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 Infectious
Disease Outbreaks
Infectious disease outbreaks
Prepare personnel for what they arecan cause considerable uncertainty,
fear, disruption, economic hardship,
likely to see and what they will besickness, and death. During an
expected to do.
outbreak, many individuals may beexposed to the dead. These exposures
can be stressful and increase the risk for post traumatic
Prior to Mortuary Operations■ If possible, practice the steps involved in the operation,
including recovery and processing of remains and thepaperwork required by the legal authorities.
■ Mortuary personnel are likely to be apprehensive about
what they will see and do. They may:x Feel unprepared for what may be a novel work
experience.
x Fear contracting the pathogen and spreading it toothers.
x Worry about a lack of personal protective
equipment.
x Feel overwhelmed by the number of deaths andremains.
■ Prepare personnel for what they are likely to see andwhat they will be expected to do.
■ Directly address the risks and fears of contaminationfrom the remains.
x Most organisms in the tissues of dead bodies areunlikely to infect healthy persons.
x There may be a risk of transmitting infectious
diseases through contact with blood and body
fluids if workers are not wearing personal protective
equipment.
■ Train workers in proper use of personal protective

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reactions. The guidelines below
describe ways to reduce stressand increase adaptive coping inindividuals exposed to mass death,
including training personnel for
mortuary work.

equipment. Provide guidance on other ways to reduce
the risk of infection.
x Use universal precautions for blood and bodyfluids.
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.
Present information accurately, neither exaggerating
risks nor ignoring questions and concerns.
Ask workers about personal experiences with death andwork with remains. Identify fears and if they are basedon past experience or anticipation of the unknown.
Explain that some remains can be emotionally difficult(e.g., remains of children).
Provide clear lines of command authority andjurisdiction and ensure work site security.
Adhere to cultural norms on site and have a consultant
familiar with the local customs available.
Supervisors should be familiar with administrative,
medical and legal documentation including
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preservation of evidence, custody of personal effects,
and location and state of remains.
During Mortuary Operations■ Monitor personnel for signs of distress and provide
support by being available to talk and provide mental
health referrals as indicated.
■ Visitors to the work site should not be permitted tointerfere with the work.
■ 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.
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.
■ 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 lossand 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 interactionwith 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 individualsoften 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.

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work area. Provide a rest area with food and fluids
and protection from news media and onlookers. Get
workers off their feet during breaks.
Encourage workers to maintain a healthy and balanced
lifestyle: 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. 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