5-153
is unavailable, use chlorpromazine 50-100 mg po or IM. Also consider giving diphenhydramine
25-50 mg po or IM coincident with the haloperidol or chlorpromazine.
c. AVOID USE OF DIPHENHYDRAMINE, CHLOPROMAZINE OR OTHER MEDICATIONS WITH
ANTI-CHOLINERGIC SIDE EFFECTS IF YOU SUSPECT DELIRIUM. THESE WILL WORSEN THE
DELRIUM!
d. If medication fails to settle down an agitated patient, see Psychiatric Restraint Procedures (on
CD-ROM). If leather restraints are unavailable, consider restraint with sheets, wrapped around
patient on litter. Pharmacological or physical restraint may be necessary to better evaluate and
treat a delirious patient.- Consider IV hydration for those unable to care for self.
- Place on watch.
Follow-up Actions:
Evacuation/Consultation Criteria: Evacuate US service members suffering from a psychotic or delirious
disorder. Host nation service members and persons should be given behavioral redirection and managed with
a goal of maintaining safety for all parties.
Mental Health: Recovering Human Remains
How to Prepare Yourself, Your Buddies, and the Unit
MAJ Michael Doyle, MC, USAThe Mission: May include collecting the bodies of fellow service members so that the Mortuary Affairs
specialists can return them to the United States for identification and burial. It may include gathering and
possibly burying the bodies of enemy or civilian dead to safeguard public health. The numbers of dead may be
small and very personal, or they may be vast. The dead may include young men and women, elderly people,
small children or infants, for whom we feel an innate empathy. Being exposed to children who have died can
be especially distressing, particularly for individuals who have children of their own.
What To Expect: Seeing mutilated bodies evokes horror in most human beings, although most people quickly
form a tough, protective mental “shell”. The dead bodies may be wasted by starvation, dehydration and disease
(e.g., Rwanda refugees or some POW and concentration camp victims). They may have been crushed and dug
out from under rubble, (e.g., the Beirut barracks bombing or earthquake victims). They may be badly mutilated by
re, impact, blast or projectiles (e.g., the victims of the air crashes at Gander, Newfoundland; the civilians killed by
collateral damage and re near the Commandancia in Panama City, or the Iraqi army dead north of Kuwait). They
may be victims of deliberate atrocity (e.g., the Shiites of south Iraq or any side in Bosnia). Survivor reactions
may include grief, anger, shock, gratitude or ingratitude, numbness or indifference. Such reactions may seem
appropriate or inappropriate to you, and may affect your own reactions to the dead. In situations where the cause
of death leaves few signs on the bodies (e.g., the mass suicide with cyanide at Jonestown, Guyana) caregivers
often have more difculty adapting because it is harder to form the “shell.” The degree of decomposition of
the bodies will be determined by the temperature, climate and length of time since death. Bodies will emit a
strong odor of decomposition. Workers may have to touch the remains, move them and perhaps hear the sounds
of autopsies being performed or other burial activities. These sensations may interfere with work, and create
disturbing memories. In body handling situations, many personnel naturally tend towards what is aptly called
“graveyard humor.” This is a normal human reaction or “safety valve” for very uncomfortable feelings. Other
feelings may occur, including sorrow, regret, repulsion, disgust, anger and futility.
When: Personnel may have to perform these services after any death, natural or traumatic.
What You Need: Body bags, shovels, reporting forms, pens or pencils, bags for personal effects, labels,
gloves, visual barriers/screens, deodorants