Posted By Administration,
Tuesday, March 12, 2019
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.
Where it started.
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 a 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.
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."
Where it went.
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.
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.
What we know.
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.
- 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).
- Safe levels are determined by federal regulation. For the US general public, this is anything up to 100mrem in a year (excepting medical treatment — a full-body CT scan provides approximately 1,000mrem), while for people who work with the substances it’s 5,000mrem each year. A fatal dose is more than 500,000mrem. And we are exposed to radiation by taking an airplane, using the microwave, and from nature (both Earth and space).
- Radiation treatments also vary in strength. Alpha waves are stopped by paper, or blocked by your skin. Beta waves are blocked by soft tissues and thin metal of aluminum. Gamma waves travel much farther. Distance from the radioactive material also changes exposure — the medical community measures the potency at one meter to determine when a patient can go into public spaces. In most of the cases described above, treatment is outpatient (even the implanted seeds) meaning the person can leave that day.
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.
What we do next.
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.
Sources of information referenced in this article:
Barbara Kemmis is Executive Director of the Cremation Association of North America.
processes and procedures
tips and tools
Posted By Barbara Kemmis,
Wednesday, November 28, 2018
Updated: Tuesday, November 27, 2018
“What do you know about Alkaline Hydrolysis?”
Recently, I’ve been getting this question everywhere. It doesn’t matter what my presentation is about, or if I’m presenting at all, someone asks me about Alkaline Hydrolysis.
What is Alkaline Hydrolysis?
Alkaline hydrolysis. Also known as AH, flameless cremation, water cremation, green cremation, chemical cremation, aquamation, biocremation™, or Resomation™, alkaline hydrolysis is, in short, cremation. CANA took this position in 2011 for the simple fact that cremation is the method of speeding up decomposition, traditionally done with fire, but also through other methods like alkaline hydrolysis. As states and provinces began to legalize the process, their laws expanded the existing regulations to define alkaline hydrolysis as a form of cremation. In 2013, CANA observed this trend and decided to broaden its official definition of cremation to recognize this new reality:
"The mechanical and/or thermal or other dissolution process that reduces human remains to bone fragments."
CANA remains the only trade association to take this controversial position. And ever since we did, we’ve had the book thrown at us – specifically, the dictionary. Merriam-Webster defines cremate (v): to reduce to ashes by burning. “There you have it,” people exclaim, “alkaline hydrolysis doesn’t burn and thus cannot cremate. Ergo, it isn’t cremation!” But cremation is not defined in dictionaries, it is defined in legislation. For many states and provinces, cremation is not just combustion but chemical, mechanical, or thermal dissolution of remains to bone fragments.
In essence, CANA is following the leadership of the state and provincial regulatory bodies and classifying alkaline hydrolysis as cremation. And since it’s cremation, it can be marketed as such. Hence, the many terms to describe the process.
What AH Is, and Isn’t
In practice, CANA prefers the term “alkaline hydrolysis” because it clearly describes what happens – an alkaline solution using water to break chemical bonds at the atomic level (aka hydrolysis). What it looks like, though, is a typical cremation: body goes in, bone fragments come out. The process of alkaline hydrolysis requires that the body be submerged in water with alkaline (base) chemicals and, through a combination of time, pressure, heat and possibly agitation, the body is reduced to bone fragments. The sterile waste water (or effluent) can flow into the water system with the remaining chemicals (salts, amino acids, peptides, etc.) which help break down waste at the water treatment plant or even fertilize crops.
But the public isn’t thinking about that. Current practitioners find that their families don’t ask much about these details. Instead, they see the same results as flame cremation (cremated remains) but, presented side by side, perceive “water cremation” as gentler and more environmentally friendly. The term evokes something like a bath – one person called it “the final spa treatment.”
Our profession, on the other hand, hasn’t seen it the same way. While AH practitioners find the public doesn’t ask about the process, it seems to be all the profession can think about. And many people say it’s gross to “dissolve bodies in acid” and disrespectful to “flush grandma down the drain” and celebrate legislation being quashed in their state or province. But these fears aren’t based in fact: AH doesn’t use acids and the waste water doesn’t contain identifiable bits of grandma (especially when compared to the wastes of embalming). This has not stopped the Catholic Church from taking an official position opposing AH, nor industry leaders from dismissing it out of hand and even attempting to make it illegal.
But the process has caught people’s imagination and emotional reactions have spread faster than good science and facts.
Emerging Technology That’s Here to Stay
Alkaline hydrolysis has been everywhere recently from letters to newspaper editors, national science magazines, and governors’ desks. When they call CANA, they are looking for answers and predictions. I explain that, while it’s gaining popularity as an alternate form of human disposition, it’s a proven technology that has been in use in universities and colleges since 1994, and was originally patented in 1888.
Recently, I had a reporter ask if alkaline hydrolysis is the reason that the US cremation rate is over 50%, if it had pushed the cremation rate passed this milestone. The question is logical given the coverage AH has received in the media and also the push to legalize the disposition, but the impact of AH on cremation rate growth is negligible. Because alkaline hydrolysis is considered a form of cremation, it is counted with cremation in disposition rates and there is no way to accurately report AH alone.
CANA estimates that less than one tenth of one percent of cremation uses the alkaline hydrolysis process nationally. This is roughly on par with home funerals and green burials, which have also captured the imagination of consumers and professionals alike, but is rarely practiced. This figure does not (nor should it) count the thousands of pets and animals (data not collected) or the hundreds of bodies donated to institutions like the Mayo Clinic or UCLA that have AH machines in their medical schools (reported in vital statistic data as body donation).
More and more states and provinces are legalizing AH, but few of them have actual practitioners. While it takes a united front of practitioners, manufacturers, consumers, and the media to change the law, it is a different mix to make a business successful. One of the primary obstacles to new AH businesses is the business model itself. There are regulatory and financial barriers to entry, as well as the need to educate and recruit the public. Then significant capital investments and uncertainty of what consumers choosing AH will ultimately pay for the option. It took 100 years for traditional cremation to reach 5% of dispositions in the United States, but AH businesses will need to see a return on their significant investments in a much shorter timeframe to be successful. Early adopters have navigated these obstacles and are enjoying success that may be a model for others to follow.
Outcomes of CANA’s Alkaline Hydrolysis Summit
The second Alkaline Hydrolysis Summit brought practitioners, regulators, and other curious people together to discuss the practicalities of running an AH crematory. But with such low adoption of AH to date, why talk about this now? CANA specializes in bringing experts together, pooling knowledge and problem-solving with peers facing similar challenges. Our attendees were people who have been operating an alkaline hydrolysis facility for years, people who are eager to launch their own, and so many others curious about the process and how it works. And this group doesn’t represent even half of the people operating alkaline hydrolysis units every day.
Together, we gained a greater understanding of the practical and technical matters of running an alkaline hydrolysis crematory. We learned that cotton is the enemy of the process, that a larger urn is actually not always necessary, a mixture of two hydroxide salts is more effective than either alone, and so much more. But, there’s a lot we still need to learn and to share with our colleagues and the public to combat the misinformation out there. Alkaline hydrolysis has been in use for over twenty years in body donation programs and pet crematories. The science of the process is well documented. It has a significantly different environmental impact. Current practitioners have much to share regarding best practices and successful business implementation. CANA is excited to be involved in curating all this information for use by future practitioners.
The outstanding questions can only be answered by time. For instance, cremation started in cemeteries who built crematories as a side project – who will be the early adopters and evangelists for AH? At the moment, practitioners are installing units in response to market interest, regulations prohibiting flame crematories, and curiosity. Which leads to another question – what kind of training will regulators require of AH owners and operators? States and provinces vary on crematory requirements, certification standards, and even funeral director licensing, so it stands to reason that variance will continue when AH is in the mix.
We’re excited to participate in this conversation, and proud to be a resource for practitioners and the curious alike. The content presented at the summit will be made available in the coming months through articles in The Cremationist, online learning modules, and presentations at various events. Stay tuned for more...
Barbara Kemmis is Executive Director of the Cremation Association of North America.
processes and procedures
Posted By Administration,
Wednesday, November 7, 2018
Updated: Wednesday, November 7, 2018
The International Association of Pet Cemeteries and Crematories (IAOPCC) and the Cremation Association of North America (CANA) share similar values of dignity and respect in the care of the deceased and standards to maintain this level responsibility at all times. We’re pleased to present this post from our partner association about determining proper standards of care for our loved ones, no matter how many legs.
According to the 2017-2018 APPA National Pet Owners Survey, 68% of U.S. households own a pet, which equates to 84.6 million homes. In 2018, it is estimated that over $72 billion dollars will be spent in the U.S. on these pets for everything from food to vet care to grooming and boarding. Because most people see their pets as members of their family, they are often willing to pay more for their death care as well. Thus, it is reasonable to presume that they also expect their pets’ remains to be treated with the same dignity and respect we would use with their human family members. If that is what families expect and are willing to pay for, we must meet this expectation as pet death care providers or else face a growing potential liability.
While it isn’t imperative (or even practical) that pet death care be exactly the same as human death care, they should be treated similarly. This does not mean that pets should be embalmed, placed in $10,000 caskets and the costs should be in line with human services. But it does mean that, when handling the death care of pets, you need to establish policies, procedures and documentation that provides the same safeguards to ensure that the remains are cared for properly.
Pet Death Care: The Standard of Practice
So what standards of practice should providers follow? In order to determine this, we must first look at how standards of practice are determined. When we talk of standards of practice, there are two different standards that apply: 1) the Regulatory Standard and 2) the Civil Standard. The Regulatory standard is the standard that that is established through the applicable rules and regulations of the jurisdiction in which you practice. The Regulatory Standard establishes the bare minimums of practice, all of which must be met to be able to practice.
The Civil Standard is the standard that applies in a civil lawsuit. While the Regulatory Standard helps form the Civil Standard, there are other factors that can affect it. In short, the Civil Standard is: What the reasonably prudent operator would do under the same or similar circumstances. In certain situations, the Civil Standard could significantly exceed the Regulatory Standard. Ultimately, in a lawsuit, it is the jury that determines what the standard is and deciding whether or not the Defendant failed to meet that standard.
When it comes to damages in a civil lawsuit, the intent is to make the Plaintiff “whole” by requiring the Defendant who has been found to have been negligent to compensate the injured Plaintiff. The intent is to put the Plaintiff in the same position he or she was in prior to the injury.
Traditionally, only economic damages have been recoverable damages related to injuries to Plaintiffs for their pets. In other words, the amount recoverable for a wrongful cremation, for example, is the value of the pet (i.e., purchase price, etc.). This is because the pet is considered personal property the same as a car or smart phone.
However, the landscape is changing. Some jurisdictions are beginning to allow for other categories of damages other than economic damages, such as punitive damages and emotional distress damages. Many jurisdictions leave the door open for the possibility of accepting these damages in the future, should the facts of a case support them.
Therefore, when looking at which human care procedures and policies should be mirrored in caring for pet remains, we need to consider what the common pitfalls are, and essentially, it comes down to the big three: 1) Authorization, 2) Identification, and 3) Chain of Custody. In order to protect your business from the significant liability that can arise from these three elements, you need to focus on documentation including policies and procedures, authorizations, and chain of Custody. As a largely self-regulated industry, the pet aftercare profession has little oversight, other than environmental regulations and business licensing. Currently there are only two states, Illinois and New York, that have any legal standards for pet cremation.
Recognizing the importance of the big three, and of having a standard of practice for the pet industry, the International Association of Pet Cemeteries & Crematories (IAOPCC) began development of such a standard in 2009, and the project culminated in the release of the IAOPCC Accreditation Program in 2014. This is the first and only Accredited Program with published and recommended procedures for every step of the pet cremation process. With the introduction of this program, the IAOPCC has given the industry and the pet owner a measure of protection regarding the integrity of the pet aftercare processes from those pet crematories who seek out Accreditation and inspection.
From Standards to Accreditation
In 2009, a committed group of pet crematory professionals dedicated to identifying and promoting standards of quality care and procedures within the pet aftercare industry gathered to form the IAOPCC’s Standards Committee. These individuals, with a combined experience of more than 120 years, met monthly over a five-year period to develop the rigorous evaluations and standards. What resulted was a core set of Accreditation standards, processes, and a program of inspections that were copyrighted and rolled out across the United States, Canada, and worldwide to its Members. Since its inception, these worldwide standards have continued to raise the bar of excellence throughout the pet aftercare industry.
Under the IAOPCC Accreditation program, members are subject to a rigorous examination and evaluation of their services and operations. Through the program, pet crematories are evaluated against a pool of nearly 300 standards that represent the best practices in pet cremation care and pet crematory management. The IAOPCC Standards Committee continually updates the Accreditation standards to reflect the latest developments and improvements in pet aftercare, pet cremation techniques, records, cleanliness, staff and client safety, and a host of other areas essential to excellent pet and client care. Those Members who choose to achieve Accreditation through the IAOPCC have set their practices and standards at the highest level in the pet aftercare industry.
To become accredited, a business much meet certain standards of practice and pass inspection by their peers. Depending on the profession, the process can take time and commitment to changing policies and procedures – the IAOPCC requires almost 300 standards be met and documented. So why pursue Accreditation? Members of the IAOPCC began asking that question of themselves early on. Our family has been in the pet aftercare business for more than 46 years. Since 1972, we have taken care of pets and the people that love them. My father, Doyle L. Shugart, spent his life as a human funeral director in Atlanta, during which time he started Deceased Pet Care Funeral Homes. As a second-generation family business, we understood cremation and we felt sure we already had the very best procedures and processes in place, so what could Accreditation do for us? Turns out, it taught us more than we realized!
Once we began the process of reviewing all of our systems, processes and procedures, we quickly realized we actually had many of these in place – we just needed to document them! It gave our family and staff a tremendous sense of pride in evaluating ourselves at the highest level. Some other benefits we found during the experience:
- It provided us with challenging benchmarks in which to strive and achieve;
- We improved and refined many of our procedures, and this in turn resulted in our overall operations becoming more efficient;
- We saw immediate enhanced credibility with our clients, our community, and peers;
- It inspired pride among our Staff Members – There were “high 5s” all around;
- Our Staff members were encouraged in their leadership abilities and development and it was wonderful to have the teams’ achievements recognized once we received our Accreditation.
As Members of the IAOPCC for over 40 years, we’ve spoken to many members who have experienced the same results in seeking and achieving Accreditation with many questioning, “Why didn’t I do this sooner?” I recently read an article that appeared in Slo Horse News regarding one of our long-time IAOPCC Members, Christine Johnson of Eden Memorial Pet Care. “There needs to be a standard Code of Ethics in our industry,” explains Christine. “It just makes us all better and that is good for the Pet Cemeteries and Crematories industry.” Now that Eden Memorial Pet Care has set the bar for other California Pet Cemeteries and Crematories, their peers are coming to them for advice on how to get accredited too. This keeps Eden at the top of the pack when it comes to proper care and processes. “Now we have an association which says we are the best,” Christine states. “This means our customers, and the Veterinarians we work with, know we are doing what is best for the pets we provide end-of-life care for.”
Putting Standards into Practice
Accreditation can seem like a daunting task, and it certainly takes a lot of work, but the end result is worth the effort. The best way to begin is one standard at a time. Not sure where to begin? We suggest the standard that states that crematory operators should be certified. In 2016, CANA and the IAOPCC collaborated to create an all new Certified Pet Crematory Operator Program (CPCO), which has been offered annually at the IAOPCC Conference. Two years later, both groups are excited to announce the availability of this program online, making it even easier to meet the standard. And whether or not you go for the full accreditation, it’s best practice to train your operators. So take advantage of this new pet specific cremation program today, learn more at www.cremationassociation.org/PetCremation.
Being IAOPCC-Accredited demonstrates to your community and to your clients your ongoing commitment to excellence in every aspect of pet cremation care and management. So, why wouldn’t you do it?
For more information regarding the IAOPCC Accreditation Program, contact the IAOPCC Home Office at 800-952-5541, or firstname.lastname@example.org.
Excerpts taken from The Cremationist, Vol 50, Issue 1: “Pet Death Care: The Standard of Practice” by Chris Farmer. Special thanks to the IAOPCC Accreditation Committee for lending their experience and expertise to develop these standards, an important facet of our profession.
Announcing the Online Certified Pet Crematory Operator Program developed in partnership with IAOPCC and CANA. Pet crematory operators can now get certified online, on their schedule, at their pace and at home! This course coming soon – learn more at www.cremationassociation.org/PetCremation.
Donna Shugart-Bethune is part of the Shugart Family business of Deceased Pet Care Funeral Homes and Crematories located in Atlanta, Georgia. As one of the largest pet funeral homes in the nation, Deceased Pet Care has served pet parents for more than 46 years. Donna, who grew up in the family business, pursued her BBA from Georgia State University. Over the past few years, she has concentrated her efforts as the company’s Public Relations & Marketing Director.
In addition to the family business, Donna has served as the Executive Director for the International Association of Pet Cemeteries & Crematories (IAOPCC) for more than 8 years. Donna is a member of the Georgia Veterinary Medical Association (GVMA) as well as the GVMA Industry Council. Donna is certified as a Pet Bereavement Specialist, a Registered Pet Funeral Director, Pet Celebrant, and Pet Crematory Operator. Deceased Pet Care was voted Best Pet Cemetery in Atlanta Magazine, Nominated for Georgia Business of the Year, and is the recipient of the Chamblee Business of the Year Award.
processes and procedures
tips and tools
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