circumstances. PPE management includes sizing, quantity, resupply, donning, doffing, cleaning, use/reuse limitations, disposal, initial use, and reuse inspections; consumable items (batteries, filters, etc.); oxygen supply sources and resupply; and other manufacturer or health care professional instructions.
(b) Water source is identified as potable or non-potable.
(c) Medical and occupational health support is sufficient for occupational health needs, as well as immediate medical needs for MA personnel.
1. Health is focused on preventing the spread of disease from human remains to personnel working in or near MA facilities. More specifically, occupational health is focused on ensuring processes and procedures exist pertaining to:
a. Reporting of blood-borne pathogen exposure.
b. Administering vaccines, immunizations, and other prophylactic treatments (e.g., antibiotics). Baseline immunization requirements and testing should include at a minimum, hepatitis B, human immunodeficiency virus, and tuberculosis.
Additional immunizations may be required based on the hazards in the region.
c. Health and wellness checks to monitor vital signs.
d. Health guidelines that prevent the spread of disease in the physical work place (e.g., sanitation of work area; preventing cross contamination by preventing eating, smoking, or drinking in work areas; and safety assessment reviews of the physical layout).
2. Immediate medical support is focused on ensuring access to nearest medical unit or medical treatment facility in the event of injury, illness, or occupational exposure to bio-hazardous blood and body fluids during operations.
(d) Regulated medical waste must align with biohazard material disposal procedures required by the Code of Federal Regulations for Occupational Safety, Public Health, Environmental Protection, and Transportation, established government-to- government agreements, or GCC interim operational policy for environmental compliance.
Guidance often identifies the proper PPE and establishes safety and sanitation guidelines.
It also addresses the need to incinerate all disposable protective clothing, bandages, dressings, sheets, towels, and other items coming into direct contact with the human remains or body fluids unless incineration is not the recommended method of disposal (i.e., for some CBRN contamination). The plan should address how the MA personnel are to dispose of hazardous waste if an incinerator is not available at their location or when incineration is not the preferred method. See USAPHC’s TG 195A, Safety and Health Guidance for Mortuary Affairs Operations: Infectious Materials, for more detail.
(e) Work site safety is performing ongoing operational site reviews to prevent cross-contamination (e.g., eating in work areas), minimize slips/trips/falls, and adherence to personnel work-rest cycles.
(f) Explosive ordnance management identifies explosive ordnance disposal assets available to MA personnel and establishes procedures to include unexploded ordnance inspection and reporting procedures.
(g) Behavioral health support identifies behavioral health professional assets available to MA personnel and establishes procedures for accessing these assets.
(2) Incident-Specific Considerations. In addition to the normal safety considerations, there may be times when the handling of human remains requires a detailed specific plan due to the presence of additional hazards. In these instances, the use and disposal of PPE, bandages, dressings, sheets, towels, and other items that came into contact with the human remains or body fluids must be in accordance with biohazard material disposal procedures as required by the Code of Federal Regulations for environmental compliance, established government-to-government agreements, or GCC interim operational policy for environmental compliance. An incident-specific plan should address how the MA personnel are to don and doff PPE, proper use protocols, and disposal of hazardous waste and contaminated PPE.
c. Contaminated Human Remains and Decedent Effects (DE). Human remains contaminated with chemical agents, biological pathogens, or radiological or nuclear material may require temporary interment or placement in storage until safe handling and transportation procedures and protocols are approved for the situation. The nature of each contaminant type requires specific response planning, including an understanding of HN laws, international agreements, and state/local laws when associated with a domestic incident, to determine potential COAs to safely handle the contaminated human remains.
DE, which are PE found on human remains, contaminated by CBRN material will be destroyed, decontaminated, placed in storage, or interred with the human remains until safe handling and transportation procedures and protocols are implemented to account for the situation.
d. MA Support Protocols. While it is anticipated that MA support to personnel not affiliated with the DOD may be provided by the HN or other international organizations, DOD may be requested to provide MA support to non-DOD-affiliated personnel within the JOA. Consequently, MA planners should review entitlements, laws, and regulations for the provision of US military mortuary services, eligibility for transportation, and procedures for obtaining SecDef approval when required. In consultation with the staff judge advocate, MA planners should establish MA support protocol recommendations for the JFC. Once established, JTF and MA planners should ensure the approved MA support protocols are published and disseminated. It is important to coordinate support with outside relief agencies (International Committee of the Red Cross, NGOs, and international organizations) in theater to ensure complete visibility for overall MA situation and requirements.
e. MA for CAAF. The terms and conditions of the contract between the DOD organization and the contractor dictate what MA support is authorized and provided either on a reimbursable or non-reimbursable basis. However, transport of contractor human remains may be subject to local HN laws and jurisdiction prior to arrival at a civilian APOE. The company of the deceased is generally responsible for notification of next of kin and transfer of human remains and DE. Companies may or may not be responsible for storage of DNA [deoxyribonucleic acid] samples to facilitate identification of the deceased.
Estimated costs of MA provided to contractors must be accounted for to facilitate reimbursement by the contracting officer as appropriate.
f. Use of Non-Military MA Support. The use of HNS, local national support, or third-country national support should be limited to general labor, administration, transportation, and facility support. Only US military, US Government civilians, and DOD-contracted civilians should be used to accomplish search, recovery, and processing of US human remains and inventory of PE. If an agreement cannot be negotiated, MA support is performed under current US military procedures.