Guide For Crime Scene Biological And Infectious Hazard Clean Up

biohazard-clean-up-remediationProfessional cleaners that deal with trauma clean-up can better market their services by advertising their full compliance with guidelines laid out in the Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up. This standard, which can be purchased from the IICRC website, outlines procedures for removing any disease-causing agents that escape into the environment when an individual dies or suffers severe injury.  It also enumerates the many health effects caused by biohazards, necessary equipment professionals require, and the safe transport and disposal of waste materials.


One of the more important points of focus addressed by the standard is that of material and building science
.  Any tissue or bodily fluid is classified as a biohazard per Federal regulations.  Whenever a violent crime occurs within a building, or when a body begins to decompose within its interior, the surrounding building materials become contaminated with a variety of toxic agents.  The Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up provides a number of detailed items that cover the removal of these toxins from building materials.  For example, blood stains on the carpet typically soak through the carpet and seep into the flooring beneath.  Effective environmental cleaning not only removes the biohazard from the carpet, but also from its supporting understructure.

Certain tools are required for biohazard removal.  Special equipment, such as protective gear, must also be worn by the removal personnel in order to protect them from the hazardous materials they are using.  It benefits any organization specializing in this type of work to follow the recommended equipment list found in the standard.  Tools that can be reused, along with equipment that is by nature disposable, is clearly defined.  Containers for various types of waste, along with chemicals that help sanitize the environment after cleaning is complete, are also covered in the standard.

The Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up also talks about the various health effects associated with different types of incidents.  Diseases such as the Flu, including Type A and H1N1, HIV/AIDS, Type A and B Hepatitis, TB, Cholera, and Salmonella are all diseases that can be transmitted from bodily fluids.  These fluids escape into the environment any time a body decomposes, whether a person commits suicide, is murdered, or suffers some type of tragic, accidental death.

Other aspects of the biohazard removal industry are also covered in the Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up.  General safety and health precautions are addressed in the standard.  Administrative procedures that pertain to the execution of various cleanup jobs are also enumerated.  Guidelines for inspection are covered, along with information on when and how to demolish structures that are simply too hazardous to remain standing.  Content removal, transportation, and disposal of contaminants are also covered in the material.

Professionals interested in purchasing the Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up can do so online at the IICRC website.  This site also contains information on continuing education, professional certification, and marketing materials that registrants and certified firms can use to solicit their services to their respective communities.

 

Written By: The Institute of Inspection, Cleaning and Restoration Certification (IICRC)

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Suicide survivors face grief, questions, challenges

Harvard Women's Health Watch

POSTED AUGUST 12, 2014, 1:21 PM , UPDATED OCTOBER 29, 2015, 8:26 PM – Harvard Women’s Health Watch

The death of Robin Williams, reportedly from depression-related suicide, can seem paradoxical. How can such a funny, lively, and successful person be depressed enough to end his life? Crushing sadness can hide behind humor.

Source: Suicide survivors face grief, questions, challenges

In the United States alone, nearly 40,000 people a year die by suicide. Each of these leaves behind an estimated six or more “suicide survivors” — people who’ve lost someone they care about deeply and are left grieving and struggling to understand.

The grief process is always difficult. But a loss through suicide is like no other, and grieving can be especially complex and traumatic. People coping with this kind of loss often need more support than others, but may get less. Why? Survivors may be reluctant to confide that the death was self-inflicted. And when others know the circumstances of the death, they may feel uncertain about how to offer help.

What makes suicide different

The death of a loved one is never easy to experience, whether it comes without warning or after a long struggle with illness. But several circumstances set death by suicide apart and make the process of bereavement more challenging. For example:

A traumatic aftermath. Death by suicide is sudden, sometimes violent, and usually unexpected. Depending on the situation, survivors may need to deal with the police or handle press inquiries. While still in shock, they may be asked if they want to visit the death scene. Sometimes officials discourage the visit as too upsetting; other times they encourage it. “Either may be the right decision for an individual. But it can add to the trauma if people feel that they don’t have a choice,” says Jack Jordan, Ph.D., clinical psychologist in Wellesley, MA and co-author of After Suicide Loss: Coping with Your Grief.

Recurring thoughts. A suicide survivor may have recurring thoughts of the death and its circumstances, replaying over and over the loved one’s final moments or their last encounter in an effort to understand — or simply because the thoughts won’t stop coming. Some suicide survivors develop post-traumatic stress disorder (PTSD), an anxiety disorder that can become chronic if not treated. In PTSD, the trauma is involuntarily re-lived in intrusive images that can create anxiety and a tendency to avoid anything that might trigger the memory.

Stigma, shame, and isolation. There’s a powerful stigma attached to mental illness (a factor in most suicides). Many religions specifically condemn the act as a sin, so survivors may understandably be reluctant to acknowledge or disclose the circumstances of such a death. Family differences over how to publicly discuss the death can make it difficult even for survivors who want to speak openly to feel comfortable doing so. The decision to keep the suicide a secret from outsiders, children, or selected relatives can lead to isolation, confusion, and shame that may last for years or even generations. In addition, if relatives blame one another — thinking perhaps that particular actions or a failure to act may have contributed to events — that can greatly undermine a family’s ability to provide mutual support.

Mixed emotions. After a homicide, survivors can direct their anger at the perpetrator. In a suicide, the victim is the perpetrator, so there is a bewildering clash of emotions. On one hand, a person who dies by suicide may appear to be a victim of mental illness or intolerable circumstances. On the other hand, the act may seem like an assault on, or rejection of, those left behind. So the feelings of anger, rejection, and abandonment that occur after many deaths are especially intense and difficult to sort out after a suicide.

Need for reason. “What if” questions can arise after any death. What if we’d gone to a doctor sooner? What if we hadn’t let her drive to the basketball game? After a suicide, these questions may be extreme and self-punishing — unrealistically condemning the survivor for failing to predict the death or to successfully intervene. In such circumstances, survivors tend to greatly overestimate their own contributing role — and their ability to affect the outcome.

“Suicide can shatter the things you take for granted about yourself, your relationships, and your world,” says Dr. Jordan. Some survivors conduct a psychological “autopsy,” finding out as much as they can about the circumstances and factors leading to the suicide. This can help develop a narrative that makes sense.

Sometimes a person with a disabling or terminal disease chooses suicide as a way of gaining control or hastening the end. When a suicide can be understood that way, survivors may feel relieved of much of their what-if guilt. “It doesn’t mean someone didn’t love their life,” says Holly Prigerson, Ph.D., professor of psychiatry at Harvard Medical School and Director of Psycho-Oncology Research, Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute.

Support from other survivors

Suicide survivors often find individual counseling (see “Getting professional help”) and suicide support groups to be particularly helpful. There are many general grief support groups, but those focused on suicide appear to be much more valuable.

“Some people also find it helpful to be in a group with a similar kinship relationship, so parents are talking to other parents. On the other hand, it can be helpful for parents to be in a group where they hear from people who have lost a sibling — they may learn more about what it’s like for their other children,” says Dr. Jordan.

Some support groups are facilitated by mental health professionals; others by laypersons. “If you go and feel comfortable and safe — [feel] that you can open up and won’t be judged — that’s more important than whether the group is led by a professional or a layperson,” says Dr. Prigerson. Lay leaders of support groups are often themselves suicide survivors; many are trained by the American Foundation for Suicide Prevention.

For those who don’t have access to a group or feel uncomfortable meeting in person, Internet support groups are a growing resource. In a study comparing parents who made use of the Internet and those who used in-person groups, the Web users liked the unlimited time and 24-hour availability of Internet support. Survivors who were depressed or felt stigmatized by the suicide were more likely to gain help from Internet support services.

You can join a support group at any time: soon after the death, when you feel ready to be social, or even long after the suicide if you feel you could use support, perhaps around a holiday or an anniversary of the death.

Getting professional help

Suicide survivors are more likely than other bereaved people to seek the help of a mental health professional. Look for a skilled therapist who is experienced in working with grief after suicide. The therapist can support you in many ways, including these:

  • helping you make sense of the death and better understand any psychiatric problems the deceased may have had
  • treating you, if you’re experiencing PTSD
  • exploring unfinished issues in your relationship with the deceased
  • aiding you in coping with divergent reactions among family members
  • offering support and understanding as you go through your unique grieving process.

A friend in need

Knowing what to say or how to help someone after a death is always difficult, but don’t let fear of saying or doing the wrong thing keep you from reaching out to a suicide survivor. Just as you might after any other death, express your concern, pitch in with practical tasks, and listen to whatever the person wants to tell you. Here are some special considerations:

Stay close. Families often feel stigmatized and cut off after a suicide. If you avoid contact because you don’t know what to say or do, family members may feel blamed and isolated. Ignore your doubts and make contact. Survivors learn to forgive awkward behaviors or clumsy statements, as long as your support and compassion are evident.

Avoid hollow reassurance. It’s not comforting to hear well-meant assurances that “things will get better” or “at least he’s no longer suffering.” Instead, the bereaved may feel that you don’t want to acknowledge or hear them express their pain and grief.

Don’t ask for an explanation. Survivors often feel as though they’re being grilled: Was there a note? Did you suspect anything? The survivor may be searching for answers, but your role for the foreseeable future is simply to be supportive and listen to what they have to say about the person, the death, and their feelings.

Remember his or her life. Suicide isn’t the most important thing about the person who died. Share memories and stories; use the person’s name (“Remember when Brian taught my daughter how to ride a two-wheeler?”). If suicide has come at the end of a long struggle with mental or physical illness, be aware that the family may want to recognize the ongoing illness as the true cause of death.

Acknowledge uncertainty. Survivors are not all alike. Even if you are a suicide survivor yourself, don’t assume that another person’s feelings and needs will be the same as yours. It’s fine to say you can’t imagine what this is like or how to help. Follow the survivor’s lead when broaching sensitive topics: “Would you like to talk about what happened?” (Ask only if you’re willing to listen to the details.) Even a survivor who doesn’t want to talk will appreciate that you asked.

Help with the practical things. Offer to run errands, provide rides to appointments, or watch over children. Ask if you can help with chores such as watering the garden, walking the dog, or putting away groceries. The survivor may want you to sit quietly, or perhaps pray, with him or her. Ask directly, “What can I do to help?”

Be there for the long haul. Dr. Jordan calls our culture’s standard approach to grief the “flu model”: grief is unpleasant but is relatively short-lived. After a stay at home, the bereaved person will jump back into life. Unfortunately, that means that once survivors are back at work and able to smile or socialize again, they quickly get the message that they shouldn’t talk about their continuing grief. Even if a survivor isn’t bringing up the subject, you can ask how she or he is coping with the death and be ready to listen (or respect a wish not to talk about it). Be patient and willing to hear the same stories or concerns repeatedly. Acknowledging emotional days such as a birthday or anniversary of the death — by calling or sending a card, for example — demonstrates your support and ongoing appreciation of the loss.

Helpful resources for suicide survivors are available at from the American Foundation for Suicide Prevention and the American Association of Suicidology.

(An earlier version of this article appeared in the July 2009 Harvard Women’s Health Watch.)

 

Suicide in America

U.S. Department of Health and Human Services
National Institutes of Health – NIH Publication No. TR 14-6389

barn-lonely-suicideSuicide does not discriminate. People of all genders, ages, and ethnicities can be at risk for suicide. But people most at risk tend to share certain characteristics. The main risk factors for suicide are:

  • Depression, other mental disorders, or substance abuse disorder
  • A prior suicide attempt
  • Family history of a mental disorder or substance abuse
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the home
  • Incarceration, being in prison or jail
  • Being exposed to others’ suicidal behavior, such as that of family members, peers, or media figures.

The risk for suicidal behavior is complex. Research suggests that people who attempt suicide differ from others in many aspects of how they think, react to events, and make decisions. There are differences in aspects of memory, attention, planning, and emotion, for example. These differences often occur along with disorders like depression, substance use, anxiety, and psychosis. Sometimes suicidal behavior is triggered by events such as personal loss or violence. In order to be able to detect those at risk and prevent suicide, it is crucial that we understand the role of both long-term factors—such as experiences in childhood—and more immediate factors like mental health and recent life events. Researchers are also looking at how genes can either increase risk or make someone more resilient to loss and hardships.

Many people have some of these risk factors but do not attempt suicide. Suicide is not a normal response to stress. It is, however, a sign of extreme distress, not a harmless bid for attention.

What about gender?

Men are more likely to die by suicide than women, but women are more likely to attempt suicide. Men are more likely to use deadlier methods, such as firearms or suffocation.Women are more likely than men to attempt suicide by poisoning.

What about children?

Children and young people are at risk for suicide. Suicide is the second leading cause of death for young people ages 15 to 34.

What about older adults?

Older adults are at risk for suicide, too.While older adults were the demographic group with the highest suicide rates for decades, suicide rates for middle-aged adults has increased to comparable levels (ages 24–62). Among those age 65+, white males comprise over 80 percent of all late-life suicides.

What about different ethnic groups?

Among ethnicities, American Indians and Alaska Natives (AI/AN) tend to have the highest rate of suicides, followed by non-Hispanic Whites. Hispanics, African Americans, and Asian/Pacific Islanders each have suicide rates that are about half their White and AI/AN counterparts.

How can suicide be prevented?

Effective suicide prevention is based on sound research. Programs that work take into account people’s risk factors and promote interventions that are appropriate to specific groups of people. For example, research has shown that mental and substance abuse disorders are risk factors for suicide. Therefore, many programs focus on treating these disorders in addition to addressing suicide risk specifically.

Psychotherapy, or “talk therapy,” can effectively reduce suicide risk. One type is called cognitive behavioral therapy (CBT). CBT can help people learn new ways of dealing with stressful experiences by training them to consider alternative actions when thoughts of suicide arise.

Another type of psychotherapy called dialectical behavior therapy (DBT) has been shown to reduce the rate of suicide among people with borderline personality disorder, a serious mental illness characterized by unstable moods, relationships, self- image, and behavior. A therapist trained in DBT helps a person recognize when his or her feelings or actions are disruptive or unhealthy, and teaches the skills needed to deal better with upsetting situations.

Medications may also help; promising medications and psychosocial treatments for suicidal people are being tested.

Still other research has found that many older adults and women who die by suicide saw their primary care providers in the year before death. Training doctors to recognize signs that a person may be considering suicide may help prevent even more suicides.

What should I do if someone I know is considering suicide?

If you know someone who is considering suicide, do not leave him or her alone. Try to get your loved one to seek immediate help from his or her doctor or the nearest hospital emergency room, or call 911. Remove any access he or she may have to firearms or other potential tools for suicide, including medications.

If you are in crisis

Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.

For more information on Suicide in America

National Institute of Mental Health
Science Writing, Press & Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or
1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
E-mail: nimhinfo@nih.gov
Website: www.nimh.nih.gov

U.S. Department of Health and Human Services
National Institutes of Health
NIH Publication No. TR 14-6389

* For the most up-to-date statistics on suicide, visit the website of the Centers for Disease Control and Prevention, http://www.cdc.gov/

Bloodstain Precautions

Vernon J. Geberth, M.S., M.P.S. author of the textbook, Practical Homicide Investigation: Tactics, Procedures, and Forensic Techniques, FOURTH EDITION, 2006.

UNIVERSAL PRECAUTIONS TO TAKE SERIOUSLY
blood-crime-scene-clean-upInvestigators and crime scene technicians need to be cognizant of the potential dangers in handling blood and other biological fluids in the crime scene. The presence of airborne pathogens and other biohazards such as AIDS, hepatitis and hepatitis B, meningitis and even tuberculosis create a potential risk. Investigators should adhere to the following procedures at any crime scene where blood or body fluids are encountered.

The CSI should wear approved disposable gloves while in the crime scene and remain aware that blood and other body fluids may carry diseases. Consider wearing a disposable mask while in crime scenes where airborne communicable diseases such as meningitis or tuberculosis might exist. Wear eye protective and disposable infectious disease gown to protect clothing when exposed to large amounts of blood or other body fluids.

After the investigation is complete, dispose of gloves, masks, and gowns contaminated by blood or body fluids in a biohazard bag and wash hands thoroughly with an antiseptic hand rinse. Before returning to the station, wash hands again with water and a bacterial liquid hand wash, i.e., Bacti-Stat. Restrict the number of investigators on the scene who may come in contact with the scene of the potential infection exposure. Advise any investigators on the scene who may come in contact with the scene of the potential infection exposure.

Decontaminate all equipment used prior to your return to the station. Change clothing contaminated with blood or other body fluids immediately and decontaminate. Dispose of contaminated supplies as recommended in this protocol. Skin provides a very effective barrier for the prevention of infectious diseases. Wash all contact areas as soon as possible after exposure to help prevent contamination. Wounds such as cuts, sores, and breaks in the skin, regardless of the size, provide an entrance for infection into the body and should be properly bandaged. Report all significant exposures to blood or other body fluids within 24 hours of exposure.

References

Bevel, T and Gardner R., Bloodstain Pattern Analysis with an Introduction to Crime Scene
Reconstruction, 2nd Ed
, Boca Raton, FL: CRC Press, LLC Inc., 2002
Gardner, Ross M. Practical Crime Scene Processing and Investigation. Boca Raton, Florida:
CRC Press, LLC Inc., 2004.
James, Stuart et. al. Principles of Bloodstain Pattern Analysis Theory and Practice, Boca Raton,
FL: Taylor & Francis CRC Press, 2005.

When faced with an ‘unattended death’

February 26, 2011 – By ANTHONY GAYNOR Staff Writer
unattended death med tech blog
Image Source: Pulptastic

When a loved one passes away unexpectedly and alone, family members may be forced to wait before the body is released to a funeral home. West Virginia law states certain deaths must be reported to medical examiners before they can be released for services.

Law enforcement officials refer to the deaths as “unattended deaths,” and certain activities must be concluded before the family can begin funeral services.

The code states when any person dies from “violence, or by apparent suicide, or suddenly when in apparent good health, or when unattended by a physician, or when an inmate of a public institution, or from some disease which might constitute a threat to public health, or in any suspicious, unusual or unnatural manner,” the chief medical examiner, county medical examiner or county coroner must be notified by a physician in attendance or by law enforcement if a physician is not present, or by the funeral director or any other person present.

“We secure everything and get in touch with the county coroner,” Randolph County Sheriff Jack Roy said. “They direct us to what they need us to.”

Roy said anytime there is an unattended death, the police will photograph the scene and prepare for an investigation in case it is needed. Roy said many different circumstances can be considered an unattended death.

“If the person lives alone or has not been seen in a while,” he said. “There is no set amount of time, it just depends on the circumstances.”

Roy said if two people are in a home and they are separated for a long period of time, it can be considered an unattended death.

Roy said the body cannot be released until the county coroner makes a determination.

Randolph County Coroner Scott Shomo said each case is different and if an autopsy is needed it can take “a while” before the body is released.

“If it is a true natural death, it can be released,” he said. “If it’s an elderly person, the medical examiner’s office doesn’t even get involved and the body will be released to a funeral home. All unexplained children’s deaths are sent to the medical examiner.”