Trauma Cleaning: Without Standards, The Pain Can Keep Coming

by Kent Berg
National Institute Decontamination Specialist

As an instructor in crime and trauma-scene recovery and a board member of the American Bio-Recovery Association, I am often approached by attorneys, the public and insurance adjusters to evaluate the service they or their clients received from other crime-scene cleanup companies.

For the most part, these are just routine questions from people who want to make sure that the service they received was within the normal parameters of good practice. But a few times each month I receive calls that just cause my stomach to knot up and my blood to boil.

With the bio-recovery industry in its 14th year, it is mind-boggling to find individuals who still decide that they are going to start-up a new company and declare themselves “experts” in crime and trauma scene cleanup without any research or training.

It is even more outrageous to find that, although they know almost nothing about the science, chemistry, biology or laws of our industry, they are charging fees that are often four or five times the industry average.

The majority of those operating in the industry today are honest, ethical professionals. It’s the few bad apples in the bio-recovery barrel, so to speak, that amplify the problems tainting our industry.

Example 1: The Hit-and-Run Guys
A husband argues with his wife in their kitchen. As she prepares supper, he grabs a shotgun and, standing in the doorway between the kitchen and dining room, blows his head off.

It is still daylight when the police arrive. In order to see better, they open the brain-splattered dining room drapes. Splatter is on the dining room and kitchen walls, but since the body fell onto the vinyl tile floor of the kitchen, the largest amount of blood pooled there.

The family asks the police about scene cleanup, and is directed to a local company. The company tells the family that payment will have to be made in cash prior to starting the job, and that the family will not be allowed inside of the house while the cleaning process takes place.

The family agrees and stays with relatives until they get the call that the job is complete and they can return. The company is long gone, and upon cursory inspection, the rooms look contaminant-free.

It is now night and, in an effort to keep neighbors from seeing into the dining room, the wife pulls the drapes closed. To the horror of the family, the drapes had apparently never been checked and still have blood and brain matter clinging to the material.

The kitchen floor appears to be clean but, when the wife walks across the floor, bright red blood spurts up between the tiles, making little puddles and polka-dotting her shoes.

If this isn’t enough to re-traumatize the family, the wife goes to remove the now-cold pot of chili from the stove and promptly throws up when she sees a 3-inch piece of her husband’s skull nestled neatly atop the pot.

The family contacted the attorney general for their state, who then called me to review the family’s statements prior to a decision on prosecution.

Example 2: The Little-Extra-on-the-Side Guys
A man who lived alone died in his bed of natural causes, but wasn’t found for several weeks. When the authorities were finally called, the decomposition could be smelled from the street.

When a crime-scene-cleanup company was called in, the man’s relatives were told that the odor had permeated everything in the house with disease. Their recommendation was that everything in the house should be removed and destroyed.

The family, already nauseated from the smell, relied on the “professional opinion” of the technicians and agreed to let them remove everything from the good silver and china to the appliances.

In short, every piece of furniture, appliance, electronic component and fixture was removed because they were declared “not salvageable.”

The relatives were then presented with a bill for approximately $40,000! If this wasn’t obscene enough, a few weeks later the family found many of the home’s contents that were supposedly “not salvageable” being sold at a local flea market.

Example 3: The Cutting-Down-on-Overhead Guys
It is standard practice for crime and trauma-scene cleanup companies to dispose of human-blood-contaminated items that can’t be salvaged. They do this by red-bagging and boxing these items and sending them to a medical waste processing facility. This includes dismantling recliners, mattresses, and other large items to fit in these containers.

In this case, a company responded to a gunshot suicide in an apartment. The victim had sat in his favorite recliner and put a pistol in his mouth. The subsequent wound bled profusely until there was no more blood for the heart to pump. This resulted in the complete saturation of the recliner.

In an apparent effort to save on labor and disposal fees, the crew decided that they would dispose of the recliner by wrapping it in plastic, putting it in the back of their truck and then dumping it in the woods of a neighboring county.

All seemed to go well until a few days later, when hunters found the chair and called police. Thinking that they had stumbled upon evidence of a homicide, the police launched a full-scale investigation that lasted for weeks and logged many detective hours before they were actually able to review the crime scene photos of every police department in the surrounding counties.

When the mystery was finally attributed to this particular crime-scene-cleanup company, not only were they slapped with fines for littering, they were saddled with reimbursing the cost of the investigation. Every law enforcement agency that heard about this dropped the company like a hot potato, and the subsequent media attention tarnished the reputation of crime-scene-cleanup companies everywhere.

I would like to emphasize the fact that these complaints are not clients disappointed with a poorly painted wall or an out-of-true vanity top. These are abuses by unscrupulous companies that are subjecting their clients to financial greed, improper disinfection, and re-traumatizing that no one should have to endure.

Could training and certification eliminate these types of abuse? Perhaps a good portion of them, but in the end, it is the honesty and character of the companies themselves that should be monitored. I believe the way to do that is to pursue standards, as well as meeting with our state legislators to create specific regulations for our industry.

Disaster and then Disease

By Elizabeth Batt

The International Federation of Red Cross and Red Crescent Societies, describes a natural disaster as a “sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources.”

The earthquake in Haiti that occurred on January 12, 2010, caused death and destruction, the extent of which has yet to be realized. Sadly, Haiti’s problems might be only just beginning. Often following the initial aftermath of any natural disaster there follows a second wave of deaths, caused by disease.

Types of Disease Prevalent in the Aftermath of a Natural Disaster
When a natural disaster strikes to the extent that it did in Haiti, the infrastructure of a country is decimated. Fresh water supplies, sewage disposal and power is destroyed or severely interrupted. What remains is often contaminated, initiating a vicious cycle that cultivates communicable diseases. In a third world country like Haiti, where resources are already stretched thin and immunizations are not standard practice, the loss of life is certain to be much higher because they’re simply not equipped to deal with an incident of this magnitude.

The study, “Management of dead bodies in disaster situations.” PAHO; 2004, indicates that little threat for communicative disease outbreak is posed by actual human remains. The threat comes from the survivors themselves, the destruction of their surroundings and an inevitable crowding situation caused by displacement. Without a continuous fresh water supply, survivors are forced to drink polluted water just to stay alive. Aided by the lack of adequate sanitary conditions, these pollutants are ingested and then defecated back into the water source. It becomes a breeding ground for communicable diseases.

Water-related Diseases
Water-related diseases include infectious diarrhea or norovirus, salmonella and cholera. Noroviruses are transmitted through the fecal-oral route after the ingestion of contaminated food and water. Once infected, a person-to-person transmission can occur. Noroviruses cause diarrhea and vomiting that without adequate sanitization amenities, continue to perpetuate.

Salmonella is often referred to as food poisoning. It causes the same symptoms as norovirus and can be present in almost any type of food. Salmonella is transmitted through infected feces that come into contact with a food source. People can become carriers of salmonella, transmitting the disease for life.

Cholera, transmitted by the fecal-oral route has an extremely brief incubation period of just 2-5 days. It can cause acute diarrhea, dehydration and kidney failure. Of all water-related diseases, cholera is perhaps the most insidious and can kill an adult within hours.

Crowding-related Diseases
The three most common crowding-related diseases are meningitis, measles and acute respiratory failure (ARF). Meningitis causes an inflammation of the membranes surrounding the brain and spinal cord and can lead to permanent neurological damage. Measles is a highly contagious viral disease that can cause seizures and coma. The complications of measles can include blindness and brain inflammation. ARF has a high morbidity rate of 50-70% in both children and adults. Caused by inadequate gas exchange, oxygen levels drop and carbon dioxide levels rise. An effect of displacement, over-crowding issues and poor nutrition, ARF is a major cause of death.

Vectorborne Diseases
Vectorborne diseases are caused by “vectors” such as mosquitoes that carry malaria. Earthquakes and other natural disasters can change a habitat, as evidenced in Saenz R, Bissell RA, Paniagua F. "Post-disaster malaria in Costa Rica." Prehospital Disaster Med. 1995;10:154–60. This change in habitat can create conditions that are ripe for breeding, causing an upsurge in outbreaks of malaria. Children are particularly at risk of contracting malaria, a virus that in its most dangerous form, can affect the brain and kidneys. Dengue, also carried by mosquitoes, can develop into dengue haemorrhagic fever. The spread of dengue can be directly related to inadequate solid waste disposal and water storage. Without treatment, fatality rates can exceed 20%.

Haiti's challenges are far from over and despite aid being sent to this ravaged country, the death toll as it stands now, is certain to rise.

Teen Suicide Risk Factors: Parents Are Too Often Clueless

By Nancy Shute

Suicide is the third leading cause of death among teenagers, and it's a tragedy that can be prevented. Given that almost 15 percent of high school students say they've seriously considered suicide in the past year, parents and friends need to know how to recognize when a teenager is in trouble and how to help.

Parents can be clueless when it comes to recognizing suicide risk factors, or at least more clueless than teens. In a new survey of teenagers and parents in Chicago and in the Kansas City, Kan., area, which appears online in Pediatrics, both parents and teenagers said that teen suicide was a problem, but not in their community. Alas, teen suicide is a universal problem; no area is immune.

The teenagers correctly said that drug and alcohol use was a big risk factor for suicide, with some even noting that drinking and drug use could be a form of self-medication or self-harm. By contrast, many of the parents shrugged off substance abuse as acceptable adolescent behavior. As one parent told the researchers: "Some parents smoke pot with their kids or allow their kids to drink."

Both teenagers and parents said that guns should be kept away from a suicidal teen. But since parents said they didn't think they could determine when a teenager was suicidal, parents should routinely lock up firearms, the researchers suggest. That makes sense. Firearms are used in 43.1 percent of teen suicides, according to 2006 data, while suffocation or hanging accounts for 44.9 percent.

The good news: Both parents and teenagers in this small survey (66 teenagers and 30 parents) said they'd like more help learning how to know when someone is at risk of committing suicide and what to do. Schools and pediatricians should be able to help, but we can all become better educated through reliable resources on the Web. These authoritative sites list typical signs of suicide risk, and they also provide questions a parent or a friend can ask a teenager to find out if he is considering killing himself. Here are good places to start:

The American Academy of Child and Adolescent Psychiatry lists signs and symptoms of suicidal thinking, such as saying things like "I won't be a problem for you much longer."

The American Academy of Pediatrics urges parents to ask the child directly about suicide. "Getting the word out in the open may help your teenager think someone has heard his cries for help."

The National Suicide Prevention Lifeline provides free advice to someone considering suicide, as well as to friends and relatives, at 800-273-TALK.

The National Alliance on Mental Illness's teenage suicide page makes the point that talking with someone about suicide will not "give them the idea." "Bringing up the question of suicide and discussing it without showing shock or disapproval is one of the most helpful things you can do," the NAMI site says. "This openness shows that you are taking the individual seriously and responding to the severity of his or her distress."