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 in Mortuary andDeath Care Operations during
Infectious Disease Outbreaks
Infectious disease outbreaks
tragedy. You may feel guilty for not
Remember that the work you do will be
can cause considerable uncertainty,
helping enough. These reactions arefear, disruption, economic hardship,normal and a part of being human.
important to others. Families may findsickness, and death. Exposure toYou may feel emotionally numb,comfort in knowing you cared for their
human remains can be stressful. Theor you may even use “graveyard
loved one respectfully.
guidelines below will help you managehumor” to make the suffering andyour stress and increase adaptive
death less terrible. These are also
coping. These guidelines are applicablenormal responses. Strong emotions
to inexperienced and experienced mortuary personnel,
or reactions may be most painful when working with the
medical staff, first responders, military service members,
remains of children, or when the remains remind you ofand those planning for current or upcoming mortuary
someone you know or of yourself.
operations.
Here are lessons learned by other people who have
In your work, you may see, smell, and handle theworked with remains in disasters. Although these tips
remains of individuals of all ages. Working with orcannot make a horrible event easy, they will help you
around remains may arouse strong feelings of pity, horror,
continue to work and to live with your experiences andrepulsion, disgust, and anger at the senselessness of thememories without being haunted by them:Prior to Mortuary Operations■ It is normal to feel some apprehension about the workthat you will do and what you will see. Seek informationfrom your supervisor about what you will be asked todo.
■ Talk with your supervisor about the risks of infection.
■ Learn to use personal protective equipment properly
and practice risk reduction behaviors:
x Use universal precautions for blood and body
fluids.
x Disinfect or dispose of infected gloves andprotective equipment according to policy.
x Prevent cross-contamination of personal items
including shoes.
x Disinfect commonly touched surfaces, equipment,and vehicles.
x Wash hands thoroughly after handling remains andbefore eating.
■ Talk with your supervisor about your prior experience

with death and work with remains. This may help in theformation of effective work teams.
■ Ask questions and seek guidance on any aspects of thework you may be concerned about. Others may have thesame concerns.
During Mortuary Operations■ Minimize exposure to the remains and the associatedunpleasant sensory stimuli.
x Keep remains covered using partitions and bodybags. Avoid looking at the face and hands. Remind
yourself that bodies are not people anymore — justthe remains.
x Avoid imagining what the person’s last moments
might have been like.
x Unpleasant smells may become associated withthe experience of working with the dead. Masks orusing masking smells like Ben-Gay and breathing
through the mouth may be helpful in diminishingunpleasant smells.
Continued

■ Minimize exposure to personal effects of the deceased,

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e.g., watch, wallet, photos that can evoke thoughts
about the deceased’s life and possibly feelings of loss
and grief.
Be compassionate but avoid focusing on any individual
remains—especially those you mahy identify with.
Remember the larger purpose of your work. Throughyour work with the dead, you are showing care, giving
hope, and preventing disease for the living.
Talking with others while working and during downtime is very important. It keeps the mind from dwellingon troublesome thoughts. Humor is a good stressrelease. Humor can be a good release of stress, but itshould not get out of hand or be used outside of thework group.
Help others in distress by being a good listener. Don’t
mistake expression of feelings for weakness. Remind
others that strong emotions are normal and honorable.
Assist a distressed individual in seeking professional
help if needed.
Take frequent breaks, maintain hygiene, drink plentyof fluids, and eat good food. Facilities for hygiene andlaundry should be available.
Remember that the work you do will be importantto others. Families may find comfort in knowing you
cared for their loved one respectfully. Your work will
also help families to prepare for funerals, monuments,or memorials for their loved one.
It is okay to say silent prayers, but let local religious
leaders conduct memorial services or more public
ceremonies.
Be respectful of local cultures and religious beliefs that
may be very different from your own.

■ Keep your supervisor informed of the work that you

do and coordinate with the local authorities requesting
assistance.
■ As time allows, have your team get together for mutual
support and encouragement.
■ Acknowledge horrible aspects of the work, but do
not dwell on memories of the details. You should let
your supervisor know if an aspect of your work is
particularly difficult or stressful for you — a job change
may be helpful.
■ When not working, get adequate sleep, exercise, do
enjoyable activities, and stay in touch with family andfriends.
After Mortuary Operations■ Do not feel guilty about having mentally distanced
yourself from the suffering or tragic deaths ofindividuals.
■ Strange dreams or nightmares, feeling tense, or having
intrusive memories are common during or shortly after
stressful work with human remains.
■ Sharing your emotional reactions with loved ones isoften helpful, but may be difficult to do.
■ If anxiety, depression, sleep difficulties, or irritability
persist more than two weeks after your return home,
you should seek assistance from a counselor or aphysician.
■ Operational group meetings after the event provide
the opportunity for team members and supervisors toreview their experiences and develop lessons learned toenhance future performance.

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