Alcor 1997 Stabilization and Transport Manual
Table of Contents

Chapter 3: Administrative Requirements

Of all the responsibilities facing a transport team member, the most important one is to REMAIN CALM. Emergency situations are best handled by individuals who are calm and well-organized. This holds especially true for cryonic suspensions. Keep in mind that responses from hospital administrators or physicians, coroners or their deputies, and all other professionals with whom a transport team comes into contact, will depend largely upon the demeanor and professionalism exhibited by the team members. Many of these professionals may have control of an Alcor patient prior to, during, or after the pronouncement of legal death. Team members have seldom experienced barriers to the release of an Alcor patient when these professionals received clear, calm explanations of the transport objectives, procedures, and requirements from the transport team.

It is generally easier to select a specific course of action when sufficient information about the situation is available. A team member should be prepared not only to gather information on the patient's condition and prognosis, but also to provide pertinent information to the hospital personnel and other professionals involved in the care of the patient in order to facilitate their cooperation or noninterference.

The primary informational objectives for the situations a transport team member will encounter include: providing reassurance to the patient's family and friends, providing clear explanations of the purpose of a cryonic suspension and transport, supplying information and instructions to the professionals with custody of the patient, and keeping Alcor Headquarters informed of any significant changes. To assist the team members with gathering relevant information about the patient's situation, an Emergency Information Questionnaire has been developed and should be used during a transport. In filling out this form, the patient's physician or nurse, family, or friends may have useful information. Usually, professionals are willing to cooperate (or at least not interfere) with the cryonic suspension arrangements of an Alcor client if they are dealt with openly and honestly.

'Usually' does not mean 'always.' Those in charge of the patient could be aggressive, hostile, belligerent, and uncooperative. Alcor has the legal authority to accept custody of the patient, but only after pronouncement. Gaining access before that time will improve the transport; therefore, at times like this, a transport team member will need to employ every available reserve of patience, rationality, and self-control to gain access to the patient. Although this book will examine some basic strategies for dealing with such situations, in-depth coverage is presently beyond its scope. Additional in-formation is available from Alcor Headquarters.

Alcor's Emergency Information Questionnaire

Introduction

This questionnaire is being provided to transport coordinators just in case the coordinator receives a call from a member requiring cryonic suspension in an emergency situation, and before Alcor has been notified. Before deploying any equipment or personnel, the coordinator is required to ask the caller to answer the questions below. Because the patient may not be a member-in-good-standing, the coordinator must verify the patient's membership status, by calling Alcor Headquarters, before any response is initiated.

Much of this information is necessary for a swift transport. Especially critical are current information about the patient's medical condition; the contact (telephone or otherwise) numbers for the patient's physician and hospital; the hospital name and room number, and the names and contact information for family members and the person placing the call.

General Information

Date of call:
Time of call:
Name and Alcor number of patient:
Patient location (inlcuding room number):
Physician:
Will the patient be moved from this location at any time?
If yes, what will be the new location?
What are the name, location, contact information, and relationship (to the patient) of the caller?
Are any of the patient's relatives present?

Medical Information

What is the patient's current condition and prognosis?
Weight:
Temp (C):
Conscious?
Legal death pronounced?

Has the patient ....(if yes, provide more information)
Undergone thoracic or abdominal surgery?
Ever been diagnosed with or treated for atheroschlerotic disease?
Been diagnosed with an infectious disease?

If legal death has been pronounced:
Time of pronouncement:
Date of pronouncement:
Causes of death:
Last recorded temp:
Was ice used to cool?
Will there be, or was there, an autopsy?
If so, when and where?
Was there an embalming?
If so, when and where?

Additional notes:

Responsibilities of a Transport Team Member

Certification as a transport team member requires attending an Alcor-sponsored training course and passing all applicable practical and written examinations. After the initial training, experience in transports and suspensions is essential to maintaining sharp skills.

Letters of appointment are issued to all certified transport team members who are authorized to take action on behalf of the Alcor Life Extension Foundation. A team member will be authorized to accept custody of patient remains after pronouncement of legal death, in order to fulfill contractual obligations for cryonic suspension services. In accepting human remains, an authorized transport team member is an Alcor representative and may invoke Alcor's non-profit, tax-exempt status or its classification as an educational and scientific organization, if necessary. This authority is only bestowed upon transport team members for use during cryonic suspensions and related emergencies involving Alcor clients.

Once a team member has secured the release of a patient after pronouncement, the team is authorized to implement the appropriate transport protocol, including but not limited to: cooling the patient through all available methods; providing cardiopulmonary support through the application of stabilization equipment and administration of medication; transporting the patient to an appropriate location for blood washout; and preparing the patient for shipment to the cryoprotective perfusion facility.

A certified transport team member has the authority to represent Alcor during negotiations with hospitals and other professional institutions in order to gain their support and cooperation. This includes negotiating subcontracts to satisfy the stabilization requirements (as with a mortician for the use of his facility and skills). Team members can execute all legal paperwork necessary to secure the timely release of the patient, within the existing structure of individual state and federal regulations.

In addition to the above, it is imperative that the team members remain in consistent contact with Alcor Headquarters during transport proceedings. Periodic telephonic communication is acceptable, and some technicians may also carry a paging device so they can be immediately notified to contact Alcor. The appropriate response to an Alcor emergency page is discussed in a later section of this chapter (see On-Call Procedure).

Revocation of this authority to act on the behalf of Alcor and its Board of Directors may occur at the joint discretion of the President and the Suspension Services Manager for reasons which may include, but are not limited to: team member discontinuation of Alcor suspension membership, nonperformance of duties as required, negligence, deliberate at-tempt to undermine the efficacy of a cryonic suspension, or failure to maintain skill or training requirements.

Central Support

Alcor Headquarters will generally notify the local transport coordinator (the individual who holds the transport equipment for the area, or otherwise designated authority) of the existence of an imminent cryonic suspension, rather than the other way around. This is the usual direction for the flow of information. Most patients will either notify Alcor directly of their condition, or Alcor' s medic alert system will have been activated through someone examining the bracelet or necktag worn by suspension clients and calling Alcor. Another likely source for activation of the medic alert system is the wallet card indicating the clients' participation in an anatomical donation program.

Once the local transport coordinator has been notified, Alcor will continue to provide support through coordination of personnel, services, and supplies, as the situation merits. It is the responsibility of the local transport coordinator to ensure that Alcor Headquarters is kept informed of the ongoing situation.

On-Call Procedure

Alcor transport team members are required to be on-call at all times. For those who have paging devices, those pagers should be operational at all times. A simple test can ensure the function of a paging device: page yourself. If the page does not go through after several attempts, and there is no digital readout in the screen, the batteries probably need to be replaced. Most pagers use AA-size batteries. If the pager proves to be nonfunctional after the batteries have been replaced, notify Alcor Headquarters of the situation and arrange a protocol for maintaining regular communication.

Those carrying pagers are required to respond to any page by Alcor Headquarters, for which either (602) 922-9013 or (800) 367-2228 will appear on the screen. During an unexpected cryonic suspension, even a few minutes' delay in response may have devastating consequences. To help clarify the nature of a page and its level of urgency, the Alcor staff has developed a code system for its own use. Local team members may find it useful to develop similar systems. The only caution here is not to confuse local codes with those of Alcor headquarters.

Further care must be taken when the only form of contact between Alcor Headquarters and the transport team is a paging device. Pagers are not reliable, in that a page may not be received if a team member is in a large building with significant steel construction, in underground facilities, outside the paging area, on an airplane over various parts of the country (requires a nationwide pager, which may still not work in an airplane), in mountainous areas, or at other, difficult to predict locations. Team members who will be spending significant amounts of time in underground or steel-framed facilities where a page will not penetrate should provide Alcor Headquarters with a telephone number where they may be reached in an emergency and also arrange a protocol for maintaining regular communication. It's recommended that a code be established for a predetermined, test page for which no response is required (unless the expected test page doesn't materialize).

Individuals should conduct test-paging at all frequented locations, such as home, work, and local shopping centers. These tests can verify the operation of the paging device at locations where the individual is most of the time, and should be done before a transport is required. During transport operations, the team member should work in conjunction with Alcor Headquarters to verify the operation of the pager, and if the pager fails to respond, the member will be required to call Alcor at specified intervals to ensure that lines of communication are maintained.

If an Alcor transport team member is contacted by a relative or physician of an Alcor Suspension member, for the purpose of starting an emergency response, the Emergency Information Questionnaire in the Appendix should be completed. All information should then be forwarded directly to Alcor's President or Suspension Services Manager. If neither are available, any Alcor staff member may take the information but should contact at least one of them immediately.

Important information to have available for Alcor Headquarters personnel includes the member's name and Alcor number, the location of the hospital, the clinical condition of the member (including the nature of the illness and the physician's prognosis), and the name, telephone number, and relationship of the individual contacting the transport team member. Names, telephone numbers, and relationships of any family members present are also important. Make certain that the contacting individual supplies a number where they can be immediately contacted (e.g. if they are in the hospital waiting room, get that number).

Alcor transport team members shall not respond to any request for emergency response, except one from Alcor Headquarters, without first calling Alcor Headquarters to verify the membership status of the patient.

No transport team member shall use the equipment and medications provided by Alcor on any individual who is not a Suspension member in good standing of the Alcor Life Extension Foundation without the express, written permission of Alcor's President. Facsimile (fax) transmission of this document is acceptable, but the original document must be mailed immediately.

Team Member Identification

All certified transport team members will be issued an identification badge with photograph. This badge allows immediate identification of team members as representatives of Alcor. It is to be worn at all times when interfacing with medical personnel. In addition to providing name-recognition for transport team members, it may also provide a common element of professionalism for dealing with medical personnel, as they often wear similar identification badges. Establishing common ground is critical to negotiating the logistics of a transport, as external (non-cryonicist) cooperation usually depends upon understanding the goals of a cryonic suspension.

When dealing with any medical personnel, coroners, morticians, or family involved in an imminent or ongoing suspension, always use their names. Use whatever appellations will make the individual most comfortable (Mr., Mrs., Dr., first names, etc.) Identification badges are good sources for this and other useful information. Communication should always be on an individual level, as opposed to an institutional level, as this is more likely to engender cooperation. Be careful to avoid statements which may alienate individuals by way of antagonizing "their" institution. Don't criticize their office. Even if they hate their boss, their job, and their parking space, you will nonetheless be an outsider attempting to undermine their livelihood. You will not gain cooperation this way.

In cases where medical personnel or governmental representatives (coroners, medical examiners, police officers, etc.) are hostile, be certain to take note of their names, identification numbers, and organizational affiliation in addition to the specifics of the conflict. This information will assist Alcor Headquarters in determining a further course of action, should a patient's suspension be jeopardized. It is also recommended that you not take these notes in front of the hostile individuals, as this may further escalate any conflict.

Liability and Ethical Concerns for Team Members

It is imperative that transport team members maintain a respectful distance from the member before pronouncement occurs, except in cases where another non-Alcor affiliated individual is also present. (The natural exception to this occurs when relatives of the patient are also Alcor suspension members and have interests and expectations matching Alcor's.) Unsupervised access to a patient in advance of pronouncement of death opens up the potential for "conflict of interest" accusations. Alcor stands to gain financially from the legal deaths of its clients, though cryonicists understand that this involves little (if any) profit, this is not necessarily information which can be effectively conveyed to others. The absolute bottom line is this: there must be NO possibility for accusations that Alcor exerted improper influence while the patient was still alive or took any action to hasten that patient's clinical death!

With these precautions in mind, one further policy affords the trans-port team members some legal protection — that of continuity of care. Once a team member has become involved in the stabilization and trans-port of an Alcor client, it is the responsibility of that member to remain with the patient (although the restrictions above should be taken into account) until care of that client is handed off to another Alcor representative. The only exception to this is that care may be given over to law enforcement officials (but only under duress). A written receipt must be obtained for the patient from the official in charge. On the receipt should be the following information: name of the individual assuming care, badge number (most law enforcement agency officials have one), time, date, and circumstances of discontinuity. Once the patient is pronounced legally dead, the conflict of interest concerns should be removed.

Liability and Ethical Concerns for Medical Personnel

Armed with moral, legal, or territorial objections to the practice of cryonics, many hospitals, hospices, or nursing homes may refuse to provide any active assistance to Alcor personnel after the pronouncement of legal death, and may also minimize their involvement in advance of pronouncement. When a physician or hospital administrator is being uncooperative without any apparent "good reason," the source of hostility may simply be personal prejudice or bias. In these instances, and if the opportunity exists, offer to discuss the aspects of cryonics with this individual (and any others who may be interested in learning more about Alcor and its mission) which make them uncomfortable. Encouraging an open and honest discussion may negate harsh feelings among those having control of the patient before pronouncement. However, conversation should be friendly and informative. Never push it to the point of becoming an impediment to cooperation.

There are also more rational concerns — such as organizational liability — which may inhibit hospital staff, physicians, or administrators. For instance, noncooperation may be advocated because of the hospital's inexperience with cryonic procedures, and therefore, both legal and ethical reasons may be part of the reluctance to assist. In these cases, Alcor personnel are to offer the hospital a hold-harmless agreement, which states that Alcor agrees to hold the medical establishment and its personnel free from all civil liability resulting from cryonic suspension procedures initiated on the premises. This agreement is not limited to hospitals; it may be applied to hospice or home care facilities and their personnel as well.)

Sample hold-harmless agreement

Agreement to Hold Harmless

The Alcor Life Extension Foundation of 7895 East Acoma Drive, #11O in Scottsdale, Arizona hearby holds ________________ harmless as the result of any acts or decisions made with respect to the duties arising from service to Alcor. In return for your cooperation in this matter, Alcor releases you, your successors, assigns, or other agents acting on your behalf from any and all civil liability resulting from the post mortem handling or transfer of the patient's remains to Alcor or Alcor's representatives or assigns. We appreciate your lack of familiarity with cryonic suspension procedures and intend this release of civil liability to be all-inclusive. For the patient's sake, we seek your cooperation, and it is our intention that this cooperation will be given with the certainty that you will be held harmless and free of all civil liability from the consequences of your assistance in this matter.

We further agree that this hold-harmless agreement shall be binding for the heirs, successors, and assigns of the Alcor Life Extension Foundation.

This document shall be signed by the President of Alcor and one other Board Member.

Legal Status

It is important to emphasize that Alcor is accepting a whole-body anatomical donation on behalf of the patient. This authority is governed by state statutes in the Uniform Anatomical Gift Act, and certain precedents have already been established for cryonics suspension patients. In California, a person's legal right to choose cryonic suspension as an alternative method for disposition of corporeal remains has been upheld by the judiciary system and has the force of law (Roe v. Mitchell). Since many states have similar laws and look to other states for precedents, it's likely that court cases in other jurisdictions would also be resolved in Alcor's favor. This case was exceptional in another way: because the court issued a restraining order against the hospital caring for Richard Jones, compelling them to allow Alcor personnel to initiate transport protocol on the premises (to the extent of cooling and mechanical cardiopulmonary support). Further, it specifically warned the hospital against unnecessary delays in releasing the patient to Alcor personnel. The hospital was required to release the patient within two hours of the pronouncement of legal death. Two hours is a long time, compared to Alcor's average, but the hospital could conceivably have delayed for a much longer time.

Alcor will not generally take legal action during transports, since doing so will likely delay transport procedures for a patient who is agonal (clearly dying and not to be kept alive using extraordinary measures) or already deceased. Legal action is usually reserved for cases which would provide significant precedents for future patients and which may be undertaken long in advance of a member's agonal decline. All decisions regarding legal action by Alcor are made by Alcor's President and Board of Directors. Copies of previous legal decisions may be forwarded to hospital administrators or legal counsel upon request, but this should only be done in cases where the hospital seems likely to interfere with the timely transport of a cryonic suspension patient.

Some sample letters which may be of assistance in securing the cooperation or noninterference (by medical personnel) with the duties of the transport team are available for reference in the Appendix, and any of these letters may be faxed to the team during a suspension. Originals can be obtained by transport team members within 24 hours. The specific letters may be modified according to circumstantial differences, but please be certain to inform Alcor Headquarters as to the letter (and the necessary modifications) appropriate to the situation at hand.

Information Gathering

Adequate record-keeping is essential for evaluating the quality of any cryonic suspension. Much of this record-keeping falls to the transport team members. Throughout the transport proceedings, it is extremely important that the names, contact information, and relationships to the patient of all key people involved be noted in a secure place. Information gathered should include the names and phone numbers of any hospital or hospice personnel, relatives, morticians, and law enforcement personnel involved.

Information acquisition and recording is the first aspect of the transport procedures which is likely to be neglected in circumstances where the team is short-handed. Prioritization is essential, and there is certain information which absolutely must be recorded. In addition to the post-suspension evaluation, the presence or absence of good notes will be significant to any legal actions brought against Alcor or by Alcor, against interfering agencies or individuals. It is incumbent upon the transport team members to keep track of the following items:

  • Any visit with the patient by transport team members. The patient's mental condition, vital statistics (if available), time of the meeting, information on the conversation content, and any other interesting or potentially useful items should be noted.

  • Significant conversations. These may include conversations with relatives, physicians, administrators, etc. The names of involved individuals, their future contact information, topics of conversation, attitudes expressed, promises made (by anyone), and the time and date of the conversation should all be recorded.

  • Medical information on the patient's condition. This is information which may be obtained from hospital personnel or from personal examination (preferably discreet). Include the source of the information, time provided, and whether or not the information is detailed in the patient's medical chart.

  • Medications administered to the patient! This information is critical. Include medications given by both the hospital and (after pronouncement) the transport team, the drug administered, the dosage, the route of administration (peripheral IV, nasogastric tube, gastric tube, central venous IV, etc.), and the name of the individual administering the medications. Charting medications immediately is necessary to prevent oversight in critical care for the patient and utilizes a common, useful convention under which medical personnel operate — the assumption that if it's not recorded, it wasn't administered.

  • Additionally, team members are encouraged to exercise their own judgment in ensuring that further information which may be relevant is recorded.

Team members are encouraged to carry personal notebooks or recording devices with them on transports. These may enable more efficient information collection and storage.

Individual Preparations

Transports usually begin with only a few hours notice to prepare, and often none at all. Thus, it is recommended that all transport and suspension personnel maintain an Overnight Kit in readiness at all times. In order to accommodate both administrative duties and personal needs, the Overnight Kit should be subdivided into an overnight bag and a separate briefcase (or similar bag). See the illustrations for recommended contents of an Overnight Kit. Contents should be sufficient for at least a 48 hour stay. Some items have been included on both lists because it may not be appropriate to carry both bags with you at all times.

Overnight Kit
Administrative Contents

Transport Manual
ER Manual
Passport
Alcor ID Badge
Exam Gloves
Notepad/Pen
Tape Recorder (optional)
Alcor Contact Info
Calculator
Flashlight
Energy Snacks
Reading Material

Overnight Kit
Personal Contents

Attractive Slacks, dark colors
Matching Shirts, white
Lab Coat
Towel and washcloth
Underwear (several pair)
Comfortable Shoes
Jacket
Personal Medical Supplies
Hygenic Supplies
High Energy Snacks
Air Mattress
Light Blanket
Small Pillow

Safety Precautions

To protect against the spread of infectious diseases (like tuberculosis or hepatitis B), vaccinations are made available to members of the transport and suspension teams. These vaccinations are either administered at Alcor or the expenses are reimbursed (upon proof of vaccination) should the team member prefer a local physician. Vaccinations may also be available — free of charge for common diseases — from local health organizations.

There is no way to be certain that any patient is free of infectious disease at the time of pronouncement. With some illnesses, incubation can continue for several years prior to any symptoms surfacing, and infection can only be verified through a blood test or similar invasive procedure. Given that the cause of death may be unrelated to such infection, suitable precautions must be taken to prevent the spread of bloodborne pathogens during every cryonic suspension Alcor performs. No team member will ever be asked sacrifice their own life for that of the patient, and adhering to the safety precautions will reduce the chance of this sacrifice occurring by accident.

All personnel wear face masks, hair covers, and puncture-resistant gloves if they are to come into contact with either the patient directly or the patient's body fluids. If a patient is known to have an infectious disease, full-body, water-resistant coveralls and goggles should be added. For team members whose positions have a greater potential for exposure to blood (for example, the surgeon and the perfusionist), face shields or goggles are mandatory in all cases.

Conclusion

Once an emergency response has been initiated, one of the best methods for ensuring that the patient will receive a quality cryonic sus-pension is to make certain that all transport preparations that can be done in advance are actually done in advance. In the past, patients have occasionally been pronounced before the team was ready. This is something which should be avoided at all cost. It is a difficult burden to carry — knowing that you could have and should have done more. Under no circumstances should blame be assigned to transport team members. While a transport is in progress and difficult circumstances arise, assigning blame for errors will detract from the entire team's performance. Flogging and self-flagellation are generally counterproductive. The events of the transport will be evaluated once the patient is safely in liquid nitrogen, not before. When the inevitable mistakes occur, learn from them. Remember, when a situation leaves you wishing you'd been better prepared, move on. Prepare for the next time. Cope with the situation you have, not the one you should have had.

Applying basic common sense is essential to accomplishing many of the tasks listed in this and other chapters. As mentioned initially, and still deserving of repetition, the most important thing for a transport team member to remember is to REMAIN CALM. Nothing is more critical to obtaining the cooperation (or at least, noninterference) of family members, medical personnel, morticians, coroners, etc. than simply maintaining a rational and even-keeled approach to managing the cryonic suspension at hand.

Alcor Headquarters can always be called on for support, including a friendly ear at which to "vent" frustrations during an unpleasant situation. (But remember to remain calm with others.) This emotional support may be solicited in conjunction with keeping both Headquarters and off-site personnel informed of the ongoing situation.

Information about past cryonic suspensions, current techniques, and scientific data supporting the concept of cryonics is available to the transport team, and it is incumbent upon the team to request anything which might improve the outcome of any given transport. Some of that information is contained within this handbook; much of it is simply referenced. All of it may be useful.

 

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