Chapter 40: Death and Survivors

INTRODUCTION

Maximizing the utilization of resources means that some deaths will be unavoidable, especially in resource-poor situations. When resources are limited, you may have to forego trying to save patients whose deaths are imminent or unavoidable. Considerable improvisation may be required to fashion body bags, equip holding areas, set up a body-identification system, and even embalm a body or perform an autopsy.

RISK OF DISEASE FROM CORPSES

The myth that all human and animal corpses pose a public health threat following natural or human-made disasters continues to lead to the misallocation of many scarce resources needed to help the living. Corpses pose only a limited health threat when the person did not die from an infectious disease, because most bacteria and viruses die quickly in a dead body as the internal temperature drops and the body desiccates. This limits any microbe’s ability to transfer to vectors that could infect humans. In fact, corpses pose a much lower risk of infecting people than do the living who are harboring an infection.¹

For those corpses of people who died from infectious diseases, the Centers for Disease Control and Prevention (CDC) guidelines require standard precautions for personnel involved in handling the bodies. These include using a surgical scrub suit, a surgical cap, an impervious gown or apron with full-sleeve coverage, a form of eye protection (e.g., goggles or face shield), shoe covers, and double surgical gloves with an interposed layer of cut-proof synthetic mesh. Those doing autopsies should wear N95 respirators and, if available, consider using powered air-purifying respirators equipped with N95 or high-efficiency particulate air (HEPA) filters. Much of this equipment cannot be easily improvised.²

General Population

Dead bodies from natural disasters do not cause epidemics. Because they do not have infections when they die, they do not spread diseases. Despite the hysteria from the media and politicians, the risk to the public from even masses of corpses is negligible. However, corpses can leak fecal material that can contaminate rivers or other water sources, causing diarrheal illness. Do not drink untreated water that has had dead bodies in it. In reality, routine disinfection of drinking water is sufficient to prevent waterborne illness.

In cases in which people died of an endemic, communicable disease (e.g., cholera, hemorrhagic fevers), see that the populace uses the best hygiene possible. Also, try to prevent direct contact between corpses and family members. One way to do this is to give the family the body in an airtight box for rapid burial.³ Spraying bodies with disinfectant or lime powder does not hasten decomposition or provide any protection to the living against disease.⁴

Body Handlers

Those handling corpses have a small, but real, risk of contracting diseases through the bodies’ blood and feces, particularly when the individual ...