MODERN MORTUARY

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MODERN MORTURY: 

MODERN MORTURY Dr. Jinesh P. S. 20/06/2012

OUTLINE OF PRESENTATION : 

OUTLINE OF PRESENTATION Introduction Role and functions of mortuary Important judgments & reports Staff pattern by bureau of police research & development Role of an ideal mortuary complex General guidelines Mortuary for a tertiary level Miscellaneous requirements Conclusion and future advancements

INTRODUCTION: 

INTRODUCTION The mortuary is the most neglected and ignored place in all hospitals including medical colleges. It is not having even basic facilities for the departed souls, public and officials working there. F rom the overall expenditure of any hospital, a very minute share is spent on the autopsy facility; it being considered a necessary evil & the overall environment in a mortuary is depressing and gloomy; this situation is further compounded by administrative apathy towards medico-legal work as a whole. Working in a mortuary is an extremely stressful experience which is made worse in India due to the large number of people dying sudden violent deaths due to trauma and the pitiable condition of mortuaries throughout the country.

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New concepts regarding Mortuaries include the need for a change in the way bereaved families are being managed as well as revision of the environment for the staff working in mortuaries Sanctity of the 'dead' is a universal concept and is intimately related to the cultural background of the community. Facilities for safe custody of dead bodies before and after post-mortem are to be provided accordingly. The concept of health of the population from "womb to tomb" in the community health care clearly indicates that in a health care set up, a doctor's duty is not only caring for the living but also in helping to arrange for the disposal of those patients who die.

ROLE AND FUNCTIONS OF MORTUARY: 

ROLE AND FUNCTIONS OF MORTUARY To keep the dead till the relatives claim and take over the body for disposal. To keep unclaimed bodies until disposal To allow viewing and identification by relatives, police and other people. To receive dead bodies requiring pathological post-mortems pending final disposal. To receive dead bodies brought to the hospital for medicolegal post-mortem work and store in the mortuary pending further disposal. For teaching the undergraduates as well as post-graduates.

IMPORTANT JUDGMENTS & REPORTS: 

IMPORTANT JUDGMENTS & REPORTS According to Bureau of Police Research & Development sub-committee report 1975, no teaching hospital should have more than 500 autopsies in a year otherwise teaching activities suffer. In criminal case no. 214 DB of 1997, Justice Amar Dutt & Justice Kiran Anand Lall ( Punjab and. Haryana High Court) on 23.10.2005 have passed orders for ways and means to facilitate better conduction of post-mortems plus medicolegal work The division Bench has observed that orders be served to the States of Punjab and Haryana and Union Territory of Chandigarh The court has also observed, "It may be appropriate if the concerned state communicates the steps taken by it to the sister States so that they do not lag behind."

STAFF PATTERN BY BUREAU OF POLICE RESEARCH AND DEVELOPMENT : 

STAFF PATTERN BY BUREAU OF POLICE RESEARCH AND DEVELOPMENT For initial 100 autopsies per year i ) Specialists-Two (as one specialist is likely to be busy in other important work, teaching work, in court attendance, or if he falls sick, it is necessary to have two specialists). ii) Post mortem technician-One. iii) Post mortem Assistant- One. iv) Clerk/Steno-One. v) Chowkidar - One. vi) Peon- One vii) Sweeper/Morgue attendants-4 (Three sweepers for shift duty round the clock and one as a reliever).

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For every additional 100 autopsies per year i ) Specialist- One. ii) Post mortem assistant - One. iii) Technician- One (for teaching institutions). iv) Technical assistant- (300-500 autopsies/yr)-One,(>500 autopsies/yr)-Two. v) Photographer - One. vi) Dark room attendant- One (on big centers, personnel for photographic work)

ROLE OF AN IDEAL MORTUARY COMPLEX : 

ROLE OF AN IDEAL MORTUARY COMPLEX The services provided by a Forensic facility’s comprehensive morgue and postmortem component are Specimen handling area Administrative functions (documentation of incoming or outgoing bodies report preparation ) Receiving , preparation and temporary storage of cadavers. Investigations into the cause of death by performing a PM examination of the body (including forensic autopsies). The demonstration of PM findings in cases of clinical interest, for teaching or forensic purposes. Mobile radiography. Photography . Family/police viewing and/or identification of the body.

GENERAL GUIDELINES - MINIMUM FACILITIES NEEDED : 

GENERAL GUIDELINES - MINIMUM FACILITIES NEEDED Arrangements for receiving the dead bodies from the hospital or from outside, with separate arrangements for keeping decomposed and infectious bodies (known HIV/hepatitis death cases) etc Arrangements for performing autopsies Handing over the dead bodies after postmortem examination to the relatives/ undertakers through police Postmortem viewing gallery for the students /IO /nominees as per court orders etc Other basic essential requirements like offices and related rooms should have basic facilities like furniture, telephone and other infrastructures

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The design of the teaching mortuary was prepared keeping in view the intake of students in medical college, workload, condition of the various bodies being brought for postmortem examination and to have workable atmosphere as to cleanliness & breathing with fresh air and natural light to be available in each room of the mortuary It should have adequate parking space It should be preferably centrally air conditioned

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The mortuary should be located in a separate building near the pathology laboratory on the ground floor, easily accessible from the wards, accident and emergency departments and operation theatres, in an area with ample natural light through windows; the widows of the principal rooms should preferably be on the northern side. It should be located in one wing of the hospital near the main road, preferably away from major traffic junctions. It must have a separate entrance and exist for relatives.

MORTUARY FOR A TERTIARY LEVEL: 

MORTUARY FOR A TERTIARY LEVEL 1. Veranda should be in front of the faculty office, autopsy surgeon room in which these should open and working windows for the reception room on both sides. 2. Faculty office with an attached toilet. 3. Autopsy surgeon’s room (size 14x20 sq. ft.): where the Autopsy surgeon /medical officer can discuss details of the case with police and relatives and write reports peacefully without any disturbance. 4. Computer Room & Office (12x10 sq. ft): with furniture, computer, printer cum scanner, photography instruments. 5. Stores-1 (12x10 sq. ft) for clean gowns, aprons, rubber gloves, gumboots, towels etc.

6. RECEPTION AND WAITING AREA (Size 240 sq. ft.) : 

6. RECEPTION AND WAITING AREA (Size 240 sq. ft.) It should be easily approachable and due care should be taken to shield if from OPD/ward block This area should be gently illuminated, warm and have comfortable chairs. It should be pleasantly and soberly furnished and decorated with plants and pictures, which would create a pleasant atmosphere, as the last impression of the relatives receiving the deceased is one of quite dignity in death. This area can also be used as prayer area where relatives and friends of all religion may like to offer prayer. A lavatory also must be provided Waiting hall for attendants, police with provisions for a central platform.

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7. Investigating officer /Police Room (10x10 sq. ft.) for the police personnel accompanying the body who has to watch and take care of the dead bodies in the mortuary complex. 8. Veranda/shade for trolley etc. 9. Class IV Rooms (8x10 sq. ft.); it has lockers etc. and used as changing place for them. 10. Toilet for staff. 11. Walled enclosure with gate.

12. PRE AUTOPSY ROOM (16x20sq. ft): 

12. PRE AUTOPSY ROOM (16x20sq. ft) The number of bodies to be accommodated will be taken as three percent of the hospital bed holding Body racks should be refrigerated, with a temperature maintained between 4-6.5°C The chambers should be about 6 ft. wide, 8 ft. 9 inches deep and 6'ft high in which six bodies may be stored in two sets of three tiers. Body in the mortuary should be kept with complete identity

13. A/C PLANT ROOM: 

13. A/C PLANT ROOM Where more than twelve bodies are to be stored, a separate plant room 25-30 sq. ft. may be required, immediately adjacent to the body storeroom. Access for maintenance should be arranged externally so that it is unnecessary to enter the building.

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14. Post Autopsy Room (14x18 sq. ft.): should have a central platform (4x8 sq. ft.) for handing over the body to the investigating officer who subsequently handover the body to the relatives for final disposal after competition of the post-mortem examination. .

15. TEACHING AUTOPSY ROOM I (size 30' × 20) : 

15. TEACHING AUTOPSY ROOM I (size 30' × 20) The size should be at least 400 Sq. Meters or more. This room, like an operation theatre must be kept clean to protect the doctors & staff from bacterial contamination It should have at least two mortuary tables of stainless steel with arrangements for free drainage of a constant flow of water (hot and natural) from top to bottom. A proper vent and duct system for exit of foul smelling gases and entry of fresh air. Each room should have mortuary work station. There should have big windows up to the level of roof with glasses facing the east, south and west, so that the maximum adequate sun light may remain in the rooms. Fluorescent lighting/good concentrated lighting over tables with at least one having tilting mechanism.

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There should be large charts depicting weights and measurements of viscera, bones etc. for quick reference There should be X-ray view boxes for seeing x-ray film etc. Portable x-ray machine should be available. Built in cupboards for keeping instruments and equipments. Water-impervious floors sloping to a drain Tiled walls so that the whole room can be easily washed Suitably covered junctions between the walls and floors Two sinks for clean and dirty work Writing desk and chairs Shelving for jars (and tanks under) for depositing the immediate specimens.

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Space for mortuary trolley Trolleys for shifting dead bodies and adequate furniture Testing bench, accommodating scales, gas, and light with blackboard on wall behind Fans if the room is not air conditioned The viewing gallery for the students shall be constructed around the autopsy tables depending upon their strength in both teaching autopsy rooms. Tiered benches at the sides of the room for observers to visualize and avoid interference The doors should be fly proof. 16. Teaching Autopsy Room II (of same as above). Used when fumigating room 1

17. LABORATORY FACILITIES: 

17. LABORATORY FACILITIES Biochemistry and Microbiology laboratories should be present inside the mortuary complex preferably near the teaching autopsy room Tests for infectious diseases must be compulsory before every autopsy Chemical examination laboratory for quick examination of blood, viscera and urine is very useful

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18. Space for open mortuary /maceration tanks/open research lab; (with roof covered with net) for the decomposed bodies and other ancillary work. This space should be all around both the teaching autopsy rooms so that public cannot have an access to the ongoing postmortem 19. Instrument Room (8x10 sq. ft.): instrument cleaning room to be provided for the thorough cleansing of all numbered instruments / equipments between the two autopsy rooms 20. Viscera Preparation Room (12x10 sq. ft.) where the technician / mortuary attendant can do the assigned job under the supervision of the medical officer

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21. Stores-II (12x10 sq. ft.) for reserve stocks of and chemical solutions for preserving the viscera and packing materials etc. 22. Stairs and side gate. 23. Officer’s toilet; (8x12 sq. Ft.) One separate male and female W.C. lavatory, basin and a shower cubical are needed. 24. Doctors changing room: there must be two changing rooms (12x10 sq. ft. each) having bath with shower for autopsy surgeons and with lockers for male and female officers. 25. Green belt: this is required to make mortuary complex eco-friendly.

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26. Corridors & Verandas’ all around: these will help not only in free movement of the functioning officials in the premises of mortuary but also in cases of emergency of handling of mass disaster cases and will provide more space for decomposed gases to spread and exit. 27. Main Gate; preferably it should be sliding type. 28. Open space for parking for vehicles bringing and carrying the dead body

PROPOSED PLAN FOR A MORTUARY COMPLEX: 

PROPOSED PLAN FOR A MORTUARY COMPLEX

MISCELLANEOUS REQUIREMENTS: 

MISCELLANEOUS REQUIREMENTS a.) Floors: should be hard and durable, moisture resistant and can be easily cleaned. Floor ducts and trenches should be avoided. The junctions between the walls and floors should be suitably covered. (b.) Walls: the walls of the mortuary should be thick, durable and permanent. The walls should be fitted with pale blue color tiles up to the ceiling so that natural colors of the dead body can be appreciate as in day light. (c.) All doors in the mortuary complex should be wide sliding type and fly proof. (d.) Windows: the mortuary should have sufficient natural light. The windows should be preferably on the east, south and west sides whenever possible for receiving maximum sunlight. They should have glass. Windows sills should be at least 5 ft. above the floor and go up to near the ceiling.

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(e.) Corridors: the corridors of the mortuary limit should be wide to allow passage of trolleys. (Not less than 8 ft.) (f.) Air conditioning: the entire complex should be air conditioned with a separate system for the autopsy rooms to prevent foul air permeating the rest of the area. No air should be re-circulated in the mortuary in order to ensure a clean air environment. (g.) Proper disposal of waste: the mortuary complex should have all the arrangements for disposal of different types of waste products. Cleanliness and sanitation in and around the mortuary should be maintained properly (h.) Measurements of the space may be adjusted depending upon the requirements and workload. The mortuary complex must have different sign boards like “No Admission”, “Prohibited Area’ etc.

(i.) LIGHTING: 

( i .) LIGHTING The light fitting should be designed to avoid glare, and should be easy to clean and maintain. In the mortuary either tungsten or florescent lighting can be used. Switches in wet area should be hose proof. Special lighting should be provided in the post-mortem room to ensure adequate illumination of post-mortem tables and dissection benches. The wall between the two mortuary rooms should have glass on their upper three feet area so that the natural light may pass to either room. The height of these rooms should be optimum preferably twenty feet

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(j.) Hot and cold water supply: hot and cold water be required in the sinks, wash-basins and showers. The post-mortem tables should be fitted with individual /water hoses. Water suction pumps should not be used. Floor service ducts should be avoided. All the taps in the mortuary complex should be of elbow operated type particularly in the working area.

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(k.) Safety: the complex should be fitted with emergency lighting, fire sprinklers and smoke/thermal detector in all rooms. A fire alarm system with blue /red beacon light with hooter should be installed. Fire exit routes should be clearly identifiable, well illuminated and earmarked with bold red arrows. (l.) Refrigeration: the temperature of cold rooms is to be maintained between 4°C to 6.5°C, thermostat control will be required for each cold chamber. Facilities should be provided to enable the chambers which are not in use to be switched off.

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The design of the ventilation system should provide air movement which is generally from clean to less clean areas. To satisfy exhaust needs, replacement air from the outside is necessary. Number of air changes may be reduced when the room is unoccupied if provisions are made to ensure that the number of air changes indicated is re-established any time the space is being utilized. Adjustments shall include provisions so that the direction of air movement shall remain the same when the number of air changes is reduced. Air from areas with contamination and/or odor problems shall be exhausted to the outside and not re-circulated to other areas

CONCLUSION AND FUTURE ADVANCEMENTS : 

CONCLUSION AND FUTURE ADVANCEMENTS Safety and security are integral components of a forensic facility. Defining public areas from secure zones to ensure the secure custody of sensitive items such as case files, evidence, and human remains is critical. The concept of a modern and ideal mortuary will protect the occupants against diseases emanating from filthy and unhealthy environment and the mortuary contents against destruction from decay of unrepaired and neglected mortuary buildings. Tele-medicine facilities can be envisaged in the modern mortuary complex using large training areas and various meeting rooms with video conferencing capability

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CT, MRI, and digital x-ray technology should be an integral component available to the mortuary staff – to limit invasive procedures for operational or religious reasons. An ideal mortuary will undoubtedly contribute to the advancement and evolution of forensic science and medicine, strengthening the relationship between service, teaching, and research. The public safety network and criminal justice system will benefit tremendously and will now be supported by a forensic facility built to match the level of excellence required.

THANK YOU: 

THANK YOU

REFERENCES: 

REFERENCES Dr. Sanju Singh, Dr. U.S. Sinha , Dr. A.K. Kapoor , Dr. S.K. Verma , Dr. Dalbir Singh, Dr. Susheel Sharma; PLANNING AND DESIGNING OF MODERN MORTUARY COMPLEX IN TERTIARY CARE; IIJFMT 4(1) 2006 Basant lal sirohiwal , paliwal PK, luv sharma and hitesh chawla ; design and layout of mortuary complex for a medical college and peripheral hospitals. J forensic res 2011, 2:6 Dr. Shilekh Mittal , Dr. Mukesh Yadav , Dr. Harnam Singh, Dr. Gaurav SharmaDr . Rahul Chawla ; Current Scenario of Forensic Medicine in India; JIAFM, 2007 29 (2) B. Umadethan . Principles & practice of forensic medicine. 1 st ed.2008 http://www.leec.co.uk/products/mortuary/autopsy/autopsy-downdraft-tables/post-mortem-extraction-table http://ookaboo.com/o/pictures/picture/2049134/Medical_post_mortem_table http://australianmuseum.net.au/image/Autopsy-table/