Posted By Administration,
Wednesday, June 6, 2018
All cremation equipment, regardless of the manufacturer, is lined with refractory materials. By technical definition, refractory materials are substances that are resistant to heat. The term comes from the Latin refractarius meaning stubborn. The refractory materials used in cremation equipment are designed, not only to keep the intense heat required for cremation contained within the chambers, but also to retain as much heat as is safely possible to aid in subsequent cremations, saving fuel.
Even the most sophisticated refractory materials will wear out over time and need to be replaced since the refractory floor or hearth is subject not only to the intense heat of cremation, but to the abrasion of sweeping and cleaning out cremated remains after every cremation. It’s typical for the floor to be the first, and most common, area that is replaced in a cremator. Because refractory repairs are such a necessary (and expensive) part of operating a crematory, we went to the experts.
We asked all CANA member crematory equipment manufacturers questions regarding the replacement of the hearth or floor of a cremator, seeking their insight and wisdom as well as any tips on how to increase the longevity of the refractory hearth.
How often should a crematory operator expect to replace the refractory floor in their cremator?
This question got quite a range of answers – anywhere from one thousand to five thousand cremations! Our experts agreed that so much of the lifespan depended on the design of the units and the materials that are used. Determining the longevity of the floor (or hearth) is based on frequency of use, load volume, and remember that loading the case and removing the cremated remains causes abrasions. The average of the companies’ responses ranged from 1,250 to 2,500.
How long should one expect to be out of service while this type of repair is completed?
Our manufacturers generally said two full days – one for removal and pouring the new refractory, one for curing. Curing refers to the hardening of the refractory materials (poured to a minimum of 2½ inches thick) and gradually heating the materials to the temperature of a cremation. This timeline assumes that the machine starts fully cooled, and you may need to plan for an extra day depending on the kind of material and the size of the unit.
Is there a specific or particular type of refractory material that you use? What are its advantages? Disadvantages?
To a one, this was proprietary – no one wanted to say what was in the secret sauce – but all have tried and tested many materials until they found ones that could withstand very high heat, held up with heavy use, and created a smooth surface.
Does the material used play any part in ease of installation of the new floor?
Here, our manufacturers formed two camps:
Cast and Cure manufacturers require an on-site, expert technician for the install. This, they argue, ensures professional, quick, seamless work for a solid floor.
Pre-Cast Tile manufacturers may not require an expert technician (though some still recommend it) since the units are placed, not poured. This, they argue, cuts down on install time since the floor is pre-cured as well.
Is there anything an operator can do to increase the longevity of the refractory hearth in their unit?
Be gentle in loading by using rollers and in recovering the cremated remains with the right tools and method. Don’t use the rake like a garden hoe, but gently remove then brush – vacuum systems are preferred, cold air blowers are not.
Plan your day, or even week, ahead of time. There’s a reason that we spend so much time on this in our Crematory Operations Certification Program. A well-planned day saves fuel, labor, time, and your refractory floor. Cremate cases back to back, not one a day, and don’t leave the unit running if the case is done to minimize thermal shock on the refractory.
BONUS! Are there options other than full replacement? Patches? Protective overlay?
Some manufacturers offer options to patch problem areas, particularly when using pre-cast tile floors.
One CANA member decided to have a refractory overlay installed on top of the existing worn floor in one of his units to test the concept. Tim Gjerde of The Cremation Society of Minnesota (which performs 5,000+ cremations per year) wanted to see if he could extend the life of the hearth for a year or two and stave off a complete floor replacement — as busy as they are, down-time is disruptive and avoiding large repair expenses for as long as possible is just good business.
Preparation for the overlay involved a jackhammer and a chisel to remove approximately 2 inches from the existing worn floor surface. Once the surface was ready, a high density 3000°F rated castable refractory product was mixed with water in a specialized mortar mixer and packed into shape on top of what was left of the existing hearth. Because the moisture in all newly formed refractory materials could vaporize and “pop” the refractory shape during the drying process, a slow gradual cure-out is necessary to assure the material sets up properly.
Tim is happy with his decision to try the overlay and plans to repeat the repair on his other units. He claims that the cost is about 10% of what a full hearth replacement would be and that he should get a year and a half more life from the floors on which he performs this procedure. Tim also cautions readers that this procedure should only be carried out by an experienced refractory expert such as a crematory manufacturer or accomplished refractory technician.
There are many factors affecting the life of the refractory floor, such as cremator design, total case volume, actual refractory materials used, clean out procedures, and even the number of cremations performed in a day. One thing is certain; unless you have previous knowledge or skills working with refractory materials always seek the guidance of an expert for any repairs.
Refractory materials are also potentially hazardous and should always be handled in accordance with safety protocols and procedures. Most refractory materials contain aluminum, silica and magnesium oxides which are all known to cause respiratory problems if inhaled. Precautions must be taken to avoid this and only those trained in the safe and proper handling of these materials should be involved.
Many thanks to the CANA Crematory Manufacturers that contributed to this article: Dr. Steve Looker, President, B&L Cremation Systems; Mr. John Raggett, Vice President, American Crematory Equipment Co.; Mr. Ernie Kassoff, Sales Manager, FT the Americas; and Mr. Kevin Finnery, President, Cremation Systems/Armil CFS.
This article is excerpted from "All Systems Go: The Refractory Floor" by Larry Stuart, Jr. which first appeared in The Cremationist Vol. 53, Issue 2 — CANA Members can log in to see this and more articles from our quarterly publication. This is the first piece in our recurring column All Systems Go! written specifically for the crematory operator and featuring an assortment of practical knowledge regarding operations, maintenance, and best practices for running an efficient, safe, and cost-effective crematory.
There are so many ways to use (and abuse) cremation equipment. How the equipment is operated and the procedural and maintenance choices that the cremationist makes during operation can affect his or her well-being, the safety of the facility, the quality of the air and the environment, and the profitability of the business—as well as the perception of cremation in the eyes of the public. Practical wisdom concerning cremation equipment maintenance, operation, and function are key to running an effective crematory business.
Have more questions about refractory and your cremation equipment? These and other crematory manufacturers will be on the exhibit floor at CANA’s 100th Annual Cremation Innovation Convention! Ask your questions and learn more about how to keep your refractory floor and entire unit running at peak efficiency in-person July 25-27 in Ft. Lauderdale, Florida. See what else CANA has planned for this unique event: goCANA.org/CANA18.
processes and procedures
tips and tools
Posted By Administration,
Thursday, March 1, 2018
Updated: Tuesday, February 27, 2018
In light of recent regulatory events, the consumer media is turning to all of us and asking the question that everyone in the cremation industry hears most often:
How do I know this is my loved one?
A Chain of Custody procedure is never more important than in moments like these. Here, you can demonstrate your commitment to a family and leave them with confidence to trust you with the care of their loved one.
But what do we mean by chain of custody? Every step of your work in the handling of each case must be documented accurately and carefully: custody, control, transfer, analysis, and disposition. CANA recommends crematory facilities make a description of the cremation practice, policy, and procedures available to the family. And, even more importantly, the policy must by followed every time, no exceptions.
Chain of Custody
Many forms are used to document the steps in the cremation process. It may seem that some of the forms repeat the same information, but it is important to maintain complete, accurate, and cross-referenced records. Your firm should have a comprehensive written procedure guide outlining the steps in the process from receipt of the deceased to return of the cremated remains, and it should include the associated forms, verification, and documentation required. Chain of custody documentation, including the ID tag, ensure the identity of the remains and provide objective evidence of identification post-cremation.
Keep in mind that state and provincial laws governing documentation and record keeping range widely, and every crematory operator must learn what laws specifically apply to their location(s).
But chain of custody goes beyond merely complying with regulations. A thorough and followed chain of custody demonstrates professionalism by establishing and adhering to policies and procedures consistent with industry best practices. Every step of the process needs to be performed in absolute accordance with policies and procedures that have been designed to prevent errors.
Once the remains are in the custody of the crematory, it is important to track and record every step of the cremation process. In the event that there are ever any questions about any case, you will be able to demonstrate that the remains were appropriately handled at every stage. Policies, procedures, forms and all of the paperwork in the world are worthless without compliance and consistency. Doing it the same way every time helps assure that mistakes are not made. If you never do it differently, you will do it right every time.
Documenting chain of custody is key to avoiding lawsuits for negligence in this area. Every step of the way must be recorded without exception, and the records must be archived and accessible if needed. Inaccurate, incomplete, or unfollowed documentation is worse than not having it.
Be thorough and complete with every entry every time. Write legibly when filling out forms. A document that you cannot read is worthless. If you leave a field blank it will raise a red flag. Was that field forgotten? Or was it really not applicable? If there is a space to record information and you either do not have that information or it doesn’t apply to this individual, mark that fact down in the space.
Document retention and filing methods are important as well. If you can’t find something, even if it was filled out perfectly, it doesn’t exist.
If you use a third party for your cremation families, you must still prepare chain of custody procedures and require the crematory you work with to meet or exceed your standards. Ask to see their policies and tour their facility. Conduct random checks of the crematory and audit their paperwork as you would your own. You must be able to stand by the practices of their crematory and clearly describe the chain of custody to the families you serve.
If you operate as a third party crematory serving funeral homes, you know better than most the complications that can occur when working with a remote facility. Not only should any crematory working as a third party maintain the standards described above, but you must maintain your policies and follow the procedures for your various clients. Holding their staff to the standards you hold your own requires diligence. Keeping open communication and maintaining transparency allows your clients and their families to rest easy with loved ones in your care.
Assess Your Standards
Despite the importance of maintaining clear and comprehensive documentation throughout every step of the process, too many facilities make the same types of easily avoided errors. Overconfidence in experience, employees spread too thin, sacrificing thoroughness for efficiency, and choosing the company over compliance are common errors but indefensible. A key thing to remember about liability risk is how small, seemingly minor lapses can have huge consequences for the operator and the facility.
How do you know your chain of custody meets appropriate standards? Walk through your documentation with a hypothetical case (like the one below) and make sure you track the remains throughout the entire process: from when you first take custody of the remains until they leave your control.
Management should perform regular audits of the crematory’s record keeping to assure that all the procedures are being consistently performed. Because cremation has become the number one area of liability in the funeral profession, solid documentation accompanied by iron-clad policies and procedures are the best way to demonstrate the truth and ease the mind of a concerned family member.
What follows is a case study of a cremation gone wrong. The case is an amalgam of true events which have occurred in businesses over the past several years.
The decedent is Peggy Jones of Anywhere, USA. Peggy died alone in her home in July at the age of 62. Although she was married when she died, Peggy had been separated from her husband for 20 years. At the time of her death, Peggy was living with Mr. Smith, her partner of 18 years. Mr. Smith was traveling overseas when Peggy died, and thus, her remains were not discovered until several days after her death.
Peggy’s remains were discovered when a neighbor noted an odor emanating from Peggy’s home. The local authorities were notified, who in turn contacted your facility regarding the death.
ISSUE 1: Identification of the Remains at Removal
The medical examiner staff member was on scene when your removal team arrived. Having located Peggy’s driver’s license, the ME staff tagged the remains correctly, i.e., “Peggy Jones.” However, the remains were verbally identified as “Peggy Jonas.” The body bag contained a tag which also identified the deceased as “Peggy Jonas.” Finally, although her given name was “Peggy,” the ME staff prepared documents identifying the deceased as “Margaret” Jones. From the outset, Peggy’s remains had been identified in three ways - two of which were inaccurate.
The easiest way to cremate the wrong remains is improper identification.
What should have happened . . .
The removal staff should have personally examined the remains to confirm the identification affixed thereto. If any discrepancy among the documents, bag and tag affixed to the remains existed, then that discrepancy should have been resolved prior at removal.
ISSUE 2: Tracking and Identification of Remains from Removal to Crematory
The remains were placed into refrigeration at your facility. The refrigeration log reflected that the remains of Peggy Jonas were placed into refrigeration at 8:42 a.m. Due to the uncertainty over the cause of her unattended death, Mr. Smith requested that a private autopsy be conducted by State U. State U logged the remains out of refrigeration at your funeral facility at 5:00 p.m. that same day, having presented documents identifying Peggy as M. Jones. State U logged Peggy’s remains back into your care the following morning at 8:00 a.m., again, as M. Jones.
Each and every document must identify the remains correctly.
What should have happened . . .
You should have ensured that Peggy’s remains were identified correctly and in exactly the same way on each document making reference to them. Effective tracking and accurate cross-reference, is a must.
Cremation is Permanent
As it turns out, the language contained on nearly every cremation authorization form is true:
Cremation is an irreversible, unstoppable process.
Of course, one would think that the statement goes without saying, and yet, every cremation customer is reminded of the permanence of the cremation process. What makes the phrase worth repeating here, however, is that too often cremation providers fail to recognize the weight of the statement. Failing to follow standard practices jeopardize the trust of the cremation-buying public, as well as your license to practice.
By now, you may be thinking: “Any licensee that would make the type of mistakes described in this case doesn’t deserve to serve the cremation buying public.” But, mistakes just like these can be made every day, not from malice but from negligence and ignorance. Keep current on your state’s requirements related to identification, authorization and disposition. Audit your procedures to make sure they are thorough and followed by everyone. Doing so will protect you and your families from the devastation which can be caused by a simple error.
A crematory operator is a vital part of the overall process of turning a dead body into a living memory for a family. It is absurd to think that any good operator would want to do anything less than a perfect job for the family of the deceased. After all, it’s more about the family than anything else, right?
Excerpted from The Cremationist, Vol 54, Issue 1: “All Systems Go 4 Record-Keeping” by Larry Stuart, Jr. of Cremation Strategies & Consulting and CANA’s Crematory Operations Certification Program™ (COCP™) Module 4: Chain of Custody. Special thanks for Wendy Russell Weiner of Broad & Cassel for lending her experience and expertise with the case and important lessons we can all learn from.
Members can read the full article with specific recommendations paperwork to use and proper filing in Vol. 54, No. 1 Issue of The Cremationist. Not a member? Consider joining your business to access this and all archives of The Cremationist plus resources and statistics to help you find solutions for all aspects of your business -- only $470.
Always obtain expert legal advice on policies and procedures for compliance and liability review. Contact CANA’s own Legal Counsel Lara Price, Wendy Russell Wiener’s firm, Broad & Cassel, or any death care legal advisor. You can also learn more by contacting Cremation Strategies & Consulting for consultation on improving your systems.
Throughout his experience as President of Crematory Manufacturing & Service, Inc., Larry Stuart, Jr. has seen, first hand, the negative impact that poor crematory operations can bring about, both in the front and back of the house. Larry has written articles, developed cremation curricula, and spoken at numerous professional events. He has trained and certified thousands of cremation professionals across North America, all with a mission to advance the safety and efficiency of cremation facilities and the safety of their employees, and to foster a more positive impact on our community and our environment. As the founder of Cremation Strategies & Consulting, Larry continues his mission to educate our industry peers, our customers, and the public about cremation, its history, its cultural significance as part of the funeral rite, its impact on the environment, and operational best practices.
Wendy Russell Wiener is a partner at Broad and Cassel, LLP, and the chair of the regulatory department. Wiener practices regulatory insurance law and regulatory death care industry law, representing entities and individuals who interact with the administrative agencies that regulate all aspects of insurance and the death care industry. She represents clients in all types of licensing (for individuals and entities) and disciplinary matters, practice before the administrative tribunal, state and federal courts and interaction with regulators. Wiener is a member of the Federation of Regulatory Counsel (FORC), a limited group of lawyers who focus their practices on regulatory insurance law. She is a frequent contributor to the organization’s quarterly journal. Wiener is an active member of various professional and community organizations and is the former president of Temple Israel in Tallahassee. She is co-chair of the Tallahassee Jewish Food Festival and of the Southern Shakespeare Festival (Festival Day). She has served as past president of Raising a Healthy Child, Inc., and is involved with the ACT Board of the Young Actors Theatre.
processes and procedures
tips and tools
Posted By Administration,
Tuesday, January 2, 2018
Happy New Year from CANA!
As we lay 2017 to rest and get used to writing 2018 on our paperwork, we asked a few CANA members what resolutions they have for 2018 and each said the same thing: I don't believe in New Year's Resolutions.
Instead, they strive to improve the performance and service of their company throughout the year by supporting their staff's professional development, by protecting the safety and well-being of their operators and their image, and by caring for themselves and their colleagues the same way they care for our communities everyday. These goals aren't something we can do in one day, but something we can continue to strive for throughout the year.
So from our experts to you:
And there's a hand, my trusty friend!
And give us a hand of yours!
And we'll take a deep draught of good-will
For auld lang syne.
We look forward to seeing all that you accomplish in 2018 and continuing our support of our members and the industry throughout the year.
Heffner Funeral Chapel & Crematory, Inc.
I don’t do New Year’s resolutions. When I’m motivated over a topic, I make a commitment and set timelines for accountability to follow through, timelines for myself included. These timelines may or may not coincide with January 1st.
As much as I’m flattered to be asked to contribute to CANA’s Cremation Logs and make recommendations for staff training in the new year, I’m not even sure I know what “improving staff training” means. I also flinch at the word “training” – I think we train dogs and we educate people.
Heck, for some employers, any training would be perceived as an improvement. My guiding principle, from the book Good to Great, is that you get “right people on the bus and wrong people off the bus.” If the wrong people snuck on the bus, either by acquisition of a firm, marriage to a relative or simply a wrong hire, then no amount of training will change the person. Instead, you need to do some top-grading and weed out the low performers.
Great people in end-of-life care sincerely want to do all they can for a family in grief. Every year they want to enhance their skills to serve. They want to be the very best informed and most knowledgeable caregiver they can possibly be. If those are not obvious traits, than the wrong person is on the bus!
Top-grading is probably an excellent resolution. The right staff will rise to the top and the opportunities for improvement will be natural. The problem is, it may start with the owner – it’s up to management to decide what talents they need and what skills they’ll teach or have others teach for them by sending staff to appropriate seminars and continuing education.
In the end, the words don’t matter if there is no downside to refusing to be enlightened – make sure the right people are on the bus and get the others off. Not just January 1st, make a point of doing this continuously.
Larry Stuart, Jr.
Cremation Strategies & Consulting
Generally, I think New Year's resolutions are ridiculous. We try to solve all of our perceived problems at the stroke of midnight only to fail miserably, usually before Valentine's Day. The key to true success is to declare broad-based, realistic resolutions and work on them all year long. Baby steps, if you will. For instance, a cremationist could resolve to focus on improving three important facets of cremation operations: safety, the environment, and the public’s perception of a crematory.
So, for 2018, repeat after me: "I resolve to be an even better cremationist by working to improve Operational Safety, Environmental Impact, and Public Perception regarding cremation.
Working on these three goals in progressive steps will be much easier to accomplish than resolving to “never leave the crematory during the cremation,” because we know that there will be times that, sooner or later, this will happen. Then, you will feel defeated and risk scrapping the whole thing. Instead, implement the following procedures throughout the new year. Here are a few examples of things that will help to succeed with your New Year’s resolution.
- Improve Operational Safety: Don’t bypass or short-cut the cool-down step of the process. If your equipment is meant to cool-down between cremations (and most are) you should never bypass this to rush the process. Typically, operating procedures call for a cool down period between cremations to approximately 600ºF before the chambers can be safely swept out. Waiting until the unit is cool to perform the next cremation also helps prevent premature ignition as you load the next case — which can be extremely dangerous. Waiting can also help to prevent a “run away” cremation; the cremation is better controlled with less heat at the start, and the likelihood of overheating is decreased. And remember, regardless of the unit, operators must always wear personal protective equipment to safeguard against harm from the heat.
- Reduce Environmental Impact: No matter how new and advanced your equipment is, failure to operate it properly can and will produce hazardous emissions and harm our environment.
- Scrutinize. Examining the materials included with the remains assures operator safety and reduces the volume of pollutants released into the atmosphere. Often friends and loved ones will place objects in the casket as a token of remembrance or as a personal gesture. Items like stuffed animals, picture frames, bullets, plastics, etc., are not meant to be cremated and could damage the unit, cause unnecessary toxic pollution, or even compromise the safety of the operator.
NOTE: In some parts of North America, the operator is not legally allowed to open the casket prior to cremation due to regulatory laws. Confirm compliance with all relevant laws and take reasonable action to ensure the safety of yourself and your community.
Any new policy implemented in effort to improve operator safety and improve environmental impact will help to paint cremation in a better light with the public. News stories that feature cremation fires or YouTube videos that show dark billowing smoke being emitted from a cremator stack do more harm than just to the environment and the safety of the operator. They tarnish our credibility and creates a negative perception with the public.
Improve Public Perception: The easiest resolution is to assure that your facility is always clean and tidy. As cremation becomes even more popular, so will the public’s desire to visit crematories before deciding on which firm to use, which will increase your visitation and witnessed cremation services. Open and clean facilities with an engaged and knowledgeable staff are going to win every time. Clean your place daily. Wipe up any spills with a sanitary solution of 1:10 bleach and water as they happen. Sweep the floors and mop as appropriate. Dust off all surfaces on a regular basis. Treat your crematory like a funeral home is treated. It should be a showplace just as nice as any other room in your business.
- Resolve to get CANA Certified: Even if you are not an actual operator, the knowledge, information, and insight presented at a CANA Crematory Operations Certification class will not only improve the safety of your operation, our environment, and public perception, it will improve the service of funeral professionals toward their families.
As a fellow cremation professional and so-called expert, I will join you in the resolution to implement strategies and programs to help increase the safety of the crematory operator, lessen the environmental impact of cremation, and to continue to educate the public with facts, science, and emotional realities, all in the hopes of improving their perception of what goes on inside a crematory. Happy New Year!
Market Director for Manitoba / Northern Ontario, Service Corporation International
Ours is a difficult job. We meet people at the worst moments of their lives and guide them through this period of initial hurt until their mother, child, grandfather, loved one is laid to rest. And then we say goodbye. They continue on their grief’s journey, we take the next call. Our journey stops, or never stops as the phone keeps ringing, without any satisfying conclusion.
So in 2018, I want us all to make a New Year’s Resolution to take better care of ourselves.
I need to take my own advice here. We are too often a profession in which we put others’ needs before our own. This work selects those who have so much to give and who are determined to carry on through terrible situations. We continually respond in a professional and dignified way to national tragedies, horrific accidents, or acts of violence and serve our communities while grieving ourselves while our own family awaits our return.
We must take care of our mental and spiritual health and watch for warning signs in ourselves and our colleagues. We must know when it’s enough and when to reach out and ask for help. That may mean reaching out to a colleague for help with a difficult case, or for professional help to avoid or cope with a breakdown. Yes, was as death care providers can hurt too.
Your network inside the profession, your social groups outside, your hobbies and passions, your family and friends all serve important functions to ground you in life when our career surrounds us is death. This year, let’s resolve to celebrate these groups, to take stock of our physical, mental and spiritual health, and to reach out to others when we need it or we feel they do.
The CANA network is one of the most powerful benefits of attending a CANA event and membership with the association. CANA provides the space where cremation professionals can share important conversations with people who get you and your business. Consider connecting with CANA and other industry experts at the 2018 Cremation Symposium for topics that inspire innovative thinking.
Not a member? Join your business to access this article and all archives of The Cremationist plus advice, tools, techniques, and statistics to help you understand how to increase your cremation success -- only $470.
Ernie Heffner shares 40+ years of professional funeral service. He has a diverse background in the operation of end-of-life care related enterprises including funeral homes, cemeteries, a monument company, 10 funeral business relocations and 5 new replacement facility constructions. Ernie has received national recognition and has been a featured speaker on numerous occasions for a variety of state and national industry organizations, related industry organizations as well as his local public speaking engagements for community education.
Larry Stuart is a graduate of Kent State University and is a past member of the Board of Directors of the Cremation Association of North America (CANA) as Supplier Liaison. Through his experience Larry has seen first-hand the negative impact that poor crematory maintenance and improper operating procedures can bring about. Larry has spoken at numerous industry events and has conducted crematory operator training classes across North America with a mission to advance the safety of cremation facilities and their employees and to more positively impact our community and our environment.
Michael Sheedy has been a funeral director for over 20 years and currently serves as President of the Board of Directors for the Cremation Association of North America (CANA) and is a member of the Ottawa District Funeral Association. In his tenure with Pinecrest Remembrance Services, he has been part of the creation of Ontario’s first full service facility with onsite visitation and receptions.
processes and procedures
tips and tools
Posted By Paul Harris,
Thursday, September 14, 2017
Updated: Wednesday, September 13, 2017
Opioid abuse is not only causing an alarming number of deaths among users, but its effects also now stretch to those who simply come into contact with the drugs. This has led to a nationwide effort by public safety agencies to revise policies and procedures to minimize the risk of exposure to these very powerful drugs.
According to the Centers for Disease Control and Prevention (CDC), fentanyl is a synthetic drug 50 to 100 times more powerful than morphine and heroin. Fentanyl acts quickly to depress central nervous system and respiratory function. Exposure to just a quarter of a milligram may be fatal – and some of its analogs are even stronger at even smaller doses. In September 2016, the U.S. Drug Enforcement Agency issued a critical statement to the public and law enforcement personnel warning of serious effects after unintended contact with carfentanil which causes major effects at just one microgram.
A recent White House Commission study found over 100 Americans die each day from opioid-related overdoses. US Department of Health and Human Services reports the greatest numbers of deaths occur in Massachusetts, Pennsylvania, Oklahoma, and Colorado.
For the Employer
Death care professionals know of Occupational Safety and Health Administration’s (OSHA) specific workplace safety standards for bloodborne pathogens and hazardous chemicals. Although opioid exposure poses a serious health risk, OSHA does not currently have an opioid exposure standard. However, under the OSHA's General Duty Clause, an employer aware of the risks of exposure to opioids who doesn't provide training could be cited in the event an employee is exposed and requires medical treatment. This article is not a substitute for actual training, rather to provide some guidance based on recommendations to law enforcement and emergency medical service (EMS) personnel.
To address this safety challenge, follow the same process used for other workplace hazards. First, perform a hazard assessment (or include it in your annual workplace hazard assessment) to identify the tasks that expose or may expose employees to the drugs. For example, assessing the remains and surroundings before transfer to a stretcher, searching pockets for material before moving the remains, removing and storing the deceased's clothing and personal effects, etc. The assessment should also include personal protective equipment (PPE) best suited to protect workers against unintended exposure.
Exposure Control Plan
After the assessment, create an exposure control plan. This includes developing the work practice controls such as policies and procedures when employees know or suspect the drugs are present on or near the remains. The exposure control plan must also include a training program. Training will include the hazard assessment, all written procedures for minimizing exposure, use of proper personal protective equipment (PPE), recognizing effects of the drugs, and procedures for obtaining medical assistance in the event of exposure.
Of course, not all unidentified substances found on or near human remains will be an opioid drug or even dangerous. Unfortunately, it is difficult to determine the risk of an unidentified substance by sight. Thus all material should be considered hazardous until identified. When unidentified material is suspected to be an opioid, or is an employee exhibits symptoms of exposure, notify the local law enforcement agency immediately. Given recent advisories to law enforcement and EMS agencies, this may result in a hazmat treatment for the material, especially if staff develop signs of exposure at the funeral home/crematory.
The signs and symptoms of opioid exposure will depend on the purity, amount, and route of administration. The onset of symptoms can range from immediate to being delayed by minutes, hours, or even days. Watch for:
- Altered Level of Consciousness: Excessive drowsiness; difficulty thinking, speaking or walking; confusion; lack of response to pain or someone’s voice; coma; seizures; pinpoint pupils.
- Breathing: Trouble breathing – may sound like snoring; slow shallow breathing; blue lips and fingernails; respiratory arrest.
- Altered Vital Signs: Slowed heart rate; low blood pressure; dizziness; cold, clammy skin.
- Airway: Choking or vomiting.
For the Employee
Observing standard operating procedures in every case ensures the safety of you, your colleagues, and your loved ones. Contribute to a safe and healthy work environment by wearing necessary PPE, participating in risk assessment and planning, and notifying your superior of any signs of non-compliance or exposure. Keep yourself informed about the potential for contamination—reading this article is a great start!—and stay alert for dangerous situations.
This article is not a substitute for actual training, rather to provide some guidance based on recommendations to law enforcement and emergency medical service personnel.
The CDC issued guidelines to protect law enforcement and EMS personnel from exposure to fentanyl or any drug in the opioid classification. Recommended personal protective equipment: respiratory protection, gloves, eye protection, coveralls, shoe covers, and protective sleeves.
Complete information may be found at the CDC website: https://www.cdc.gov/niosh/topics/fentanyl
Industry Partners’ Resources
For more information on this and related topics connected to the opioid crisis, take a look at:
Members can read the full article in Vol. 53, No. 3 Issue of The Cremationist.
Paul Harris is President and Compliance Director of Regulatory Support Services, Inc., a company founded in 1994 and specializing in regulatory compliance consultation to the death care profession. He holds a North Carolina Funeral Service license and prior to joining the company was the Executive Director of the North Carolina Board of Funeral Service from 2004 until early 2012. Additionally, Paul served as the OSHA compliance officer for a large North Carolina-based funeral home and has eighteen years of first-hand knowledge of regulatory compliance issues.
CANA members receive a 10% discount on annual contract for OSHA and other training, services, and guidance with Regulatory Support Services.
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