often than not, the challenge can be that one drink might be too many and ten might not necessarily mean there’s a problem. It depends on how you’re using and what you’re using for. And if you’re using as a function of trying to manage other symptoms, that’s a good indicator that you can probably benefit from some additional support. It’s not the only indicator, but it’s certainly one of them.”

Dr. Carleton underscored that only licensed qualified experienced persons can and should diagnose disorders or imply diagnosis. “Dr. Google gets us part of the way there in some cases, but that’s not super reliable,” he said. “If you’re looking for help with mental health or you’re concerned about your mental health, you want to talk to a registered, licensed, evidence-based mental health care provider who can provide you with information about where you’re at and possible solutions to get you to where you’d like to be.”

Dr. Carleton turned to discussing some of the urgent warning signs and symptoms. First, he pointed out that if any symptom lasts longer than a week, at that point it’s a warning sign that your symptoms may benefit from some intervention, particularly difficulties with falling or staying asleep, intrusions, numbing, changes in your behavior, or sudden increases in substance use. Those are also potentially urgent warning signs and symptoms.

Suicidality, homicidality, violence, or sudden dramatic increases in substance use should all be taken as urgent warning signs where it’s time to get in to see somebody soon. “It doesn’t mean necessarily that we need to call 911, although that is a possibility,” Dr. Carleton said. “It does mean that help is needed sooner rather than later.”

HOW CAN MANAGERS AND COLLEAGUES SPOT SIGNS OF BURNOUT AND ENCOURAGE PEOPLE TO SEEK HELP?
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According to Dr. Carleton, the more open you keep communications, that peer connection, can help. But if you identify big behavior changes—someone normally jovial now lashes out, as an example—it’s a good indication that you should check in with them. The more engaged you are with your team with regular communication, the better positioned you are to support them.

“What can you do? Well, I think first and foremost it’s important to keep in mind that mental health is a journey, not a destination,” Dr. Carleton advised. “It’s not something you check off as a tick box because you did it well today, any more than physical health is.”

He encourages deathcare professionals to monitor both their physical and their mental health. “We have tools that we make publicly and freely and anonymously available on our website for our public safety personnel, and those tools might be beneficial for you as well,” he offered. “They allow you to compare your responses to the general population, and, in doing so, you get immediate anonymous feedback that you can use to see where you are sitting relative to everybody else.”
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Because changing mental health requires culture change because of stigma and misinformation, it’s extremely difficult and takes a long time to accomplish. Dr. Carleton believes it’s important that we all pay attention to the idea that mental health is something we’re trying to change at a population level, but he pointed out that for people who are regularly exposed to potentially psychologically traumatic events, they may very well be forced to engage with culture change more directly than everybody else. He encouraged listeners to engage in ongoing monitoring regularly and get help sooner rather than later.

What can we do in addition to the monitoring? The doctor advised people to look to their social support. “Talk about your experiences. Not necessarily about the details of what happened in your job and specific day, but how you’re feeling and what else you’re doing in order to manage those feelings. If you’re having difficulties with the symptoms we’ve discussed, talk to family or friends. Make sure that you keep a regular diary so that you can watch what changes for you that supports or undermines your mental health.”
“As cliche as this sounds—and it sounds cliche in part because we all keep saying it—engaging in regular healthy behaviors enhances your coping ability and helps to maintain your mental health,” he continued. “So, exercising regularly, even light exercise: simple walks, getting outdoors, 20 minutes. Any exercise at all tends to be beneficial as long as it’s regular.”

Dr. Carleton added that people should watch what they eat. Eating healthy is important because the highs and lows of sugar affect your biology, which impacts your mental health as well. Substance use and misuse is much more problematic and a much more slippery slope than most people realize. If, for example, you’re using alcohol to manage your emotions, that’s a good indication that there’s a better set of skills you can access to manage those emotions.

He also emphasized that, where possible, it was important to maintain routines, even in the face of COVID-19. “The more routines that you can build in, probably the better off you’re going to be, as long as those routines include strict work-life balance where possible,” Dr. Carleton said. “As a professor, I can tell you that the boundaries between my work and my life are permeable at times. They’re permeable most of the time, but it’s important to try and manage those separations because that’s what’s helping to protect and sustain your mental health. So making sure that you’re managing that is an important part of living an ongoing happy, healthy career.”
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Last but not least, Dr. Carleton addressed early evidence-based interventions. “Evidence-based interventions are evidence-based for a reason. It’s because they’re helpful. It’s because they’re beneficial and there’s proof, there’s research that says that they work.” He spoke of the importance of finding the right type of practitioner to offer those interventions. “Psychologists is a protected term. So is psychiatrist. But counselor, therapist, and healer are not protected, which means that anyone can take them—and there is a lot of variability among them. That doesn’t mean there’s not good counselors, therapists, and healers. It’s just that there are a lot fewer restrictions on those names and titles than there are on things like psychologist or psychiatrist. So I recommend you demand registered and licensed, experienced, evidence-based, empirically-supported mental health care (which is a mouthful!), but you can find that from colleges, registered provincial associations, and registered state associations.”

Funeral professionals have a challenging job under normal circumstances; these are not normal circumstances. Covid-19 has simply turned the world upside down. As a psychologist who works with funeral homes and also works in one, I want to offer several suggestions for dealing with the additional stress created by the current epidemic. Many of these ideas come from my work on the Finding Resilience program sponsored by Homesteaders. You can download free materials here.
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Professionals in a wide variety of fields consider it a badge of honor to wear many hats in their business. However, I don’t know of any professionals who wear more hats than funeral directors. Within a single week, you might be expected to demonstrate knowledge of:

In the last few months, you have also had to add “remote videographer,” “social distancing expert,” “Covid-19 expert,” and “creative rituals coordinator”. Not only are all of these duties happening under significant time pressure, but also in the midst of continually changing state and local regulations. It’s no wonder that funeral directors are feeling the effects of compassion fatigue and/or burnout.
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Ideally it is best to make relatively small changes to reduce feelings of burnout before it becomes overwhelming. These changes may include hiring additional staff, delegating responsibilities to others, or finding a colleague to cover during much-needed time off. Funeral professionals experiencing profound burnout, anxiety or depression may seek professional help from their physician or a therapist. Hopefully, you may only need a few “course adjustments” to keep you on a productive, lower-stress path. Here are my suggestions for reducing stress under normal circumstances as well as during the current crisis.

​I have been talking with many funeral professionals across the country and the most consistent reactions I hear include sadness. Funeral professionals are feeling sad that they are not able to provide the full range of funeral rituals and events to bereaved families. They are sad that people are dying alone. And they are sad that families are not receiving the benefits of funeral rituals including support and healing.

I know you can’t do your job the way you would like, but please know that you continue to provide an invaluable service. You may not be able to give someone a hug, but your simple presence and compassion (even if expressed through a video chat) are still a vital service to grieving families. Thank you for the sacrifices of your own potential safety to serve others. Thank you for the innovative ways you have created to meet the needs of the bereaved. Do your best to care for yourself. The world needs you more than ever.

Regardless of your role in the industry, it is important to understand the current laws and regulations that govern your work. Put aside the necessary time to review the federal, state, and local laws and regulations which affect your day to day operations. Right to control final disposition and cremation authorization issues dominate legal complaints against people and businesses in this industry. If you have difficulty finding the statutes and regulations, try searching the web sites for your state association or licensing board – they often have links available.
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CANA Members: If you need further assistance, use your legal consultation benefit and give me a call.

Employment issues are a prevalent headache across all industries and business models. Address common concerns in your employee handbook, so that everyone is on notice of the standards to which they will be held accountable. Implement clear, unambiguous policies on work hours, time off, sick leave, vacation time, and dress codes. Have appropriate sexual harassment policies in place. Communicate your expectations regarding social media use and restrictions on employee posts on business matters. Make sure employees are aware that social media is not for airing of workplace grievances or complaints.
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CANA Members: Read up on what my office suggests for these policies as part of the Crematory Management Program.

Periodic training and review of operational and employment policies and procedures are critical. There cannot be compliance without your employees first understanding your expectations and standards to which they will be held accountable.
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CANA Members: You can keep your standard operating procedures current and your staff informed with the Crematory Management Program and support from Cremation Strategies & Consulting.

Make sure your insurance agent or broker understands your business. Too often there are gaps in coverage discovered when you need insurance assistance or defense to a legal claim, when is too late to put the protections you need in place. Many gaps in coverage result from your agent or broker not understanding your daily work and operations sufficiently to make sure that what you actually do is covered. Just because you have “professional liability” insurance, you have no guarantee that all of your professional services are covered. Proactive insurance strategies will serve you best.
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CANA Members: Have you looked over CANA’s newest benefit, a professional liability insurance program for crematories? Read what makes this policy different and how it covers businesses like yours.

Take some time to think about the education and assistance which will benefit you and your business most in the upcoming year. Then, search for continuing education opportunities that will assist in meeting your goals. There are in person and online resources available to address almost any concern as an industry professional or business owner. Some jurisdictions even allow you to get your crematory operator certification online. If you attend CANA’s convention in Seattle this year, please say hello. I look forward to seeing you!
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CANA Members: Not sure how to get started developing a defined professional development plan for your employees? CANA Education Director Jennifer Werthman is here to help you achieve your goals – reach out any time.

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​Getting your new year off to a good start can jumpstart accomplishing your business’s New Year’s Resolutions. Best wishes for your success in 2020!
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CANA Members: Your association is here to help! If you ever need these resources or anything else offered by CANA, reach out.

When CNN’s article regarding the JAMA radiation letter first hit the CANA newsfeed on February 26, 2019, we knew immediately it would be a big deal. And yes, the story has become a many-headed hydra of confusion, concern, and misinformation, accompanied by increasingly scary rumors.

We constantly field concerns from suppliers about cremated remains placed inside keepsakes, from crematory operators and embalmers about their cases, from families about their options, from regulators about all of the above, and from you — in the middle of it all — trying to serve your families, comply with regulations, and protect your staff.

CANA has curated several of the most useful questions in one place to counter some of the fear, anger, and rumors. And it’s all publicly available, so please share this resource far and wide, bookmark it for later reference, come back to check for updates, and, most of all, DON’T PANIC.

The radiation misinformation saga began with a research letter, titled Radiation Contamination Following Cremation of a Deceased Patient Treated With a Radiopharmaceutical and published on February 26, 2019 in the Journal of the American Medical Association (JAMA). In the letter, Dr. Nathan Yu (et. al) discussed a case study of a business in Arizona that cremated a 69-year-old man with pancreatic cancer in 2017. The deceased had been treated with an intravenous radiopharmaceutical for a pancreatic tumor and died five days later. When the medical staff became aware of the cremation, they notified the crematory and the cremation chamber, equipment, and staff were all tested for exposure to radiation. The equipment was found to have traces of contamination, as was a urine sample from one crematory operator (but it was a different isotope from the one used in the patient’s treatment). The contamination levels were below the limits set by the US Nuclear Regulatory Commission. In conclusion, because this is only one studied instance, researchers recommend further testing for more data and better understanding.
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CNN was the first major media source we found to bring the letter to the general public awareness. To round out the story, the network solicited the opinion of Dr. Daniel Appelbaum, chief of nuclear medicine and PET Imaging at the University of Chicago Medical Center. He said, "If there are reasonable and fairly straightforward and simple things that we can do to minimize radioactivity, why not do that?” Applebaum also acknowledged the need for better understanding and regulations that keep workers safe. In the case of crematory operators, the doctor recommends "robust enforcement of mask and gloves and handling techniques."

Other media outlets picked up the story and it spread quickly, with information traveling like a game of telephone. My mother’s church group argued against cremation for spreading radiation in the community. One CANA member’s staff are expressing concerns about “the crematory operator who died from radiation” (when none have). Each of which are exaggerated concerns about what we know.
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Because while the case study is new, the knowledge about radiopharmaceuticals and brachytherapy is not. And the medical community is quick to reassure that there is Low Risk of Radioactive Contamination from Cremation When Proper Safety Procedures Followed. CANA is aware that these concerns and fears are rooted in a lack of awareness and understanding, so we want to provide information to help.

RADIATION 101
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At CANA’s second Alkaline Hydrolysis Summit, we invited Jeff Brunette, Health Physicist and Manager of Radiation Safety at the Mayo Clinic, to talk about nuclear medicine and its impact on death care. His full presentation is available as a free, on-demand webinar for you, your staff, and anyone to access anytime on CANA’s Online Learning platform, but here are some highlights:

• Nuclear medicine, as administered by a medical professional, is very different than a nuclear warhead. These treatments are administered at doses for safe and healthful diagnostic imaging and cures, not mass devastation.
• These treatments have known efficacy windows which range depending on the use. Diagnostic imaging (e.g. PET scans) can take 20 minutes to 67 hours to clear the system. Radiopharmaceuticals can take 3-12 days (this is where the case study falls). Radiation oncology, like brachytherapy, implants treatment into the body to deliver targeted doses over a treatment window and these isotopes can take weeks or months (or longer) to decay to acceptable exposure levels.
  • These implants are often the size of a grain of rice and inserted throughout the impacted area, thus impractical to be removed by a funeral or medical professional.
• The variations in the length of radiation are due to different materials (called isotopes) used in treatment and their half-lives (i.e. how long it takes the radiation to degrade to half its original mass).
  • Recommendations from the Canadian Nuclear Safety Commission state that "if the therapeutic nuclear medicine procedure or manual brachytherapy procedure took place more than two years ago, the decedent can be treated in the usual manner. No precautions are necessary for autopsy, cremation, embalmment or alkaline hydrolysis."

WHAT'S THE RISK?
The US Nuclear Regulatory Commission has set specific levels (mentioned above) to regulate emissions and uses. In the case of cremating a body treated with nuclear medicine, the Commission and medical community agrees that the potential exposure is too low to record. Though cremation volatilizes the radiation treatment, Brunette says even extreme cases are not likely to exceed the limits set for safe exposure due to the combination of medically accepted isotopes, their half-lives, and treatment use. He explains it with an analogy: taking a daily recommended dose of aspirin is fine (around 325 mg) but taking a year’s worth at once (118,625 mg or more than three bottles) is fatal.

Canadian Nuclear Safety Commission has their own rules and regulations and reviewed them extensively last year. CANA recommends their comprehensive Radiation Protection Guidelines for Safe Handling of Decedents as a great resource to learn more about the isotopes in question and safe handling procedures, even for non-Canadians.

Ultimately, Brunette argues that radiation is a limited concern because the levels you will encounter on the job are small, and not very common. Your bigger concerns are the activities that your staff do every day: musculoskeletal injury from lifting, exposure to disease during embalming (HIV; Hepatitis B & C; Tuberculosis; MRSA), and exposure to harsh conditions during cremation operations (heat, noise, dust or chemicals).

HOW CAN WE OPERATE SAFELY?
CANA recommends asking all families for detailed medical information to properly understand and respond to potential risks. Just as you ask about the presence of pacemakers, ask about nuclear medicine treatments.

Paul Harris of Regulatory Support Services encourages all funeral home, crematory, and cemetery owners to ask the pertinent questions of their families. Cause of death is the first indicator that a case is at risk for radiation therapy, but all families should be asked in the case of death unrelated to their ailment. In many cases, families may be unaware or not understand the procedures the decedent has undergone. In these cases, you may need to ask for a Health Insurance Portability and Accountability Act (HIPAA) release form (in the US, rules in Canadian provinces vary) to contact the medical provider yourself. Asking the radiologist for information on the treatment and about the specific isotope and its half-life is the best way to determine when (or if) it is safe to cremate or embalm the body.

The medical community also recommends installing a simple radiation detector to quickly alert staff to the presence of radioactivity (some states require them in all morgues). Brunette recommends a pancake Geiger-Mueller counter which can be acquired cheaply (particularly if you have them left-over from the old nuclear-powered pacemaker days) and built into your case acceptance procedure.  The Arizona Bureau of Radiation Control recommended a combination metal/radiation detector, such as the MetRad, which one school in considering adding to their intake process curriculum.

Mostly, Brunette recommends the following steps to reduce exposure:

• Awareness: Talk to families, ask the radiologist, consider purchasing and/or installing detectors.
• Protection: Wear appropriate PPE when potential for contact with body fluids, cremated remains, or AH fluids.
• Disposal: Drain blood and body fluids during embalming directly into the sanitary sewer system and don’t aspirate unless necessary.
• Proximity: Maximize distance to the body and minimize time in close vicinity to the body.

The medical community should do what Drs. Yu and Applebaum say: research. Learn more about these situations so everyone can make informed choices about safety. In the long-term, this will serve us better than knee-jerk reactions and blanket rules to refuse all cases who have ever been treated.

Our professional community should continue to do what you do best: serve your communities safely and compliantly. Enforce PPE, add this to your list of questions for families, do your due diligence. You should review your existing policies, processes, and procedures to ensure that you are screening for the use of radiopharmaceuticals and staff are taking proper precautions. Inform yourself and staff with basic information about diseases that could indicate potential treatments and which isotopes are used. Know who to contact with questions like your local hospital’s radiology department (or the decedent’s doctor) or regulator.

Mostly, DON’T PANIC. Now that the public is aware of this issue, this is an opportunity to educate our communities and ourselves with good information from reliable sources. CANA will periodically update this post with new knowledge, so bookmark this for later.