Carry out First Offices

First Offices enable the Funeral Director to present the deceased person in a visually acceptable and respectful manner, not only by restoring dignity to the deceased, but also by bringing a comforting reassurance to the bereaved family at a time when most needed.

SUGGESTED EQUIPMENT

Protective equipment appropriate to the circumstances. This may include :

 

Rubber/surgical Gloves - Overshoes or Boots

Liquid soap (germicidal)

Coverall or coat - Mask - Eye protection

Wound Sealants

Plastic or rubber apron - Face or hair protection

Ligatures

Basic items of make-up - Massage Cream

Sutures / Needles

Cotton Wool

Scissors

Sharps Container

Clinical Waste Receptacle

Forceps (McIndoe Spring)

Aneurysm hook

Forceps (Packing)

Shampoo - Hair Drier - Comb - Hairbrush

Nail file

Formaldehyde based cream or gel

Shaving Kit

Needle Holder

Disinfectant Soap

Eye-caps Bowl or other receptacle for water 

THE PROTECTIVE CLOTHING donned by you should be adequate and appropriate to the circumstances, boots or overshoes should always be worn however within the mortuary or preparation area in order to minimise the spread of pathogens. 

 

A CLEAR WORKING AREA should be prepared in order that unforeseen hazards are minimised. Any instruments that are to be used should be prepared and placed in a disinfectant solution ready for use, never transferred to and from the area whilst the task is being carried out. If the deceased has not already been transferred to the preparation table, you must obtain sufficient assistance to effect transfer using prescribed safe lifting and handling techniques. Those assisting in the transfer should also wear adequate protective clothing. It is the duty of the person carrying out first offices to satisfy him/herself that the deceased is not the carrier of an infectious disease, thus posing a health risk not only to themselves, but to colleagues and associates both in and out of the workplace. 

 

THE IDENTITY of the deceased must be checked against existing documentation before proceeding. Check instructions against the wrist band on the deceased if one exists, the label, or any other means of identification your particular company may employ. Any discrepancies must be reported to the office before continuing. 

 

SIGNS OF DEATH 

Complete lack of animation 

Lowering of body temperature (ambient temperature) 

Pallor of the skin 

Rigor Mortis 

Hypostasis ( post mortem staining caused by blood draining to the pendant parts of the body due to the cessation of the hearts pumping action  

Discolouration and/or swelling may also occur. 

 

DEATH has been defined as the total cessation of the three vital and interdependent systems of the body. 

 

THESE ARE : 

 a) The Circulatory System 

 b) The Respiratory System 

 c) The Nervous System 

 

These three systems are said to be vital and interdependent because any one of them failing will result in the failure of the other two. Failure of all three results in death. 

You must carry out tests on all three systems before continuing. 

 

SYNCOPE 

When death is due to failure of the circulatory system of the body the word Syncope will often appear on the medical forms. 

 

TESTING the circulatory system is done either by the use of a stethoscope listening for the sound of the hearts pumping action, or more commonly by placing the tips of the fingers against the deceased’s CAROTID artery. No pulse should be felt. 

 

ASPHYXIA This is the term used when death is due to failure of the respiratory system. 

 

TESTING is usually carried out by means of a mirror held over the nose and mouth of the deceased, an absence of misting indicates a failure of the respiratory system. The absence of visual rising and falling of the chest area is another indication. 

 

COMA This is the term given to failure of the nervous system. TESTING for failure of this system is most effectively carried out in the most sensitive available area of the eye. Raise the deceased’s eyelid, shine a strong light into the open eye, no change in pupil size should result from this action. Alternatively an object brought into contact with the eye in life would result in a dramatic reaction, following death the resultant reaction should be non-existent. 

 

IF YOU ARE IN ANY DOUBT AFTER CARRYING OUT THESE TESTS DO NOT CONTINUE 

 

CLOTHING The deceased’s clothing should be removed with great care, it may be that the family would like it to be returned. If however the clothing is soiled and you have established that the family are content to let you deal with it’s disposal , scissors may be used to facilitate the task where difficulties arise. Any surgical dressings should also be removed and placed in the clinical waste receptacle, any resultant exposed lesions should be dealt with using formalin based cream or gel. 

 

RIGOR MORTIS is the stiffening of the muscles which occurs after death. The degree of rigor mortis encountered will vary considerably from one body to the next, in all cases however this rigor mortis should be reduced in order that the body may repose in a natural and visually pleasing way. The limbs should be gently flexed , manipulation of the fingers and jaw should be carried out following the application of massage cream in order to prevent friction damage. 

 

Once broken down Rigor Mortis will not return. 

 

Any deformities, as a result of arthritic joints for instance however acute, should be left in their normal posture. The family of the deceased will expect to see this. A ‘modesty cloth’ must be put in place as soon as is practicable maintaining the dignity and respect for the deceased throughout. 

 

JEWELLERY must be dealt with in accordance with company procedure and clients instructions. Any jewellery awaiting return to a family should be stored in a secure place until return can be effected. Jewellery should always be listed irrespective of its ultimate destination. 

 

IF NECESSARY wash and dry the body with disinfectant solution. It may be deemed unnecessary to wash the body, the use of a residual bacteriocide rendering the body aseptic. Ease the body onto its side in order to expose the back area, it may be that bed sores, or other lesions, are evident requiring attention. If this is the case the offending areas should be treated with a cauterant chemical and covered with an absorbent dressing. 

 

BODILY ORIFICES must be cleaned, disinfected and packed as necessary, with particular attention being paid to the eyes, ears, nose, mouth and to the genital and anal areas. Vaginal and anal orifices should be packed with absorbent cotton material, as should the throat and nasal cavities. 

 

WHEN CLOSING the mouth care must be taken not to close it too tightly, so losing the ‘natural expression’. 

 

THE EYELIDS should be supported with either pledges of cotton wool or plastic eye caps, the upper lid drawn down to produce a ‘ natural’ eyes closed expression. If the deceased is a gentleman his face should be soaped and shaved as necessary. A liberal amount of massage cream should be applied prior to this task, in order to reduce the effects of dehydration. 

 

THE HAIR should be washed and dried as necessary with particular attention being paid to the style in which the hair was worn whilst in life. 

 

HANDS ARE EXTREMELY IMPORTANT. Bereaved relatives will often reach for the hands of a loved one. Liberal amounts of massage cream should be applied as necessary. 

 

FINGERNAILS should be cleaned and trimmed if required. 

 

The deceased may now be clothed in a shroud or dressed in clothes provided by the family. 

 

Make-up should only be used when requested, it is not always appreciated, especially on men. 

A light dusting of powder however will do much to reduce the possible shine caused by over enthusiastic use of massage cream. 

 

WHEN YOU ARE confident that you have completed your task you must reinstate the working area, with particular attention paid to care of waste, used linen and protective clothing, disinfecting and returning any instruments used to their rightful storage places.

 

SPECIAL TECHNIQUES

The amount of care required to be taken when inserting a mouth suture cannot be over emphasised. 

The condition of the tissues may not be good, so the more they are manipulated, the greater the danger of them breaking down. 

 

THE SEPTAL SUTURE 

Thread a curved needle doubling the suture. 

Now pass the needle through the muscle tissue at the base of the lower teeth keeping as close to the bone as you can. Make the stitch as wide as is possible. 

Now direct the needle upwards from the level of the first pre-molar into the base of the nostril on the same side. 

Pass through the base of the nasal septum 

Now reverse the pattern passing the needle through the floor of the nose to emerge in the gum above the first pre-molar tooth. 

Support the mandible using one finger whilst tying the loose ends until the jaw is supported in a natural position. When you are happy with the result, tie off firmly. 

 

THE MANDIBULAR SUTURE 

If there is softening or damage to the tissues of the mouth, or decomposition has started, the septal suture will not hold. 

An alternative method is to pass the suture behind the mandible from under the chin, emerging from the floor of the mouth. 

The suture is then re-threaded and using the same access point is then passed in front of the mandible so that the jaw is now held firmly. 

 

The upper part of the operation is the same as for the septal suture. The resultant puncture hole, which should be secreted in a natural crease beneath the chin wherever possible, should then be treated with either cosmetic wax or massage cream to ward off the effects of dehydration. 

 

Not all companies promote embalming, and not all families or relatives will permit embalming to be carried out on their loved ones for many and varied reasons; 

 

 eg: “He/She’s been pulled around / suffered enough and we just want him/her to rest in peace”. The religion of the deceased person expressly forbids this type of procedure. The family just don’t like the idea of it. 

 

Therefore it is vitally important that the funeral operative be competent in the area of First Offices.