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Procedure for Preservation and Disposal of Dead Bodies in Hospital

T. Millo, Arun Agnihotri, Shakti Gupta, T.D. Dogra

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Topics

© Cold storage room

The proper maintenance of the cold storage room is an important responsibility of the concerned hospital authority and the mortuary technician. The body should not be brought directly into the cold storage room of the mortuary. There should been open space outside the cold storage room, where the bodies can be brought in, to wait for preparation of the cold storage tray. The bodies should be brought to the morgue on stretcher and preferably be left on the stretcher in the cold room until disposed off.

Ideally, one body cabin is better than two or three bodies in one cabin which can lead to in-efficient working and occasionally to the confusion of one body with another. As a general rule, four cold storage cabins for each hundred beds in hospital is quite sufficient, excluding any provision for special circumstances like disaster, with some allowance for epidemics and the possibility of major accident. Within the cold storage area doors should be wide enough to allow easy entry and exit of corpses. The room should lead to the entrance area into the autopsy room. It is better to have a room with cold storage on each side, opening into a central wide area. Each cold storage door should bear a holder for an identification ticket. The name of the deceased should be written on a board on the wall of the room which lists each cold storage compartment. The temperature of the cold storage room must be kept at + 4 Degree Celsius.

It is the job of the technician to ensure that this temperature is maintained. It should not be allowed to fall bellow 0 Degree Celsius freezing point, because this will cause ice to form in the body tissues and the cells will be destroyed. Any subsequent microscopic examination of tissues that may be required after the autopsy will then be of little value. In case the body becomes frozen, there should be a boiler in the mortuary to provide hot water to defreeze the body. The frozen body become stiff and solidified and is difficult to conduct autopsy on it. To preserve the body for long periods, it must be deep-frozen. Therefore one compartment must be kept at-20 Degree Celsius. This is also helpful to store the decomposed body, which reduces the fowl smell. The body should not be put into this cabin until the autopsy has been carried out, the tissues taken for histological examination. Before a body is placed in the -20 Degree Celsius compartment, a linen sheet should cover the metal tray on which the body is to lie. If this is not done, the body may adhere firmly to the tray and be difficult to remove.

Disposal of dead body

1. Death occurring in the Hospital

Once the death occurs in hospital ward or casualty, the doctor (registered medical practitioner) who has attended the deceased in his last illness should issue the death certificate in a prescribed format issued by the government. Ideally there should be 4 to 5 copies of death certificate for non-medicolegal case and medicolegal case respectively

  • for relative,
  • for medical record,
  • for municipal board for issue of formal death certificate,
  • for autopsy request if required,
  • for police, if M.L.C.

In AIIMS the death certificates are made in two copies for non-M.L.C. and in three copies for M.L.C. One copy is given to the relatives and one is retained by the hospital which is forwarded to municipal body. The third copy for M.L.C. is given to police. The doctor is legally bound to report all the medicolegal deaths to the nearest magistrate or police officer in the jurisdiction (S 29 Cr.P.C)8. All bodies (M.L.C. and non-M.L.C.) are kept in the mortuary cold storage till it is handed over to the relatives or the police. The doctor on duty or nurse on the behalf of the doctor should intimate the mortuary technician and send the body to mortuary along with a copy of death certificate. The body should be transported by stretcher. It should be covered by a shroud and then wrapped in a sheet. A standard label must be fixed to the winding cloth over the upper part of the body, so that when it is taken out of the mortuary cold storage room, head first identification is easy.

The death certificate and the label should be marked “M.L.C.” in bold letters for medicolegal cases. The label should have the following information on it: Patient’s name, address, the age and sex, hospital registration number, date and time of death and when the body was placed in the mortuary cold storage. The body should also have identity wrist bands, which serves as a ready means of identification.

The best label in a plastic waterproof type that clips on the patient’s wrist. It should carry as much information as possible, but should always include the patient’s full name, age and hospital registration number. The surname alone is inadequate. There maybe three or four corpses bearing the same surname in the mortuary at any one time. This can lead to serious confusion. As per Punjab police rules (25:37;5)7 in case of M.L.C. bodies it states that two police officer who have seen the dead body in the position in which it was found, and are competent to detect any attempt at substitution or tampering with the body or its coverings, shall accompany the body to the mortuary and remain in charge of it until examination is complete. If necessary an additional guard shall be supplied by the lines officer to place a sentry on the mortuary. The officer who have accompanied the body from the spot shall hand it over personally to the medical officer conducting the postmortem examination together with all reports and articles sent by the investigating officer to assist the examination and shall receive and convey to the investigating officer the postmortem report. This rule is followed in Delhi, Punjab, Haryana and Himachal Pradesh. Also the identification of the body is the duty of the relatives and the investigating officer. Further, Punjab police rule (25:37;6)7 states that as soon as the civil surgeon has intimated that his examination is complete, the police shall, unless they have received order from a competent authority to the contrary, hand over the body to the deceased relatives or friends. If there are no relatives or friends, or they decline to receive it, the police shall decide wherein the body to the buried or burnt according to the rules framed in this behalf by the district magistrate. The mortuary technician should also make sure that is identified beyond doubt by police and relatives before handing over the body to them. In case of Non-M.L.C. bodies it is kept at the risk of the relatives concerned. The hospital shall not be responsible for any decomposition or other physical changes in the body, which could happen due to sudden current failure or contamination with other bodies in spite of all precautions. The risk should be properly explained to the relatives.

2. Death occurring outside hospital

The non-M.L.C. bodies from outside maybe permitted to be kept in the mortuary for storage on the request of the relatives on the following conditions:

  • Cold storage room must be in working condition.
  • Space must be available for the body.
  • Proper application along with a copy of death certificate, embalming certificate, if embalmed and no objection certificate from police.

The body shall be kept at the risk of the concerned relatives. In case of the M.L.C. the investigating officer should come with an application along with a copy of death certificate. As mentioned before the body shall be kept under the in charge of the police till the postmortem examination is conducted and handed over to the relatives. In AIIMS the permission for keeping the body is granted by resident doctor of forensic medicine during duty hours and by the duty officer in charge of the hospital administration after the duty hours. The body should be handed over to the police or relatives after proper identification.


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