Thursday, February 13, 2014

Death and Burial - Part 2 (Mind)

Part 1 may be found here

One of the other aspects of death and burial is the “how” behind it all. How can you tell if someone is dead? How can you tell how long someone has been dead? How do you handle a dead body? These and other questions may seem morbid or grotesque, but the answers may be relevant in a post-SHTF world.

Death is usually determined as when the brain stops functioning, or at least when the heart stops pumping blood to the brain - which leads to brain-death rather quickly, within two to six minutes. Determining brain death requires the use (and interpretation) of an electroencephalogram (EEG). I don't think many of us own an EEG and carry it around with us. In the various medical training I've received over the years (mostly advanced first aid and first responder training) they taught a few quick methods of determining whether a person was dead and therefore beyond the need of aid, freeing you to provide aid to those that could still benefit from it.

How can you tell if someone is dead?
Lack of signs of breathing is not a sign of death anymore. In earlier times it was common to check for breath by holding a mirror to a person's mouth and looking for the mirror to fog up. With the advent of CPR, a person who has stopped breathing can sometimes be "brought back". The statistics I've seen put the success rate for CPR in the 10-20% range. In “normal” times, that's only fair odds, but in a SHTF situation with no advanced/enhanced medical aid around it may all you have. CPR training is cheap or free and I strongly recommend that everyone get it.
Lack of a pulse is not always a sign of death, especially if it is a radial (taken at the wrist) pulse. Freezing and injuries can stop blood flow to the extremities, so they are not a viable place to check for a pulse. Always check at the throat (carotid pulse) if you're looking for signs of life.

Presence of a heartbeat doesn't always mean life, either. Both my father and father-in-law have pacemakers that will keep their hearts pumping for quite some time after they are brain dead. Until the heart muscle starts to decay or the blood starts to coagulate, that electrical pulse will keep it beating. Think of the high school experiment with frog legs and electricity. 

Decapitation or massive loss of brain tissue is a clear indicator that the person is dead, as is the onset of livor mortis, algor mortis and rigor mortis. 

How can you tell how long someone has been dead?
Livor mortis is the pooling of blood in the part of the body closest to the ground, and begins as soon as the heart stops beating. Gravity will pull the blood to the lowest point, causing the skin on the rest of the body to lose color and the low points to be “stained” a purplish-red by the pooling blood. The blood is “unfixed” or able to move for a few hours after death but then gels or coagulates and will no longer move.

Algor mortis is the cooling of the body after death, also referred to as “assuming room temperature”. Depending on the temperature of the environment, the rate of cooling can vary drastically.

Rigor mortis is the stiffening of the muscles once blood flow ceases. Rigor mortis has stages that it progresses through, and can give you an idea of how long someone has been dead. Be aware that small children and infants may not show signs of rigor mortis due to their smaller muscle mass and less developed skeletons.
  • The first stage begins at the moment of death - all of the muscles relax due to the absence of control by the nervous system. The anal sphincter will relax (allowing the contents of the bowels to seep out) as will the muscles around the urethra (allowing the contents of the bladder to leak out). 
  • The second stage (two to four hours after death) is the stiffening of the muscles in the body. The muscles of the face and neck generally stiffen first, followed by the extremities, and lastly the internal muscles of the body. Since the eyelids and face are the first to stiffen, we have developed the tradition of closing the eyes of the dead as soon as we're sure they're dead. Placing coins on the eyes of the dead is an old ritual that kept the eyelids closed with the side benefit of providing the soul of the deceased with the toll to pay Charon for the ferry ride to the afterlife (he charged two coins - it didn't matter what the coins were). 
  • The third stage (24 - 72 hours after death) is the releasing of the stiffness in the same order as it began as the muscle tissue starts to break down. The stiffness of corpses in modern funerals is caused by the embalming fluids used in preparing the body for burial. 

How do you handle a dead body?
Generally, unless they died of a contagious disease, you'll want to put on a pair of gloves and depending on how advanced the decay process is and a mask to minimize the odors. Friends who work for a coroner's office keep a jar of Vick's VapoRub in their vehicle. They rub a bit along their upper lip or swab it inside their nostrils to counter the smells they're going to encounter when they have to do a pick up. Some of the stories they've told me are disquieting, to put it mildly.

If they did die of a contagious disease, you'll want to take precautions to prevent the spread of that disease. Depending on the disease the precautions can range from rubber gloves and a dust mask (pneumonia or an STD) to full a haz-mat suit and respirator (plague or revived smallpox). If there is any doubt, err on the side of caution. In case of wide-spread outbreak of a highly contagious disease, burning the bodies may be the best way of disposing of them. Taking care of yourself is more important than being respectful of the dead. Decontamination is a complicated subject and may be covered at a later date.

If it is a friend or loved one's body, you may want to bathe the body and dress it for burial as soon as you can. Plugging the body's openings is a common tradition- remember that the bowels and bladder are going to leak. As the body starts to decay pressure will build up in the internal organs that will push everything out, but this takes days unless the temperatures are very warm. Perforations in the abdomen (think bullet holes) will allow the gasses created by the decay process to escape without building up pressure. Placing absorbent pads under the body to catch leakage is a common hospital practice. Wrap them in a sheet or shroud and set them aside while you're preparing the grave or tomb. If it is the body of a stranger or enemy you may not want to go to as much trouble or spend as much time in disposing of them. Rolling them onto a tarp or litter and transporting them to a grave/tomb may be all you'll want or need to do.

When you're done handling the body, wash up as best you can. Soap and water is the bare minimum; a full bath or shower will be better at removing anything that may compromise your own health.

I would suggest leaving some form of ID on any corpse that you bury for future reference, but anything of value on a stranger or enemy should be given to a living person who can get use of it. Family and friends should have made it clear ahead of time how they want their worldly possessions distributed upon their death, and if they haven't then leave that up to the next-of-kin.

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