3. The last offices – April 2015
One down side of pre-hospital work is that there will invariably be some contact with deceased persons at times. Sometimes resuscitation efforts will have been applied first. At others it will simply be a matter of breaking the bad news. The patient may have to be moved back to bed for dignity or left in place until the police have provided investigation. Some patients will be relatively clean, almost sleeping but not quite. Others will be soiled with body fluids or the results of trauma. The pre-hospital responder will be exposed to a large variety of the deceased.
One factor that remains very important is to look after those who survive. Caring for the deceased will go a long way with that, particularly since there is often little else that seems to help. The British Red Cross Society Nursing Manual published in 1941 has a detailed description to this end.
As soon as death occurs, she (the nurse) should cover the face with the sheet or a clean handkerchief and, having done everything in her power to assist any relatives or friends who may have been present, she should then proceed to prepare the body.
The top bedclothes, with the exception of the sheet, are removed and only one soft pillow is left beneath the head. The bed gown is removed and the body is then straightened out, with the arms placed close to the sides. The eyes are closed by gently pressing down the lids and covering them with two flattened pellets of wool wrung out in the lotion. Any false teeth are removed, and the lower jaw is supported by means of a roller bandage passed round the head and chin, the end being tucked in to keep the bandage firm.
The ankles and big toes are then tied together. All rings or jewellery should be removed unless the relatives wish otherwise. The face is first washed and the hair combed and brushed. If the patient was a woman with long hair, it should be neatly plaited in two plaits and tied with white ribbon. The body is then washed all over with hot soap and water, the finger and toe nails cut and cleaned, and the rectum and vagina plugged with wool or lint wrung out of the lotion. If there is a wound this should be dressed, any tubes or plugs removed and the cavities plugged with wool or lint.
The clean bed gown is put on and the hands are folded on the chest or left by the sides as preferred. Clean white stockings may be drawn over the feet and legs. A clean pillow case is placed on the pillow under the head. In many cases the nostrils are plugged but this is not always necessary and is often unsightly if relatives or friends wish to see the body again. One or two flowers may be placed in the loosely clasped hands and a vase of flowers placed near the bed. Everything connected with the illness is then removed from the room which is left as clean, fresh and sweet as possible.
Many pre-hospital responders would know very well what it is to hastily try to remove all signs of resuscitation, removing airway devices or IV needles that often appear to wish to continue to bleed. Signs of body fluids are removed and the patient made to look as close to resting peacefully as can be achieved with blankets tidily placed over them. So not very much has changed over all this time when it comes to providing basic humanity and dignity to others. Though the detail may differ, the principle was on the money in 1941. Of course it is much harder when the patient has suffered some terminal trauma in full public view but as much effort as possible is still made.
Jeff Kenneally – www.prehemt.com