Mortuary PWS.pdf

March 2019

MILITARY COMMUNITY AND FAMILY POLICY

STANDARDS FOR DOD MORTUARY

FACILITIES AND FOR DRAFTING A

PERFORMANCE WORK STATEMENT

(PWS) FOR DOD CONTRACTED

MORTUARY SERVICES

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Contents

1. Introduction

2. General Information

2.1. Authorized Personnel:

2.2. Licensed Embalmer:

2.3. Unlicensed Assistant:

2.3.1. Tasks authorized to be performed by unlicensed assistants under the authority of a licensed embalmer:

2.3.2. Tasks authorized to be performed by unlicensed assistants under the direct supervision of a licensed embalmer:

2.3.3. Tasks specifically not authorized to be performed by unlicensed assistants:

2.4. Time allotted for services:

2.4.1. Time allotted to initiate services:

2.4.2. Time allotted to perform services:

2.5. Hours of operation:

2.6. Area of performance:

2.7. Quality Control or Quality Assurance:

2.7.1. Quality Control Plan:

2.7.2. Quality Assurance Plan:

2.8. Physical Security:

3. Classification of Remains Standards

3.1. General:

3.1.1. Viewable

3.1.2. Viewable for Identification

3.1.3. Non-viewable

4. Embalming Standards

4.1. General:

4.1.1. Insect Treatment

4.1.2. Disinfecting

4.1.3. Washing

4.1.4. Body Positioning

4.1.5. Damaged Tissue

4.1.6. Dressing Remains

4.1.7. Grooming

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4.1.8. Cosmetics

4.1.9. Setting Features

4.2. Preparation of Un-embalmed Remains:

4.3. Preparation of Viewable Remains:

4.3.1. General

4.3.2. Treatment of Scalp (Viewable Remains)

4.3.3. Mutilated Hands (Viewable Remains)

4.3.4. Wounds, stains and discolorations

4.4. Preparation of Non-viewable Remains

4.4.1. General

4.4.2. Non-viewable with Full Body Wrap

4.4.3. Full-body Wrap Procedure

4.4.4. Non-viewable Head Wrap

4.5. Preparation of Autopsied Remains:

4.5.1. Internal Organs (Viscera)

4.5.2. Cranial Cavity and scalp

4.6. Embalmer Evaluation:

4.7. Quality Assurance Evaluation:

4.7.1. Contracted Facility

4.7.2. Corrective Action

4.7.3. DoD Mortuary Facility

5. Casketing Standards

5.1. General

5.2. Placement in Casket

6. Transportation of Remains

6.1. General:

6.1.1. Un-embalmed remains

6.1.2. Embalmed remains

6.1.3. Remains movement and transportation vehicle

6.2. State, Territory, Local, or International Authority-issued Permits and Certificates

6.2.1. Transit, Burial, Cremation Permits and Certificates

6.2.2. Death Certificates

6.3. Removal:

6.4. Employee Attire:

6.5. Overland transportation of casketed remains:

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6.5.1. Preparing for transport

6.6. Overland Transport of Non-Casketed Remains:

6.7. Transportation of Casketed Remains on a Common Carrier:

6.8. Sheltering of Remains:

7. Cremation

7.1. Facility Pre-Inspection:

7.2. Payment for Cremation Services:

7.3. Remains for Cremation:

7.3.1. Subsequent Remains – PADD/PAED Disposition

7.3.2. Subsequent remains - Military Service disposition

7.3.3. Cremation of Unidentified Subsequent Portions

7.4. Crematorium and cremation procedures:

7.4.1. Receipt and verification of remains within the cremation container at the crematorium

7.4.2. Sheltering of remains for cremation

7.4.3. Remains Accountability

7.4.4. Processing Cremated Remains

7.4.5. Inurnment of cremated remains

7.4.6. Release of cremated remains

7.4.7. Release Documentation

7.5. Crematory Operation:

8. Facility Standards

8.1. General:

8.1.1. Minimum Requirements – General

8.1.2. Minimum Requirements – Plumbing Connections

8.1.3. Minimum Requirements – Lighting and Ventilation

8.1.4. Minimum Requirements – Flooring, walls, ceiling, doors, and windows

8.1.5. Minimum Requirements – Equipment and Supplies

8.1.6. Minimum Requirements – Access and Privacy

8.1.7. Minimum Requirements – Sanitary conditions and permitted use

8.1.8. Minimum Requirements – Waste disposal

8.1.9. Minimum Requirements – Signage

8.1.10. Maintenance

9. Health and Safety Standards

9.1. General

9.2. Required Plans and Programs

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9.3. Housekeeping Plans and Maintenance:

10. Policy Requirements. (DoD Facility only)

11. Records Management and Release of Information

11.1. General:

11.1.1. Written Policies and Procedures

11.1.2. Functional Records Managers or Custodians

11.1.3. Records Storage, Preservation, Retirement or Disposal:

11.1.4. Record Preparation and Maintenance

11.1.5. Release of Information

11.1.6. Photographic Records and Practices

11.1.7. Public Affairs Support

APPENDICES

Appendix A- Commercial Item Descriptions

Items

Metal Interment/Entombment Casket

Hardwood Interment /Entombment Casket

Cremation Caskets

Alternative Cremation Container

Infant, child, youth containers

Shipping Containers (Air Tray or Equivalent)

Urns

Protective Carrying Case for Urn

Military Emblems

Appendix B- Classification of Defects

Classification of Metal Casket Defects

Classification of Hardwood Casket Defects

Classification of Metal Urn Defects

Appendix C – First Aid Kits and Required Supplies

Appendix D – Performance Work Statement (PWS) [Template]

1. Introduction This document establishes the DoD standards for operation of DoD facilities providing mortuary services, and funeral homes under contract for DoD mortuary services, and shall apply to all Military Service components. The Defense Federal Acquisition Regulation Supplement (DFARS) includes clauses unique to the procurement of mortuary services (252.237-7003 through 252.237-7009, and 252.237-7011).

Contracting Officers must utilize the standards contained herein and the PWS Template in Appendix D when contracting for mortuary services. The standards contained herein are not applicable to deaths where the person authorized to direct disposition (PADD), or where the person with authority to effect disposition (PAED) elects to make all arrangements for the disposition of remains.

2. General Information This document provides a description of services for use by both DoD mortuary facilities and funeral homes contracted by DoD to provide mortuary services. This section also provides clear guidance on the tasks that may be performed by an unlicensed preparation room assistant or embalmer assistant and which tasks require a license within a DoD mortuary facility. Contracted facilities will work within their licensing authority or within the DoD PWS whichever is more stringent. DoD facilities or DoD contracted facilities will comply with all existing, international, host nation, federal, state, territory, and local licensing requirements and regulatory standards applicable in the area of performance.

2.1. Authorized Personnel:

The preparation of a human remains for final disposition shall be performed with respect to the confidentiality for the deceased and wishes of the family. The following types of personnel may be authorized by management to be present in the preparation room while a human remains is being embalmed, washed, or otherwise prepared for final disposition:

(1) Licensed embalmers; and unlicensed assistance as defined in this document.

(2) Licensed and registered interns/apprentices/students as defined by State Licensing Boards

(3) Public officials or representatives in the discharge of their official duties; and

(4) Licensed medical personnel

Contracted Licensed funeral homes may work with family and friends of the deceased to allow for their participation in washing and dressing of the body in a private location other than the preparation room of the funeral home if their state law allows to accommodate religious practices. This section does not apply to Air Force Mortuary Affairs Dover.

2.2. Licensed Embalmer:

For the purposes of this document a licensed embalmer is a person licensed by a state board or certified by a Funeral Service Board as an embalmer or as an embalmer intern or apprentice. A licensed embalmer is required for the application or injection of an embalming chemical solution. The application or injection of an embalming chemical solution is required for the following embalming procedures and require a licensed embalmer: vascular embalming, cavity embalming, hypodermic embalming, and surface embalming, cleaning, dissection and treatment of viscera. A licensed embalmer is also required when performing restorative arts for areas that are visible outside the decedent’s uniform or clothing (head, neck and hands).

The licensed embalmer will also perform all tasks to temporarily preserve and sanitize the deceased and to restore the remains to an acceptable physical appearance. A licensed embalmer is required to complete all tasks associated with performing a head wrap. A licensed embalmer and a licensed intern or apprentice must follow the terms of the licensing authority or certification board of the state that issued the license or certificate. The Military Service is responsible for verifying that the mortuary director and embalmers have valid licensure to perform the tasks required for their position. The licensure will be reviewed at least annually and upon initial assignment. The director and embalmers are responsible for maintaining a current license in accordance with their state licensing authority. No DoD employee will perform embalming to include the application of chemicals externally, internally, or both unless they possess a current license to embalm from a U.S. state licensing authority.

2.3. Unlicensed Assistant:

The use of unlicensed personnel to assist an embalmer or funeral director is only authorized as specified in this document.

Contract funeral homes must comply with applicable federal, state, local, or jurisdiction laws in which the contract funeral home is located when using unlicensed personnel to assist the embalmer or funeral director in the performance of their duties. Contracted facilities may use interns (apprentices) in accordance with applicable state regulations.

DoD mortuary facilities may certify unlicensed personnel who have completed Service approved training programs and required health and safety training to perform work as a preparation or embalming room assistant under the direct supervision of a licensed embalmer unless stipulated otherwise in this document.

The list below is the minimum training that DoD personnel will complete prior to working in a DoD mortuary facility.

a. Blood borne Pathogens Training

b. Fire Extinguisher Training

c. Formaldehyde Training

d. Respiratory Protection Training

e. Hazardous Communications Training (Spill Control etc.)

f. Hearing Protection Training

g. Service Approved Training Program

h. Exposure Control Training

2.3.1. Tasks authorized to be performed by unlicensed assistants under the authority of a licensed embalmer:

The following tasks may be performed by an unlicensed assistant under the authority of a licensed embalmer after receiving the required Service or Military Occupation Specialty training: stocking preparation rooms with supplies, sanitizing instruments and equipment, removing biohazardous waste, draping closed caskets with a flag, placing closed casket into an air tray or other protective enclosure, securing documents necessary for shipment of remains overland or through the air either CONUS or OCONUS and other administrative activities associated with shipment of remains to the place designated by the PADD or PAED.

2.3.2. Tasks authorized to be performed by unlicensed assistants under the direct supervision of a licensed embalmer:

The following tasks may be performed by an unlicensed assistant who has received the required training in

2.3. when under the direct supervision of a licensed embalmer: removing remains from place of death and transporting to a mortuary facility, performing work as a remains handler to move remains throughout workstations in a mortuary, cleaning and dissecting viscera, suturing below the neck, preparing remains for large and small scale cavity fluid packs for the application of chemicals by the licensed embalmer, removing large and small scale cavity fluid packs, cleansing and drying remains, placing protective barriers over wounds and or sutures to prevent leakage, performing actions described in this document for a full body wrap, dressing remains in protective garments, underclothes, and uniforms or other clothing as directed by the PADD/PAED, and placing remains in a casket. Additional activities that may be performed by an unlicensed assistant or person holding a appropriate license (e.g. cosmetologist, hairdresser, barber), include the application of cosmetics and the styling or cutting of hair to comply with Branch of Military Service grooming standards or to meet styling preferences directed by the PADD/PAED.

2.3.3. Tasks specifically not authorized to be performed by unlicensed assistants:

An unlicensed assistant may not perform any tasks identified in paragraph 2.2. and any other tasks prohibited by the state of the licensee responsible for the preparation of the remains. The utilization of unlicensed assistants for the preparation of remains will be at the discretion of the licensee.

2.4. Time allotted for services:

2.4.1. Time allotted to initiate services:

The DoD mortuary facility or contracted facility will furnish the materials ordered and perform the services specified by the contracting officer or designee as promptly as possible. The DoD mortuary facility or contractor will initiate the services not later than 24 hours after (1) receiving notification to remove the remains, or (2) after the remains have been released to U.S. Government control.

2.4.2. Time allotted to perform services:

The time allotted to perform embalming and restoration work shall be based upon the condition of the remains and procedures necessary to restore the remains to a condition that facilitates viewing and on the volume of work at the facility. At no time will pre-set time restrictions be placed on the amount of time a DoD or contract embalmer can take to restore remains to a viewable state. NOTE: It is not unreasonable to expect an embalmer to spend several hours suturing extensive amounts of lacerations and wounds or working to restore the head/face to a condition that facilitates viewing. However, the contracted or DoD facility will notify the Military Service mortuary affairs office if the procedure will take more than 24 hours to complete services (this does not include post embalming surveillance). The Military Service mortuary affairs office will keep the PADD/PAED informed on the time required to prepare the remains. The mortuary case file will be updated to reflect when the time required to prepare the remains is in excess of the 24 hour time limit.

2.5. Hours of operation:

DoD facilities must be able to receive remains 24 hours a day. The Standard Operating Procedures or other document must indicate procedures for receiving, securing remains outside of normal operating hours.

The PWS for DoD contracted mortuary services must address the hours of operation and Government initiated work outside normal hours.

2.6. Area of performance:

The area of performance is determined by geographic boundaries. The mortuary services contract applies to the resourced services required by the Military Services. The other determining factor is whether or not transportation changes for removal or delivery of the remains, may be incurred. (See DFARS 252.237.7004)

2.7. Quality Control or Quality Assurance:

2.7.1. Quality Control Plan:

The contractor shall have an effective Quality Control Plan (QCP) to ensure their facility meets approved standards and the services are performed in accordance with contract requirements. The contractor shall provide the QCP to the COTR for acceptance not later than thirty (30) calendar days after award. The COTR will notify the contractor of acceptance or required modifications to the plan. The contractor shall make appropriate modifications and obtain acceptance of the plan within thirty (30) calendar days from the date of award. The QCP shall include the following minimum requirements.

2.7.1.1. Contract and Task Order Number

2.7.1.2. Description of processes and controls used to verify acceptable performance.

2.7.1.3. Contractor developed metrics used to verify performance level of each task order objective.

2.7.1.4.

numerical figures used to calculate the % or reportable outcome.

2.7.1.5. The Task Order Objectives, associated Standards, metrics, and quantitative values for each metric shall be reported in accordance with the PWS.

2.7.1.6. Description of the methods to be used for identifying and preventing defects in the quality of service performed.

2.7.1.7. Description of the records to be kept to document inspections and corrective or preventative actions taken.

2.7.1.8.

2.7.2. Quality Assurance Plan:

The Government will evaluate the contractor’s performance for the contract and task/delivery orders awarded. For those tasks listed in the Performance Matrix, the COTR or other designated evaluator will follow the method of surveillance specified. Government personnel will record all surveillance observations.

When an observation indicates defective performance, the COTR or other designated evaluator will require the contractor manager or representative at the site to initial the observation. The initialing of the observation does not necessarily constitute concurrence with the observation. It acknowledges that the contractor has been made aware of the non-compliance. Government surveillance of tasks not listed in the Performance Matrix or by methods other than those listed in the Performance Matrix (such as provided in the Inspection clause) may occur during the performance period of this task order. Such surveillance will be done according to standard inspection procedures or other task order provisions. Any action taken by the contracting officer as a result of surveillance will be according to the terms of the contract or task orders.

Therefore, the Government reserves the right to perform inspections to ensure facilities, supplies and services conform to approved and prescribed requirements as set forth in this document and the PWS. The goods and services purchased from the contracted facility or provided by a DoD mortuary facility will meet or exceed the standards contained within this document. Caskets and urns must meet the requirements of Subpart 225.1 Defense Federal Acquisition Regulation (DFAR).

DoD mortuary facilities will establish a Quality Assurance (QA) Plan to provide guidance on the implementation of the quality assurance procedures outlined in this document. The QA Plan shall contain at a minimum:

2.7.2.1. Description of processes and controls used to verify acceptable performance. (must specifically address the following areas: personnel, grounds, equipment, motor vehicles,

2.7.2.2. Review Plan and Schedule -The frequency of surveillance, and minimum acceptable defect

2.7.2.3. Problem Resolution and Corrective Action (Procedures for reporting deficiencies, tracking,

2.7.2.4. Tools, Techniques and Methodologies- (include: Maximum time to correct a noted

2.7.2.5. Reporting requirements.

2.7.2.6. Metrics used for verifying that standards are met.

2.7.2.7.

2.8. Physical Security:

A DoD Mortuary Facility or contracted facility providing mortuary services will be secure and areas where remains are received, stored, or processed will not be accessible to the public. When a DoD mortuary facility or contracted facility has the ability for the family to view the remains, this area will be clean, orderly, and conform to OSHA standards for viewing remains. DoD Mortuary Facilities and contracted facilities must have controlled access with appropriate signage posted on all entrances that comply with OSHA standards, applicable laws, regulations, ordinances and codes. DoD Mortuary Facilities will have a written and implemented policy or standard operating procedure, signed within the last two years covering facility security.

3. Classification of Remains Standards

3.1. General:

The embalmer will make a recommendation to the Military Service representative regarding the view ability of the deceased. Remains will be classified in one of three categories: viewable, viewable for identification, or non-viewable. Every attempt will be made to restore remains to a natural form and color that permits the person with the authority to direct or effect disposition to make the decision on whether the remains are to be viewed or not. The manner in which the remains are to be prepared will take into consideration cultural and religious customs and traditions of the deceased as well as the PADD’s preferences.

3.1.1. Viewable.

Remains are considered viewable when the face and hands have only minor or no trauma, edema, dehydration, or discoloration. Remains may be fully restored to a natural color or form. Condition of the remains allows for dressing in a uniform or other clothing selected by the PADD or PAED.

3.1.2. Viewable for Identification.

Remains may or may not be fully intact with face and hands that may have trauma, edema, dehydration, or discoloration. Although remains may be missing limbs or have received other trauma, condition of remains allows for dressing in uniform or other clothing selected by the person with the authority to direct or effect disposition. Remains may be restored to an appearance suitable for visual recognition.

3.1.3. Non-viewable.

Remains may or may not be fully intact; and may manifest extreme trauma, edema, dehydration, discoloration, or decomposition. Remains may not be able to be restored to an appearance suitable for visual recognition. Condition of remains may not allow for dressing in uniform or other clothing selected by the PADD or PAED.

3.1.3.1. Head Wrap.

Remains are categorized as such when they are categorized as non-viewable with the face or head having severe trauma, edema, dehydration, or discoloration such that restoration to a condition of viewable recognition is not possible. However, the condition of remains allows for dressing in uniform or other clothing selected by the person with the authority to direct or effect disposition. The head wrap will be accomplished IAW paragraph 4.4.4.

3.1.3.2. Full Body Wrap.

Remains categorized as non-viewable. The remains may not be intact or may have sustained severe trauma, edema, dehydration, or discoloration where restoration to a condition of viewable recognition is not possible and the remains cannot be dressed. In this situation the remains will be prepared using a full body wrap. The full body wrap will be accomplished IAW paragraph 4.4.2. and 4.4.3.

4. Embalming Standards

4.1. General:

DoD Mortuary Facilities and facilities under contract to provide DoD mortuary services will prepare and embalm the remains of all entitled personnel in accordance with the written instructions of the PADD/PAED and in accordance with law. The embalmer will verify PADD/PAED elections prior to beginning the preparation and embalming of the remains. No remains will be embalmed without written or oral instructions as outlined below. Oral instructions may be accepted if confirmed by the Military Service Casualty or Mortuary Affairs Office representative, however, follow-on written authorization must be obtained prior to the release of the remains, subsequent remains or retained organs. The Mortuary Officer will note in the case file who provided the oral instructions and when (date and time) they were provided.

The written authorization will be obtained at the first reasonable opportunity and uploaded into the case file. Pre-death directives authorizing embalming, duly executed by the deceased, shall be given full legal effect and shall constitute an effective authorization to embalm. Human remains prepared at a DoD Mortuary Facility or contracted facility may not receive final disposition for an extended period of time (10 or more days), and may have been subjected to extreme trauma, weather conditions, or have been transported over long distances. Therefore, all remains, whether viewable or non-viewable, require variations in preservation techniques and procedures to accomplish maximum disinfection, preservation, and restoration of all body tissues. The following procedures will be accomplished in the course of processing or reprocessing all viewable remains, and to the extent possible for non-viewable remains.

4.1.1. Insect Treatment.

Maggots and other insect larvae shall be destroyed and removed, and their breeding sites in or on the remains thoroughly treated with an appropriate chemical.

4.1.2. Disinfecting.

All body orifices shall be treated with a non-astringent disinfectant chemical.

4.1.3. Washing.

All body surfaces will be thoroughly washed with warm water and germicidal soap. Special attention will be given to the viewable surfaces, i.e. the face and hands.

4.1.4. Body Positioning.

The body will be positioned to appear comfortable and restful. The head will be positioned straight, without any turn, and hands will be positioned left over right. Deviation will be dependent upon the conditions of the remains at the discretion of the embalmer.

4.1.5. Damaged Tissue.

The embalmer will determine when during the preparation process ulcerated, burned, and necrotic tissue, and/or bedsores, shall be excised and/or treated either by hypodermic injection or by cavity pack application of deodorizing/preserving chemicals. All excised tissues will be retained with the remains and not disposed of as medical waste. The excised tissue will be treated with the organs and placed in the body cavity.

4.1.5.1. Prevent Leakage.

All lacerations, penetrating wounds, and autopsy incisions shall be sutured closed to prevent leakage. In cases where there has been significant loss of tissue due to dismemberment, blast damage or charring and the tissue is unable to be closed, the embalmer will ensure exposed tissue is thoroughly embalmed, dried and packed with drying powders and secured with an absorbent material to prevent leakage and facilitate dressing in uniform or clothing provided by the PADD.

4.1.5.2. General full body wrap guidance.

The use of full body wraps as prescribed in this document will be utilized as a last resort in cases where viewing would not be possible (e.g. severe charring of the upper torso and head, decapitation of the head, severe crushing of the head, uncontrolled odor caused by decomposition, etc.). The DoD facility or contractor cannot justify the use of full body wrap to just prevent leakage or to address missing limbs. There are procedures and supplies available for use by the preparing embalmer to prevent the leakage of bodily fluids onto the uniform, and to address missing limbs.

4.1.5.3. Communication required with full body wrap.

The recommendation for the use of a full body wrap must be a collaborative effort between embalmer and Branch of Service liaison/case manager. Whenever possible, the Branch of Service liaison/case manager must view the remains and discuss preparation procedures with the DoD or contract embalmer so that they can effectively communicate condition of remains and reason for the recommendation of a Full Body Wrap with the PADD. The final decision for the use of the Full Body Wrap in circumstances as described in paragraph 4.1.5.2. rests with the most senior licensed embalmer with supervisory responsibilities over the embalmers at the DoD mortuary facility, or the signatory on the contract for DoD mortuary services provided by a civilian mortuary facility. All communication among the preparing embalmer, Branch of Service liaison/case manager and the PADD shall be documented in writing and entered in the appropriate mortuary case file.

4.1.6. Dressing Remains.

The PADD/PAED will be consulted and provided the opportunity to determine the clothing the deceased is to be dressed, or which is to be displayed upon the top of wrapped remains, as the situation dictates.

The contract funeral home or DoD facility providing mortuary services will be provided the clothing selected by the PADD/PAED, or will be provided a uniform by the Military Service. Prior to dressing, all remains will be placed in a white, opaque, or clear leak proof protective undergarment (one-piece plastic garment used to cover the entire body from the neck down to include the feet). Drying powder and/or preservative powders will be placed inside the protective undergarment to absorb any possible leakage or odors.

4.1.7. Grooming.

Military personnel who are dressed in their service uniform will be groomed in accordance with Military Service regulations and standards. Male facial and scalp hair shall be washed and groomed to conform to military standards; suitable hair preparation shall be accomplished for females to conform to military standards. If the PADD requests other accommodations, the preparing mortuary will consult with the appropriate Military Service to ensure compliance with Military Service standards. Fingernails shall be cleaned and trimmed. When the PADD has requested that the Service member not be dressed in the service uniform, the mortuary representative will check with the PADD to determine the correct attire. For non-military personnel, the Military Service mortuary representative will check with the family to ascertain personal preferences.

4.1.8. Cosmetics.

Cosmetics shall be applied only in the amount necessary to produce natural color and texture. For female Service members the cosmetics will conform to military standards unless expressly requested otherwise in writing by the PADD.

4.1.9. Setting Features.

The mouth will be securely closed by needle injector, muscular or mandibular suture, where the lips abut to form a natural expression. The eyes shall be securely closed by the use of eye caps or other appropriate means, with proper attention given to prevent wrinkling of the eyelids and a sunken appearance.

4.2. Preparation of Un-embalmed Remains:

When the PADD/PAED has requested the deceased, be prepared for shipment to the receiving funeral home without embalming, the preparing mortuary will evaluate the condition of the remains and determine the feasibility of complying with the request based upon local and national regulations or laws at the place of origin and destination, and any restrictions imposed by available transportation methods, such as air, train or hearse. Unless prohibited by law, regulation, or the availability of transportation options, the preparing mortuary will prepare un-embalmed remains IAW paragraphs 4.1.1 through 4.1.9. above to the extent possible in IAW religious preparation practices or other preferences as directed by the PADD/PAED. This section applies to subsequent remains recovered and identified after mortuary processing or interment/inurnment has occurred.

4.3. Preparation of Viewable Remains:

4.3.1. General.

To obtain optimum results, a thorough pre- embalming case analysis will be completed by the embalmer utilizing the number of arterial injection sites necessary to ensure proper distribution of fluid. The only exception to this requirement is in the absence of a limb or the head. The arterial chemical solution injected into the remains shall contain a minimum 5% concentration, by volume, of formaldehyde or isomer of formaldehyde derivative preservative agent(s). The total volume of arterial solution injected shall not be less than 1 gallon per 50 pounds of body weight. Unless the decedent is edematous, a humectant must be added in equal volume to the arterial chemical, in the total fluid solution injected into the head and arms. It is permissible for a humectant based arterial chemical to be used in lieu of humectant additive being incorporated into the total fluid solution. For non- autopsied cases, the thoracic, abdominal, male genitals, and cranial cavities shall be thoroughly aspirated and injected with full-strength cavity chemicals having a 36-index (%) or greater. A minimum of 16 ounces of cavity chemical must be injected into the thoracic cavity, and a minimum of 16 ounces in the abdominal cavity and male genitals, and a minimum of 2 ounces of cavity chemical to ensure preservation of contents of the cranial cavity, having a 36-index (%) or greater.

Hypodermic injections, packs, or other special treatments shall be accomplished, as required, to assure the disinfection and preservation of all body tissues. A suitable cream or lotion shall be applied on the face and hands to prevent dehydration.

4.3.2. Treatment of Scalp (Viewable Remains).

If the scalp was shaved because of medical treatment or surgery, processing or reprocessing shall be accomplished as specified for viewable remains, after which the cranium shall be wrapped with gauze or equivalent in a neat and professional manner. The Military Service retains the ability to use an authorized uniform hat or beret, in lieu of gauze wrap. For remains requiring a partial head wrap the remains will be prepared IAW paragraph 4.4.4. The embalmer will ensure the tissue is firm, dry, and thoroughly preserved.

The wrapping will be accomplished IAW paragraph 4.4.4., but will be limited to covering the affected area of trauma providing the possibility of viewing if desired by the person with authority to direct or effect disposition.

4.3.3. Mutilated Hands (Viewable Remains).

When the hands are mutilated, to the point that restoration is not possible, or discolorations are present that cannot be cleared, the hands shall be treated in a manner which shall render all tissue firm, dry, and thoroughly preserved. The hands, regardless of condition, will then be placed in opaque, leak proof gloves followed by white (military) cloth gloves.

4.3.4. Wounds, stains and discolorations.

All lacerations, abrasions, incisions, excisions, and burn wounds shall be sealed and/or sutured to prevent leakage. Swollen or distorted features shall be reduced, if possible, to the normal contours. Applying packs and/or needle injection may be used to chemically bleach ante mortem/postmortem stains. On viewable areas, masking cosmetics may be used to render stains/discolorations non-detectable.

4.4. Preparation of Non-viewable Remains.

4.4.1. General.

To obtain optimum results, a thorough pre- embalming case analysis will be completed. Each gallon of arterial fluid shall contain a minimum 10% concentration, by volume, of formaldehyde or isomer of formaldehyde derivative preservative agent(s).

4.4.1.1. Preservation treatment.

The total volume of arterial solution injected shall not be less than 1 gallon per 50 pounds of body weight.

All body areas shall be further treated by means of hypodermic injection using undiluted cavity chemicals having a 36-index (%) or greater. In addition, packs, special gels and/or dry sanitizers shall be used, as required, to ensure preservation, prevent leakage, and eliminate all offensive odors.

4.4.1.2. 4.4.1.2. Cavity and genital treatment.

The thoracic, abdominal, male genitals, and cranial cavities shall be thoroughly aspirated and injected with full-strength cavity chemicals having a 36-index (%) or greater. A minimum of 16 ounces of cavity chemical must be injected into the thoracic cavity, and a minimum of 16 ounces in the abdominal cavity and male genitals, and a minimum of 2 ounces of cavity chemical to ensure preservation of contents of the cranial cavity, having a 36-index (%) or greater.

4.4.1.3. Procedure when arterial injection and/or cavity treatment is not possible.

When arterial injection and/or cavity treatment is not possible, all articulated and disarticulated anatomical portions shall be thoroughly disinfected and preserved via hypodermic injection and accessory chemical embalming techniques. Immersion and/or hypodermic-injection with a trocar and/or syringe and needle, using full strength cavity chemicals 36-index (%) or greater is acceptable. Surface application of liquid, gel, or dry sanitizers and preservatives is also required to supplement primary needle and/or hypodermic injection techniques.

4.4.2. Non-viewable with Full Body Wrap.

Wrapped Remains. Remains that have been processed or reprocessed as outlined in paragraphs 4.3. or 4.4.

and are traumatized to the extent that the remains cannot be dressed, shall be wrapped.

4.4.2.1. Preparation for Full Body Wrap.

Wrapping shall be accomplished as follows: Polyethylene sheeting (5 mil or greater) and a wool blanket shall be furnished by the Military Service’s mortuary representative. The military wool blanket shall be spread on the dressing table with opposing corners at the head and foot ends of the table. The blanket is then covered with white cotton sheet followed by a sheet of polyethylene. Cotton strips are laid down the center of the plastic sheet and liberally coated with a preservative/drying compound (hardening compound).

4.4.2.1.1. Dorsal side preparation.

The dorsal side of the remains shall be liberally coated with a gel preservative followed by a liberal coating of drying compound (hardening compound), and then laid on top of the prepared wrapping material on the dressing table.

4.4.2.1.2. Ventral side preparation.

The ventral side of the remains shall be liberally coated with a gel preservative followed by a liberal coating of drying compound (hardening compound).

4.4.2.1.3. Strips, sheeting and blanket preparation.

Additional cotton strips shall be placed over the remains, completely covering them. The polyethylene sheet is then folded in around the remains IAW paragraph 4.4.2.1. The folding of the polyethylene sheeting, white cotton sheet and wool blanket shall be uniform, with the head and foot ends folded in first.

4.4.3. Full-body Wrap Procedure.

The wrapping material on the left side of the remains shall be folded to the right. The right side then folded to the left side of the remains shall be secured with tape or pins, as applicable and described below. All seams in the polyethylene sheeting shall be sealed with nylon filament packing tape, to ensure no odor and/or fluid is emitted from the wrapping. When necessary, in extreme cases, duplicate layers of polyethylene sheets may be used. The white cotton sheet is then wrapped around the polyethylene-sheathed remains, secured with large safety pins (silver in color, 2-3 inches) placed no more than 4 inches apart. The wool blanket is then wrapped around the white cotton sheet, which shall have as few creases as possible, and secured with large safety pins (silver in color, 2-3 inches) placed no more than 4 inches apart.

A tag identifying the deceased shall be attached to the foot end of the wrapped remains bearing the deceased name, rank, last four of the social security number or DoD identification number, and date of death.

Remains that have been processed or reprocessed as outlined in paragraph 4.4.2. will be draped in the clothing provided by the Military Service mortuary representative.

4.4.4. Non-viewable Head Wrap.

Prior to beginning the wrapping process, all tissue and hair shall be rendered as dry as possible. During the embalming process, the tissue shall be prepared to present as natural a head shape as possible once the head wrap process is complete.

4.4.4.1. Materials.

Required materials to accomplish the head wrap process include: two (2) clear or semi- transparent plastic (.78 mil or greater) liner bags approximately 24” by 23”; 2” white surgical tape or 2” clear strapping tape; 12 yards of 4.5” (sterile or non-sterile) gauze bandage (approx. 3 rolls); cotton prep towels; (sterile or non-sterile) absorbent cotton or absorbent sheet product.

4.4.4.2. Procedure.

Wrapping shall be accomplished as follows: the embalmer will place one clear or semi-transparent bag over the head and tuck down into the full-body, plastic garment, as required in paragraph 4.1.6.

Ensure all air is removed from the bag before it is secured at the base of the neck with tape. Taping the bag around the forehead, over the nose and over the chin may provide a more aesthetically pleasing shape. The embalmer will place a second clear or semi-transparent bag over the head and repeat the above steps, taking care not to lose shape of the facial features, if present.

A minimum of three (3) strips of gauze bandage will be prepared side by side, overlapping .25 inch and centered over the crown of the head extending to the base of the skull and the base of the chin.

The bandage will be tightly stretched and unobtrusively secured by tape. Beginning at the natural hairline on the left side of the head, the embalmer will secure the end of gauze bandage roll.

Once secure, the gauze bandage will be wrapped around the head, overlapping the previous row of bandage by one half the width of the gauze bandage. This is done to ensure no visibility of the underlying plastic bag and to present a neat and professional appearance.

The gauze bandage will continue to be wrapped around the head, down the neck until it reaches the base of the neck and will be secured with white surgical tape. The remains should then be dressed IAW paragraph 4.1.6., ensuring no tape is visible above the collar of the shirt or blouse. Trauma that is isolated to a specific area will be wrapped with gauze or equivalent in a neat and professional manner.

4.5. Preparation of Autopsied Remains:

If a partial or complete autopsy is performed, chemical injection and application with multisite drainage shall be accomplished, using the arterial chemical solutions requirements as specified in 4.3. or 4.4.

Hypodermic-injection of the thoracic and abdominal walls; back, buttocks, male genitals, shoulders, vertebral column with an undiluted cavity chemical having a 36-index (%) or greater is required. The scalp will be injected by syringe and needle with the chemical solution used for the arterial injection.

4.5.1. Internal Organs (Viscera).

Under no circumstances will the service provider dispose of or destroy any internal organs (viscera) or partial remains. The viscera from remains that have had a cranial, thoracic and/or abdominal examination, shall be removed, cut into sections not greater than 2 x 2 inch and immersed in a undiluted cavity chemical having a 36-index (%) or greater, for an appropriate amount of time but typically a minimum of 2 hours.

The inner surfaces of the body cavities shall be given a liberal application of gel formaldehyde or isomer of formaldehyde derivative preservative agent.

The preserved organs are to be placed into the thoracic or abdominal cavities and liberally coated with a formaldehyde or isomer of formaldehyde derivative preservative agent and drying compound (hardening compound).

4.5.2. Cranial Cavity and scalp.

When a cranial autopsy is performed, the vertebral and internal carotid arteries must be sealed, the cranial cavity shall be packed with cotton and drying compound, both in the cranium and the calvarium secured by cranial clamps or wiring. The scalp shall be replaced over the calvarium, the incision will be coated with drying compound and tightly and neatly sutured to avoid leakage and unnatural appearance. The color of the suture cord should blend with the deceased’s hair.

4.6. Embalmer Evaluation:

The DoD or contracted facility embalmer processing or reprocessing the remains shall critically evaluate the completed treatment to ensure all remains are effectively disinfected, uniformly preserved, and will arrive at its destination in excellent condition. The Military Service mortuary representative will authorize delivery or shipment of remains from a contracted facility when assured that the services and supplies furnished by the contractor including the signed DD Form 2062 (Record of Preparation and Disposition of Remains, DoD Mortuary Facility) or the signed DD Form 2063 (Record of Preparation and Disposition of Remains, Contracted Mortuary Facility) meets the PWS, DoD Standards within this document, and commercial item descriptions in their entirety.

4.7. Quality Assurance Evaluation:

4.7.1. Contracted Facility.

Remains will be inspected after embalming, after dressing, and after placement of remains in a casket.

Failure to pass these inspections will require the contractor to remove the remains from the casket and perform one or more of the following services as directed by the contracting officer or designee: additional disinfectant or preservative treatment, re-dressing or rewrapping, or placement of remains in a new casket when the original casket is defective.

4.7.2. Corrective Action.

When the Military Service mortuary representative directs corrective action under this paragraph, the contractor shall perform the corrective measures and other required services again at no additional cost to the Government.

4.7.3. DoD Mortuary Facility.

Remains will be inspected after embalming, after dressing, and after placement of remains in a casket. If the remains do not pass inspection at any point in the process, corrective action will be taken to correct the deficiency and it will be documented in the case file. Additional actions that may be required to correct a deficiency may include any of the following: additional disinfectant or preservative treatment, re-dressing or rewrapping, or placement of remains in a new casket when the original casket is defective.

5. Casketing Standards.

5.1. General.

Caskets specifications are provided in Appendix A. Caskets will meet the specifications outlined in this Appendix and will be checked for defects (Appendix B) prior to casketing of remains. Defective caskets will not be utilized by a DoD Mortuary Facility or a contracted facility providing DoD mortuary services.

5.2. Placement in Casket.

Remains shall be placed in the casket in a manner that will create an appearance of rest and repose. When remains are prepared for transit or shipping, body positioning devices may be placed around the remains to prevent shifting. Only positioning devices available from funeral service suppliers are authorized. A piece of plastic will be placed between the decedent’s head and the pillow. A piece of plastic will be placed under the hands and folded over the top of the hands, for transit, to ensure cosmetics are not transferred onto the uniform or clothing or casket interior. When white gloves are utilized, no plastic is required for the hands. A clean piece of tissue will be placed over the face. The casket shall be of sufficient size to prevent the appearance of crowding and cramping. When an “oversize” casket is used, the preparing facility will notify the Military Service mortuary representative.

6. Transportation of Remains

6.1. General:

6.1.1. Un-embalmed remains.

When un-embalmed remains are transported they shall be wrapped in a sheet that is impervious to liquids, covered in such a manner that the body cannot be viewed, encased in a secure pouch, and placed on a cot, stretcher, or rigid tray and carried feet first. When un-embalmed remains are transported by air the remains will be placed in a transfer case after being placed in a secure pouch.

6.1.2. Embalmed remains.

When embalmed remains are transported they must be enclosed in a casket or alternative container and an appropriate outside shipping container (as applicable). All applicable regulations and policies of the jurisdiction and carrier must be followed.

6.1.3. Remains movement and transportation vehicle.

The remains must be transported in a means that promotes respect for and preserves the dignity of the deceased and shields the remains from being viewed from outside of the conveyance. The capacity of the transportation vehicle must be sufficient to permit loading and unloading of the remains without excessive tilting of the cot, stretcher, rigid tray, casket, alternative container, or cremation container, and to allow the remains to remain in a horizontal position during transport. The remains will be secured to prevent the remains or container from excessive movement within the conveyance during transport.

6.2. State, Territory, Local, or International Authority-issued Permits and Certificates.

6.2.1. Transit, Burial, Cremation Permits and Certificates.

The preparing contracted facility representative will obtain the necessary permits, licenses, and documentation, issued by the appropriate authority, to remove, inter, cremate, or transport remains (e.g., burial/transit permits, a medical examiner cremation authorization certificate or a cremation certificate), and provide two copies to the Military Service mortuary representative at the time the remains are inspected and accepted by the Military Service mortuary representative.

DoD mortuary facilities will obtain the necessary permits, licenses, and documentation, issued by the appropriate authority, to remove and transport remains. The mortuary facility will work with the applicable Service Casualty office on any other documents required. In addition to the above requirements, DoD mortuary facilities will comply with DoD policy regarding transportation of human remains, use of contract airlift, military airlift, special assignment airlift mission (SAAM), or commercial air support.

6.2.2. Death Certificates.

The preparing facility representative will submit the necessary information and documents to the appropriate authority authorized to issue death certificates.

The DoD mortuary facility will obtain one (1) certified copy of the death certificate from the issuing authority and will upload this document into the Defense Casualty Information Processing System (DCIPS).

The contracted facility representative will obtain 10 certified copies of the final death certificate from the issuing authority and will provide them to the Military Service mortuary representative or the Military Service Mortuary Affairs Office within 10 business days of it being issued. The Military Service mortuary representative or the Military Service Mortuary Affairs Office will provide certified copies of the death certificate to the family in accordance with policy and Service regulations.

In the event a supplemental/amended death certificate is issued, the DoD mortuary facility will obtain one

(1) certified copy and upload it into DCIPS. The contracted facility representative will provide 10 copies of the supplemental/amended death certificate to the Military Service mortuary representative or the Military Service Mortuary Affairs Office within 10 business days of their being issued.