Chapter 10: Shipping Requirements
Alcor 1997 Stabilization and Transport Manual
Table of Contents
Once the appropriate stabilizing measures have been taken, the patient must be transported to the designated Alcor facility. This usually means Scottsdale, Arizona, via the Phoenix (Sky Harbor) Airport. When an air ambulance service is used to transport a patient and the aircraft used is smaller than a Boeing 727, the Scottsdale Airport may be used. (The Scottsdale Airport is only a mile from the Alcor facility.)
On rare occasions, an alternative facility may be used. Alcor currently has two alternatives: one is near Miami, Florida and the second is in East Sussex, England. A patient will never be transported to an alternative facility without the permission of Alcor’s President and Suspension Services Manager.
The actual shipment of a patient to an Alcor facility is likely to be the most time-consuming aspect of the transport procedures, especially if the patient lived in a small town far from any major airport. Here, as much as in the other steps in the transport preparations, time is crucial to saving the patient’s life. This is likely to be the longest single-step of the transport, and the patient will no longer be under the direct and constant supervision of a Transport Team member if a commercial carrier is used. For these reasons, care must be taken when preparing the patient and the container for shipment.
Any shipping container must meet the particular specifications of the commercial carrier (i.e. airline) used. Find out in advance what the specifications are for each carrier contacted, as they all have slightly different limits on container size and weight. A cooperating local mortician should be familiar with the local carriers and may have a recommendation. In every case, ensure that the shipping container will not exceed the limitations of the carrier chosen.
Physical preparations, beyond estimating weights and dimensions of the container, include packing the patient in an ice- and insulation-lined container. The container must not leak, and the patient must remain cold until reaching the Alcor facility.
Packaging the patient should be a fairly straight-forward process, and the illustration below provides a fairly accurate diagram of how the Alcor shipping box is prepared. One item missing from the illustration is important for those transports which involved a blood washout, where samples were collected. All sample tubes should accompany the patient. They should be secured (e.g. using tape) to an inner forearm, where the body may cushion them against accidental breakage. Another location may be used if it provides similar or superior protection for the samples.
A patient should be surrounded by ice and insulation
for shipment on a commercial carrier.
Assemble the following supplies:
- 200 lbs. of ice, preferably crushed or small cubes
- 50 Ziploc bags, 1 or 2 gallon size
- body pouch (“body bag”)
- suitable shipping container:
- Alcor shipping container or
- Ziegler shipping container and Jim Wilson tray
- insulating material (like a sleeping bag, blankets, or foam padding)
- privacy drape
Once the supplies have been gathered, placing the patient into the shipping container should be done using the following guidelines and the illustration above as a reference if any instruction seems unclear. Then:
- Fill the Ziploc bags with ice. Remove all air from the bags before sealing them.
- Cover the patient’s genitals with the privacy drape.
- Layer the bottom of the shipping container with insulating material.
- Cover the bottom with ice bags.
- Line the bottom of the body pouch with ice as well.
- Secure all blood samples to the patient’s forearm.
- Place the patient into the pouch and cover with ice before closing.
- Place body pouch into the shipping container and cover with all remaining ice bags.
- Use the insulating materials to fill any remaining open space.
- Seal the container.
If a Ziegler case and Jim Wilson tray are being used as the shipping container, a mortician is probably involved in the case. Transport team members should persuade the mortician to assist with the packing. Solicit the mortician’s assistance about the best methods for sealing the edges against leakage. Insulating material around the body pouch may collect condensation in addition to providing a barrier against warming. (Standard mortuary shipping containers are not designed to be water-tight. Extra caulking of the casing seams will provide an additional assurance that the container should not leak in transit.)
The Alcor shipping container has been engineered to prevent this seepage (and it has built-in insulation as described above so that locating blankets or additional foam padding is not required when this container is used during the transport.) “Leakage” from human remains is regarded as a public health hazard, and it is possible that simple condensation resulting from ice melting inside the shipping container may be misperceived as “leakage”. Any shipping container requiring a quarantine will necessitate the authorities (like the local coroner) being apprised of the situation. Further, if the transport was assisted by a local mortician, this incident risks the mortician’s operating licenses. Commercial carriers might also refuse to accept future cargo shipments.
|Caution: Any container used to transport human remains which leak during transit will be removed from the shipper’s manifest and quarantined pending a coroner’s investigation.|
Alcor’s customized shipping container
Shipping containers are only needed for transporting patients who are not within reasonable reach of the Alcor ambulance. Under these circumstances, air transport is usually the most expeditious method for getting the patient to an Alcor facility for cryoprotection, deep cooling, and long-term storage.
If a local mortuary or funeral home has been used to prepare the patient for shipment, the cooperating mortician or funeral director should be asked to assist the transport team members with making airline reservations, both for the patient and for the team members accompanying the patient. Morticians are usually very familiar with local shipping requirements and local commercial carriers, and their information and assistance will save time.
The primary consideration in selecting a flight is the timely transport of the patient. While non-stop flights are preferred, they are not essential if “direct” flights (those not entailing an aircraft change) are available and faster. Situations where the patient must be transferred from plane to plane should be avoided if possible, even at the risk of 4-6 hours delay. As a cautionary note, it is important to ask the airline if the flight you’ve scheduled is being “funneled” at an intermediary airport. This is a sneaky tactic many airlines use to imply that passengers are booked on a direct flight, when in fact, the passengers must change planes at a major hub.
Whenever possible, at least one transport team member should supervise the handling of the patient throughout all steps of the loading process. (This is another reason to obtain direct, and preferably, non-stop flights.) If the weather is subfreezing, it’s imperative that the airline personnel are aware that the patient must not be allowed to sit on the tarmac awaiting loading, maintained in unheated quarters, or generally exposed to sub-zero temperatures for more than 30 minutes. These temperatures will probably result in the patient’s temperature dropping below 0°C and structural damage occurring as the result of ice formation.
|Caution: The patient must not be exposed to sub-zero temperatures for more than thirty minutes. If there will be delays in loading the aircraft, the patient must be kept indoors until loading commences. Exposure to extreme cold could result in the patient’s tissue freezing, making subsequent perfusion difficult or impossible.|
Patients should be protected from warming and jostling during transport using the best materials available to transport personnel. A patient should be brought to the appropriate Alcor facility using the fastest methods of transportation possible. Arrangements for shipping on a commercial carrier are necessary for patients who live outside the range of Alcor’s ambulance. Airlines will usually prove the fastest method of transportation.
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