Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Stress Management for Leaders andSupervisors of Mortuary and Death Care
Operations during the COVID-19 Pandemic
The worldwide spread of the■ Train workers in proper use ofPrepare personnel for what they arecoronavirus has resulted in an
personal protective equipment.
unprecedented era of uncertainty,
Provide guidance on other ways tolikely to see and what they will befear, disruption, economic hardship,
reduce the risk of infection.
expected to do.
sickness, and death. During ax Use universal precautions forpandemic, many individuals areblood and body fluids.
exposed to the dead. These exposuresx Disinfect or dispose of infected gloves andcan be stressful and increase the risk for post traumatic
protective equipment according to policy.
reactions. The guidelines below describe ways to reducex Prevent cross-contamination of personal items
stress and increase adaptive coping in individuals exposed
including shoes.
to mass death, including training personnel for mortuaryx Disinfect commonly touched surfaces, equipment,work.
and vehicles.
x Wash hands thoroughly after handling remains andPrior to Mortuary Operations
before eating.
■ If possible, practice the steps involved in the operation,■ Present information accurately, neither exaggerating
including recovery and processing of remains and therisks nor ignoring questions and concerns.
paperwork required by the legal authorities.
■ Ask workers about personal experiences with death and■ Mortuary personnel are likely to be apprehensive about
work with remains. Identify fears and if they are based
what they will see and do. They may:on past experience or anticipation of the unknown.
x Feel unprepared for what may be a novel work
■ Explain that some remains can be emotionally difficult
experience.
(e.g., remains of children).
x Fear contracting the pathogen and spreading it to■ Provide clear lines of command authority andothers.
jurisdiction and ensure work site security.
x Worry about a lack of personal protective■ Adhere to cultural norms on site and have a consultant
equipment.
familiar with the local customs available.
x Feel overwhelmed by the number of deaths and■ Supervisors should be familiar with administrative,remains.
medical, and legal documentation including■ Prepare personnel for what they are likely to see andpreservation of evidence, custody of personal effects,
what they will be expected to do.
and location and state of remains.
■ Directly address the risks and fears of contaminationfrom the remains.
During Mortuary Operations
x Most organisms in the tissues of dead bodies are■ Monitor personnel for signs of distress and provide
unlikely to infect healthy persons.
support by being available to talk and providing mentalx There may be a risk of transmitting infectious
health referrals as indicated.
diseases through contact with blood and body
■ Visitors to the work site should not be permitted tofluids if workers are not wearing personal protective
interfere with the work.
Continuedequipment.

■ Minimize exposure to the remains and the associated

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unpleasant sensory stimuli.
x Keep remains covered using partitions and bodybags. Avoid looking at the face and hands.
x Unpleasant smells may become associated withthe experience of working with the dead. Masks orusing masking smells like Bengay, and breathing
through the mouth may be helpful in diminishingunpleasant smells.
Minimize exposure to personal effects of the deceased,e.g., watch, wallet, photos that can evoke thoughts
about the deceased’s life and possibly feelings of loss
and grief.
Exposure to family members of the deceased may
increase emotional involvement and feelings of loss andgrief in the mortuary worker.
Vary tasks so workers can adjust their exposure, but
avoid exposing workers to both remains and the life
story of that person (via personal effects or interaction
with family members).
Encourage verbal interaction during work to help keep
the mind from dwelling on troublesome thoughts.
Humor can be a good release of stress, but it should not
get out of hand or be used outside of the work group.
Avoid allowing workers to become isolated.
Pair experienced workers with inexperienced workers.
When possible, pair workers by similar age, rank, andcomfort in working together. Experienced workers
should act as a mentor.
Assign persons who have difficulty with remains toanother task they can contribute to. These individuals
often do not want to be dismissed, which may
contribute to a sense of failure.
Set a reasonable work schedule and make sureindividuals do not overwork. Do not promise toaccomplish the work in an unreasonably short time.
Do not attempt to maintain any schedule longer than 8hours per day.
Ensure personnel take breaks and get out of thework area. Provide a rest area with food, fluids, andprotection from news media and onlookers. Get
workers off their feet during breaks.

■ Encourage workers to maintain a healthy and balancedlifestyle: get adequate sleep, exercise, do enjoyable
activities during free time, and stay in touch with family
and friends.
■ People can do very difficult things when they
understand the importance of what they are doing.
Remind personnel that their work will be important toothers. Families may find comfort in knowing that their
loved one was cared for respectfully. The work will also
help families to prepare for funerals, monuments, ormemorials for their loved one.
■ Chaplains and counselors can provide spiritual support
and counseling, and behavioral health teams may beavailable for visits. Provide points of contact in caseindividuals have questions or wish to seek professional
help/support after the close of the event.
■ Be aware of the personal needs of the worker and his or
her family and facilitate communication between them.
Brief families on the general aspects of the operationand tell them what they can do to support their family
member.
After Mortuary Operations■ It is helpful to review with workers theiraccomplishments. Operational group meetings can help
leaders and workers share their experience and provide
the opportunity for lessons learned.
■ Acknowledge that workers may experience “normal”
reactions to a difficult event and the following can help
reduce distress: food, rest, exercise, leisure activities,
camaraderie, contacting loved ones, and the passage oftime.
■ It may be difficult talking about the experience —especially with people who were not part of theoperation. This is to be expected and workers should do
so only when they feel comfortable.
■ Reinforce the positive aspects of the work, skills
learned, and experience gained.
■ Acknowledge and reward performance, includingawards and commendations, but often what is mostimportant is a sincere, “Thank You”!
■ Allow workers some time off to relax and take care ofbusiness.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org