NFDA Cremation 5

Question 1

• Two separate containers- inner and outer box
• Each container must be strong, durable, and siftproof.
• USPS recomments but does not require mailer to place the inner siftproof container in a sealed plastic bag.
• Proper padding should be used
• USPS recommends lining shipping box with plastic to prevent leakage

Answer 1

Domestic Shipping

Question 2

• Certified copy of a death certificate
• Burial transit permit
• letter on the funeral home’s letterhead stating that only the cremated remains of the identified individual are in the container being shipped

Answer 2

Required Documents -Domestic Shipping

Question 3

Domestic shipments of cremated remains must utilize this.

Answer 3

Priority Mail Express Service

Question 4

• USPS requires identifying contents on the address side next to the shipping label
• Recommended to always select signature upon delivery to eastablish an extra level of security

Question 5

Developed to clearly identify cremated remains in the mail stream, where they are not currently identifiable.

• When they cannot be located, causes negative customer experiencess and unfavorable publicity for USPA, as well as for the funeral home and crematory.
• USPS sales and service associate apply label when the mailer discloses the package contains cremated remains or can be located in USPS postal store

Answer 5

USPS Label 139

Question 6

• When cremated remains are not otherwise prohibited by the destination country. (check USPA International Mail Manual)
• Package is sent either Priority Mail Express International Service or First-Class Package International using Registered Mail service (using the method available for the destination country)
• 4lb weight limit for packages sent by registered mail.
• Required-applicable customs declaration form completed and has been indicated on the form that the package contains cremated remains.
• Countries may require other documents or consulate inspection before transportation.
• Always contact the consulate and/or embassy
• A lot of counries do not allow this shipment, but there are exceptions.

Answer 6

International Shipping

Question 7

• Hand Carrying Remains
• Funeral Home Shipping

Answer 7

Shipping Remains on Domestic and International Flights

Question 8

• US Transportation Security Administration (TSA) will not ship any container/urn that is lead lined, since all packages must be x-rayed
• Contact each individual airline to find out specific regulations
• Required paperwork must at all times accompany the package through the inspection process. Most airlines do not allow CR to be contained in luggage: must be hand carried.
• Most airlines require that someone must be present for pickup at the state or country of destination. Certain countries require funeral home representative to do this- not the family of the deceased.
• All documentation must at all times accompany the urn/container.

Answer 8

Hand Carrying Remains

Question 9

The funeral home is responsible for first contacting each individual airline to find out if there are any specific shipping regulations in force.

• If airline has a cargo department, it should be contacted to find out the airline’s specific cargo policy regarding cremated remains.

Answer 9

Funeral Home Shipping

Question 10

• Costs a fee
• Provides shipping services: package pick-up, completion of paperwork for th destination state or country, shipping arrangements, and package delivery.
• Primarily work with the funera home; on rare occasions they make exceptions and work with the family.

Answer 10

Working with a Mortuary Shipping Company

Question 11

• Permits
• Recordkeeping
• Crematory Inspection (required in 39 states)

Answer 11

Cremation Safety and Compliance- State Laws and Regulations

Question 12

Crematory or operator noncompliance with state and local permit licensure requirements and codes can result in fines and other enforcement actions.

• Air quality control permits/ air pollution permits
• Burial transit permit/disposition permit
• Construction permit
• Licensed crematory establishment
• Crematory Operator license (required 15 states)
• Other permits

Answer 12

Permits

Question 13

• Not required by all states
• States with regulations- compliance requirements vary widely
• Some states exempt crematroies from obtaining air pollution construction permits or air pollution operations permits, such as Wisconsin
• Typically issued by state departments or environmental conservation

Answer 13

Air Quality Control Permits/Air Pollution Permits

Question 14

• Required to accompany the decedent to place of final disposition
• Typically issued by local registrar or vital records
• Placed in the establishment’s permanent files and a copy should accompany the cremated remains when they are returned to the party authorized to receive them.

Answer 14

Burial Transit Permit/Disposition Permit (Permit for dispostion of human remains)

Question 15

• Crematory cannot begin construction until this state-issued permit is obtained
• Includes any site preparation work
• Compliance requirements vary

Answer 15

Construction Permit

Question 16

In some states crematories must be licensed by the board of funeral or cemetery service or other state agencies.

• Regulations vary
• If cremation services are provided directly to the public, may also need licensed funeral establishment license.
• Before operating permit can be obtained (ordinarily)- demonstrate to the environmental agency, either by stack testing or by providing the report of testing conducted on similar furnace model in the state, that emissions are below state-specified levels

Answer 16

Licensed Crematory Establishment

Question 17

• Complete a training course
• May be a condition for a crematory to obtain a license
• Specifically provided in state law that the state regulatory board must approve course providers.
• Requirements vary

Answer 17

Cremator Operator License (15 States)

Question 18

Be aware that some states may require the submission of certain o ther forms and permits.

Answer 18

Other Permits

Question 19

• Keep detailed cremation records until the state statutes of limitations for breach of contract and tort claims have expired in the state in which business is conducted.
• Crematory may want to expand retention period to be prudent for an additional 10 years
• Ceratin states mandate the amount of time that crematories must maintain records of all cremations performed and the disposition of all cremated remains.

Answer 19

Recordkeeping-Retention Period

Question 20

• The crematory has complied with any state recordkeeping requirements
• Crematory operator certification of training or other requirements are available (some states-conspiciously displayed)
• Cremation device has a current operating permit issued by proper authority (some states-conspiciously displayed).
• The crematory authority is in compliance with local zoning requirements
• The crematory authority license issued by the proper authority is displayed at the crematory.

Answer 20

Compliance for Recordkeeping (what Inspectors Look For)

Question 21

• Weight of each charge
• Temperature fo the secondary chamber on a continued basis for the crematory
• Hours of operation of the crematory; date and time of each start-up and shut-down
• Quaterly check to determine if visible emissions are being emitted.

Answer 21

Example of Records: West Virginia

Question 22

Comprehensive inspection laws and regulations exist in Maryland, Florida, and Georgia.

• Just that entry is authorized- Arkansas and Connecticut
• Purpose- crematory is in compliance with all applicable local, state, and federal laws and regulations
• Open-door policy- allow anyone to inspect at any time as long as cremation is not being performed.

Answer 22

Crematory Inspection (39 States)

Question 23

• Ask for credentials of official or inspector
• Ask for reason of inspection
• Be professional
• Be pleasant- not combative
• Don’t complain that the inspection has come at a bad time.
• Make sure the inspector is accompanied at all times during his or her visit by a crematory representative.
• In the absence manager- all employees should be cooperative
• Permits, records, charts- properly posted as required and readily available
• Maintenance records readily available
• Desingations of certification displayed in conspicious manner.
• Answer any and all questions to the best of your ability
• Do not offer or show information other than that which the official/inspector asks to see.
• If technical or legal questions arise during the inspection, take a break, accompany the inspectior to a conference room, and call the manufacturer’s representative or legal counsel for help.
• Do not discuss any other crematory
• Take notes of hte meeting with the inspector
• Thank the official/inspector for coming; ask when you will receive written report.
• Retain copies of documents provided to the inspector. Agree to provide documents and records requested immediately following the inspection, if possible.

Answer 23

Recommended for When Inspector Visits

Question 24

• Work safety procedures
• Proper handling procedures
• Monitoring control systems
• Recordkeeping procedures
• Malfunction prevention and abatement procedures

Answer 24

Crematory Policies and Procedures:

Question 25

* Properly designed and operated crematory equipment will have nearly complete fuel combustion, controlling emissions generated by the cremation process. * Clean air act- states may enact more stringent requirements than EPA * Most states set emission limits only for emissions of particulate matter and for opacity * Clean Air Act Secondary National Ambient Air Quality Standards Rule- EPA reaffirmed decision not to regulate crematories under federal law. EPA decided that crematories should not be regulated as "solid waste combustion units" because the human body should not be considered solid waste. * States have not restricted mercury, nitrogen and sulfur oxide emissions. In some communities, mercury emissions from crematories have become a contentious health and safety issue, arising when zoning approvals are requested

Answer 25

State Environmental Compliance Requirements

Question 26

* Controlling temperature and exhaust gas flow rate within the combustion chamber is the primary means * Complete combustion ordinarily keeps nitrogen oxides and sulfur oxide, organic compounds and carbon monoxide emissions at low concentrations

Answer 26

Achieving Low Emissions

Question 27

* Employees have the right to work in an environment free from hazards -OSHA (1970) * General Duty Clause * Safe working practices enforced by management and followed by employees * US Department of Labor Standard Classification System combines funeral service and crematories within the same code. * Emergency procedures * Every operator aware of the first-aid and emergency plans

Answer 27

Safe Crematory Operations

Question 28

Requires employers to furnish employment and a place of employment that is free from recognized hazards that are causing or likely to cause death or serious physical harm to employees. * Also required to comply with standards that are applicable to the operation in question

Answer 28

General Duty Clause

Question 29

Majority of citations found under the first 4 OSHA standards listed. Must be in compliance with each standard with a safety plan. 1. Bloodborne pathogens 2. Formaldehyde 3. Respiratory protection 4. Hazard communications 5. Medical services and First Aid

Answer 29

Top 5 Most Frequently Cited OSHA Standards

Question 30

* Gas malfunction * Fire or explosion in the cremator room * Medical incident (collaspe of employee or member of the public on premises due ti an illness or failure of mechanical equipment leading to injury or electrical fire)

Answer 30

Emergencies

Question 31

Emergency care provided for injury or sudden illness before emergency medical treatment is available. * First-aid Provider- someone trained to deliver initial medical emergency procedures, using a limited amount of equipment to perform a primary assessment and intervention while awaiting the arrival of emergency medical service personnel.

Answer 31

First Aid/Emergency Plans

Question 32

1. Receiving remains 2. Preparing remains 3. Preparing equipment 4. Loading remains 5. Operating the cremator 6. Repositioning bodies 7. Removing cremated remains 8. Processing cremated remains 9. Transferring/packing cremated remains 10. Cleaning equipment 11. Cleaning contaminated surfaces

Answer 32

OSHA

Question 33

* General duty clause coule be applicable if unsafe or hazardous methods are used to lift and moved the remains * Sufficient personnel or equipment- assist in moving and transporting remains to prevent injuries associated with lifting and moving * Walking and working surfaces must be kept free of tripping and slipping hazards

Answer 33

Receiving Remains

Question 34

* Most remains are not emblamed * Embalmed remains- may expose crematory operator to formaldehhyde as a result of possible leakage issues * Possibility of exosure to bloodborne pathogens or infectious biologic hazards from unembalmed infected remains * Use appropriate PPE * Follow Bloodborne Pathogen Standard * OSHA standard for formaldehyde- in case of actual exposure

Answer 34

Preparing Remains

Question 35

* Always follow manufacturer instructions * Temporary wiring cannot be used in place of permanent wiring- OSHA electrical standard must be followed as to the marking of controls, switches, and breakers. * Check all fire department and related regulations regarding fire detection alarms, gas monitoring systems, and carbon monoxide detectors * Systems kept functional and never bypassed * Flammable and combustible materials must never be placed or stored or allowed to accumulate near the crematory equipment * Equipment must always be installed and manintained per manufacturer instructions

Answer 35

Preparing Equipment

Question 36

* Same regulations as receiving remains apply here

Answer 36

Loading Remains

Question 37

* Manufacturer instructions * Repairs must be made by qualified individual * Operators trained and certified under applicable laws and regulations * OSHA noise standard- hazardous noise exposure, if exposed to levels above this standard, employer must use engineering and administrative controls to reduce noise level * Hearing Conservation program- if still measurable overexposure * monitoring employee * audiograms * provision of PPE * Training

Answer 37

Operating the Cremator

Question 38

The same requirements would apply to repositioning remains as would be applicable for receiving remains, preparing remains, loading remains, and removing cremated remains.

Answer 38

Repositioning Remains

Question 39

Issue is direct dust exposure * OSHA respiratory standard- dust masks provided to employees. * If a tight fitting, fitted respirator is provided and required or employee usage by the employer, rather than a dust mask, then a full respiratory protection program must be implemented per the OSHA respiratory protection standard. * If voluntary use of respirator by employee is allowed by the employer- OSHA compliance is required with that portion of the standard which governs voluntary use when workplace conditions do not make this type of respirator mandatory.

Answer 39

Removing Cremted Remains/ Processing Cremated Remains/ Transferring/Packing Cremated Remains

Question 40

* Crematory must be locked or tagged out, equipment disabled (lock or tag) to prevent unintentional startup or activation * Crematory charge door must have a safety device that prevents the door from falling (in event of unintentional movement) * Interior of the cremator may be considered a confined space if employee has to enter it- OSHA standard that governs permit-required entry into a confined space

Answer 40

Cleaning Equipment

Question 41

Must be decontaminated with an appropriate disinfectant: * End of workship * Completion of any procedures * Immediately when surfaces are overtly contamintaed * After any spill of blood or other potentially infectious (OPIM) * Bloodborne Pathogen Exposure Control Plan

Answer 41

Cleaning Contaminated Surfaces

Question 42

* 10:1 ratio (10 parts water to 1 part bleach) * Made up daily (24 hours) considered appropriate for disinfection of environmental surfaces and for decontamination of sites following initial cleanup * Contact time- generally considered the time it takes for the product to air dry * Stored in plastic, never in glass * Gross contamination- initially cleaned with soap and water

Answer 42

Household Bleach

Question 43

* Universal Precautions * Reasonable care to minimize the risk of transmitting communicable disease from dead human bodies * PPE used when accepting every decedent

Answer 43

Hazardous Conditions: Infectious and Communicable Diseases

Question 44

Illnesses that result from the infection, presence of growth of pathogenic (capable of causing disease) biologic agents (pathogens) in an individual human or other animal host. * Range from asymptomatic, to severe to fatal * Infection is not the same as infectious disease- some infections do not cause illness in a host * Pathogens- viruses, bacteria, fungi, protozoa, multicellular parasites, aberrant proteins (prions)

Answer 44

Communicable Diseases (Infectious diseases, Transmittable diseases)

Question 45

* Direct physical contact with infectious person * Consuming contaminated foods or beverages * Contact with contaminated body fluids * Contact with inanimate objects * Airborne (inhalation) * Bitten by infected insect or tick * Animals to humans

Answer 45

Transmission of Communicable Diseases

Question 46

* Hepatitis B- most dangerous, can be contacted from the body and the body fluids * Hepatitis C- less severe * Staph infections- found in the form of boils and decubitus ulcers * MRSA- bacterial infection widely seen today. A staph infection that is spread by skin contact * HIV- first observed in 1981, occurs by transfer of blood, semen, and other bodily fluids * Legionnaire's disease. Form of pneumonia, rare, must be given serious consideration when handling decedent for cremation.

Answer 46

Communicable Diseases to be Aware of When Handling Remains of the Decedent

Question 47

* Risks of acquiring and ransmitting preventable infectious diseases * Identify management precautionary measures * Updated annually or when new information becomes available

Answer 47

Written Infectious Disease Policy

Question 48

1. Requirement that universal precautions followed at all times 2. Identification of infectious diseases the funeral service business is prepared and trained to address and precautional steps to be taken 3. Identificaion of infectious diseases that funeral service is unable to safely address and procedures for this situation 4. Procedures to immediately confirm the existence of infectious disease and to initiate proper response 5. Requirement that employees should seek continuing education on fectious disease issues 6. Name and title of the person to whom questions regarding the policy should be addressed 7. Date of infectious disease policy and name/title of the person responsible.

Answer 48

It is recommended that an infectious disease policy should address the following:

Question 49

* Caused by human immunodeficiency virus (HIV) * Damages cells in body's immune system, gradually destroying body's ability to fight infection and certain cancers. * Transmission: sexual contact, blood-to-blood, sharing needles, transfusions, found in saliva tears and sweat- never shown to result in transmission this way * Does not survive well in environment- possibility of transmission is remote.

Answer 49

Acquired Immunodeficiency Syndrome (AIDS)

Question 50

Transmissible Spongiform Encephalopathy, TSE (transmititable from one animal to another producing changes in brain appearing similar to a sponge) * Rapidly progressive * fatal, no treatment, cure or vaccine * Caused by prions * 250-300 new cases per year * Transmission: spordic with no recognizable pattern of transmission. 5-15% genetic * Cerebral spinal fluid highly infectious- also present in spleen, liver, lymph nodes, lungs, spinal cord, kidneys, cornea and lens, and bone, lesser degree-blood. * Particular concern to funeral service employees * In tact non-autopsied bodies- do not pose risk * Emblaming pay be safely performed when certain precautions observed * Incineration at 1,000 degrees shown to destroy

Answer 50

Creutzfeldt-Jakob Disease (CJD)

Question 51

Inflammation of the liver by infectious agents. * Fever, fatigue, loss of appetite, nausea, abdominal pain, dark urine, jaundice * Contact physician for administration of immune globulin

Answer 51

Hepatitis (A, B, C)

Question 52

Liver disease caused by Hepatitis A virus. * Isolated or widespread epidemics * No chronic infection * Cannot get it again after infection * Transmission: person-to-person by fecal-oral * Hand washing important preventative measure, as well as Hepatitis A vaccine * Isolation for first 2 weeks, at least one week after onset of jaundice

Answer 52

Hepatitis A (Infectious Hepatitis, Epidemic Jaundice, Epidemic Hepatitis)

Question 53

Virus that attacks the liver, can cause lifelong infection, cirrhosis of the liver, liver cancer, liver failure, and death. * Best preventative: hepatitis B vaccine * Transmission: blood or bodily fluids from infected person, sex without condom, sharing drugs or needles, needle sticks and sharps exposures, infected mother to babe * Survives outside the body for 7 days and still capable of transmitting infection

Answer 53

Hepatitis B (Homologous Serum Jaundice, Serum Hepatitis, Viral Hepatitis Type B)

Question 54

Liver disease caused by hepatitis C virus (HCV) found in blood of infected persons. * No vaccine * Long-term effects: chronic infection, chronic liver disease, death from chronic liver disease. * Leading indication for liver transplants * Transmission: blood and bodily fluids entering body of non-infected person. Sharing needles, needle sticks and sharps exposure, infected mother to baby during birth. * Can survive on environmental surfaces at room temperature for up to 4 days

Answer 54

Hepatitis C

Question 55

* 8000-18000 each year in the US * Transmission: inhalation of contaminated aerosols from devices such as air conditioning cooling towers, whirlpool spas, showers and faucets and aspiration of contaminated water * Legionela pneumophila * Two forms: * Legionnaire's disease- more sever form; pneumonia, hospitalization common and death occurs 10-15% of cases * Pontiac fever- milder flu-like illness without pneumonia, generally recover 2-5 days without treatment.

Answer 55

Legionellosis (Legionnaries Disease, LD, Pontiac Fever)

Question 56

Inflammation of membranes covering the brain and spinal cord; usually caused by viral or bacterial infection. Symptoms include. (may develop over several hours or one-two days): * High fever * Headache * stuff neck * Nausea * Vomiting * Discomfort looking into bright lights * Confusion * Sleepiness * Seizures as this progresses

Answer 56

Meningitis: Viral and Bacterial

Question 57

* Generally less severe than bacterial * Serious but rarely fatal with persons with normal immune systems * Symptoms last 7-10 days * Patient recovers completely without specific treatment * Antibacterials not useful * Enteroviruses, herpes viruses, mumps, measles, influenza, and arboviruses * Transmission: * Enteroviruses: spread through direct contact with infected person's stool or direct/indirect contact with respiratory secretions, kissing, shaking hands, fomite * can stay on surfaces for days

Answer 57

Viral Meningitis (Asceptic Meningitis)

Question 58

* Can be severe and may result in brain damage, hearing loss, or learning disabilities * Number of antibiotics are effective, important to begin early in course of disease * Effective vaccines * Advisory Committee on Immunization Practices (ACIP) recommends routine vaccines for specific groups (teens). * Transmission: some forms are contagious, mainly spread through exchange of respiratory and throat secretions, occur through coughing, kissing, and sneezing. * Employees should immediately contact physician for antibiotics

Answer 58

Bacterial Meningitis (Cerebrospinal Fever, Meningococcic Meningitis)

Question 59

One of the most common causes of skin infections in the US. * most infections are minor (pimples, boils) * Most treatable with antibiotics * Serious infections: surgical wound infections, bone infections, pneumonia, life-threatening bloodstream infections. * More commonly among person in health care facilities, especially elderly or very sick or those with an open wound or intubation. * Transmission: close contact with infected persons. Almost always by direct physical contact, not through air. May occur through indirect contact (fomites)

Answer 59

Methicillin-Resistant Syaphylococcus Aureus (MRSA)

Question 60

Opportunistic Infections (aspergillosis, candidiasis, cryptococcosis) emerging as major problems in cancer patients, transplant recipients, and other immunocompromised individuals (including AIDS patients). * Classical infections- histoplasmosis, coccidioidomycosis * Harmless environmental fungi- soil organisms and organisms in soils, plants, compost heaps, rotting food. * Infections incude: aspergillosis, candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis, and spororichosis. * Transmission: various modes depending on type of bacterium.

Answer 60

Mycotic Infections

Question 61

Rispiratory disease caused by virus; symptoms of rash and fever often mild, may be missed 30-50% of the time. * Complications: encephalitis (usually adults), congenital rubella syndrome (most serious)- virus attacks developing fetus- 85% result in birth defect * Transmission: most dangerous of two forms of measles, person-to-person through air, coughing and sneezing, and by direct contact with nasal or throat secretions of infected person.

Answer 61

Rubella (German Measles)

Question 62

Acute, highly communicable respiratory disease caused by a virus. * Symptoms: fever (as high as 105 degrees F), cough, runny nose, conjunctivitis (pink eye), and rash. * Frequently complicated by middle ear infection * Can be severe, with bronchopneumonia or brain inflammation leading to death two of every 1000 cases. * Transmission: Highly contagious, person-to-person through droplet * Remains active on surfaces for up to 2 hours

Answer 62

Rubeola (Red Measles, Hard Measles)

Question 63

* Bacterial- gonorrhea, syphilis, chlamydia often cured with antibiotics; reinfection possible if exposed. * Viral- HIV, herpes, hepatitis have no cure; symptoms can be alleviated wtih treatment

Answer 63

Sexually Transmitted Diseases (STDs)

Question 64

Manifestations range from single pustule to septicemia and death. * Most common are skin infections, if bacteria invade bloodstream- pneumonia, septicemia, arthritis, endocarditis, or meningitis * Can cause UTI and eye infections * Can cause food poisoning * Communicability exists as long lesions continue to drain and/or the carrier state exists * Transmission: commonly harbored in human nose; self-infection responsible for up to 1/3 of infections via hands. By direct contact by person having draining skin lesion or who is a carrier. Spread via blood and blood byproducts; can be spread from instruments not completely disinfected.

Answer 64

Staphylococcal Disease

Question 65

(strep throat, necrotizing faciitis, Impetigo) Bacterium often found in the throat and the skin and often carried without symptoms of illness. * Most are relatively mild * Rare occasions- cause severe and life-threatening diseases if bacteria enter parts of the body where bacteria usually not found (blood, muslces, lungs) * Transmission: Direct contact with mucous from nose or throat or through wounds or skin sores * Higher risk with chronic illness (cancer, diabetes, kidney dialysis)

Answer 65

Group A Stretococcal (GAS) Disease

Question 66

Often severe/contagious airborne disease caused by Mycobacterium tuberculosis bacteria that can attack any organ of the body, but usually attack the lungs. * Transmission: air when person lung or throat TB releases droplets by coughing, sneezing, speaking, singing or laughing. * Only people with active TB can spread diease to others * Treated with correct drugs for at least 2 weeks- no longer contagious * Generally requires close and prolonged contact over long periods of time * Employee caution: barrier protection recommended

Answer 66

Tuberculosis (TB)