Understanding Attended and Unattended Death in Society

Greek philosopher Diogenes is credited with proclaiming “we come into the world alone and we die alone.” In the end, he was trying to make a point about self-sufficiency. In considering death, there are situations in which a person passes on alone, suffers an unattended death. On the other hand, there are more occasions in which a person dies an attended death. There are basic distinctions between an attended and unattended death in society.

Definition of Attended Death

There exists a legal and common definition of what is meant by attended death in the state of California. The common definition of attended death simply means that a person does not die alone. He or she dies with someone at his or her side.

The legal definition of attended death means that a person passes on in a situation or setting in which a death certificate can be signed without the need for additional forensics investigation, like an autopsy. Examples of situations or settings in which a death legally is considered attended include:

  • Hospital
  • Long-term care facility
  • Hospice
  • At home, but under doctor’s care
  • Deceased individual saw primary care physician within 30 days prior to death and died around others

Definition of Unattended Death

An unattended death occurs when an individual dies alone. Oftentimes, in the case of an unattended death, the body is not immediately found, according to the Los Angeles County Coroner.

The most common types of situations in which an unattended death occurs include:

  • Accident
  • Sudden health issue (like a fatal heart attack or stroke)
  • Suicide
  • Homicide
  • Natural causes

The Evolution of Attended Death in the U.S. Society

Dying and death in the United States has been an evolutionary process. (Some would argue it has been a devolutionary process.) Until the early part of the 20th century, a majority of people in the United States died at home attended by their immediate or even extended families. The family doctor may have been in the home at the time of death as well, but not always. The process of dying was an occasion that brought loved ones together.

Following the passing, the local undertaker may have taken the body for basic embalming and preparation. In many occasions, when that process was completed, the remains of the deceased was returned to the home and the family for a period of mourning. This process oftentimes included a wake, followed by a funeral. The funeral was conducted in a local church or in the home. Burial followed, typically on the grounds of the church or even in property owned by the family of the deceased, if they had a family graveyard.

In today’s world, the aftermath of death involves a process that is much less personal. Far more laws and regulations exist detailing what must be done following a person’s death. For example, California law mandates embalming within 24 hours after death unless the remains are refrigerated or direct burial occurs.

A direct burial is one in which a body is interned within about a day of death without embalming or much preparation of any kind. There are a trio of cemeteries in Los Angeles that have plots available for direct burial:

  • Joshua Tree Memorial Park
  • Woodlawn Memorial Park
  • Hillside Memorial Park

Hearkening back to days gone by, a direct burial can also occur in a family plot, if approval for that type of land use was already obtained from either the county or city.

The Evolution of Unattended Death in the U.S. Society

A hundred years ago, the very concept of unattended death really didn’t exist. The occasions in which a person died in what today would be called an unattended death were virtually nonexistent.

The death and dying process a hundred years later has become things less personal and more regimented. More often than not, death occurs outside of the home – in places like hospitals, long-term care facilities, and hospices. When a passing occurs at home, with the nature of society today, the odds of it being an unattended death are significantly greater than at any time in U.S. history.

In California today, approximately 600 unattended deaths are reported to individual coroners’ office statewide annually. That equates to about 2 unattended deaths reported in the state every day.

The Aftermath of Unattended Death

Directly after a person dies, the human Decomposition commences. When a death is unattended using the common definition of the term, days, weeks, or even longer may pass before the deceased individual’s remains are discovered. Thus, the decomposition process carries on unabated.

The unabated decomposition process has what fairly can be classified as horrific and even dangerous consequences. There exist more bacteria in a human body than actual cells. There can be between 500 and 1,000 different types of bacteria in the pancreas and intestines of a human begin.

At the time of death, the nutrient supply, drawn from the blood, no longer reaches these bacteria. As a result, the bacteria begin to “feed” on the organs of the body themselves. As a result of this process, after an unattended death, dangerous pathogens release from the body into the surrounding area surrounding the body. These include blood and other bodily fluids that are contaminated with biohazardous pathogens. Gases also escape the body during the decomposition process which are not only dangerous but can also be contaminated with dangerous pathogens.

What to do When an Unattended Death is Discovered

If you’re ever in the truly unfortunate position of discovering an unattended death, there are a set of steps that you must take immediately to address the situation and to protect your welfare and that of others.

Because an unattended death very well may have occurred more than a couple of days prior to the discovery of the remains, physical contact with the body must not occur. Indeed, once you have discovered the remains of a person clearly is deceased, you need to remove your self from the room in which the body is found. The area around the remains very well may be contaminated with dangerous, even potentially deadly, pathogens. This includes contaminants released into the air through gases from the decomposition of the body.

Once you’ve retreated to safe space, telephone 911 and explain the situation to the dispatcher. Appropriate emergency personnel will be dispatched to the scene. The remains are highly likely to be transported to the county coroner’s office for a forensics examination, including an autopsy. This process normally takes between 24 and 48 hours.

At the conclusion of this process, the remains will be available for transport to a funeral home for preparation and internment. If you find yourself in the position of having to arrange for the transport of the remains of a deceased person to a funeral home, you have 72 hours to get this accomplished from the conclusion of the forensics examination.

Once the remains are removed from the death scene, the process of unattended death cleanup cannot yet commence. Law enforcement and the coroner’s office must first complete their on-scene investigation and release the premises to you for unattended death cleanup.

When Does Biohazard Remediation Need to Occur?

Immediately after the remains of a deceased loved one are removed from a room, arrangements for biohazard remediation should be underway. The reality is that significant damage to a room can begin to occur within a few days after a person dies as a result of the decomposition process.

The best way to ensure that the long-term effects associated with an unattended death is to start the biohazard remediation process as soon as possible. Remember, as was referenced a moment ago, depending on the circumstances surrounding the death, the coroner or law enforcement may have to “release the scene” to permit biohazard remediation to start.

Steps to Clean a Room Following an Unattended Death

Unlike what normally is done following an attended death, what is known as biohazard remediation follows an unattended death. A biohazard technically is defined as material of a biological origin that has the ability to have negative, even fatal, effects on humans. Following an unattended death, remediation is the process of eliminating harmful or fatal substances associated with the remains of the deceased individual. 

In comparing and contrasted an attended death with an unattended death, there can be circumstances when biohazard remediation is necessary following an attended death. For example, if a person dies a traumatic death of some type, with family and even medical personnel in attendance, biohazard remediation may be necessary. In addition, if someone experiences some sort of traumatic event and survives, the resulting disbursement of blood, bodily fluids, and other biological materials at the scene may warrant biohazard remediation.

The standard stages of biohazard remediation are:

Cleaning

The first stage is the actual cleanup of blood, bodily fluids, biological materials, and anything somehow contaminated by this biological matter. Personal protective equipment must be worn commencing at this stage of the overall biohazard remediation process. Personal protective equipment sometimes is referred to as PPE. This gear includes:

  • Gloves
  • Smock or proper outer clothing
  • Eye protection (goggles)
  • Mouth protection (surgical mask or respirator)

Sanitization

The second stage in the remediation process is sanitization. Specialized medical grade chemicals are used.

Deodorization

If a body was unattended for more than a few days, foul odors associated with decomposition will exist. Commercial deodorizing agents are used to eliminate these odors

Restoration

The final objective of biohazard remediation is to restore a residence to a livable condition. When the process is completed, you are able to return to the residence with the comfort of knowing that all evidence of what occurred has been eliminated and that the premises are safe for occupation by your and your loved ones.

Differences in Grieving an Attended Death Versus an Unattended Death

If you lose a loved one in a situation that falls within the context of an attended death in society today, a person like you faces a grieving process that can prove to be challenging. In recent years, many experts on dying and death have suggested that there are five stages to the grief process when most people face the final loss of a loved one. These stages are:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

When an unattended death occurs, in addition to the five stages of grieving, an individual may also face what is oftentimes called traumatic grief. Traumatic grief is defined as an extremely, and ultimately unhealthy, reaction to the death. This can occur when the loved one’s death occurred suddenly or was not immediately discovered. Traumatic grief very well may be compounded for an individual who discovers the body of a loved one.

Although traumatic grief can prove to be unhealthy, it is an understandable response when a person is involved in some manner in the traumatic death of a loved one, including discovering the body following an unattended death. 

Traumatic grief manifests itself in a number of ways, which include:

  • Inability to sleep
  • Nightmares
  • Appetite changes
  • Increased irritation
  • Increased aggression
  • Deep sadness
  • Depression
  • Anxiety

Traumatic grief is not the only type of negative emotional reaction that can follow an unattended death or a traumatic attended one, for that matter. A person in this type of situation may also suffer chronic depression, severe anxiety, or post traumatic stress disorder.

There are mental health professionals experienced in working with people who are trying to come to terms with the death of a loved one, whether that death is attended or unattended. In addition, there are mental health who work with people who faced the traumatic death of a loved one, or an unattended death, and suffer from traumatic grief.

When to comes to attended death or unattended death in society today, you are not alone. Odds are that you have people in your life who have experienced either a traumatic attended death or an unattended death (with its manifold complications). In addition to seeking professional assistance for biohazard remediation as well as professional mental health assistance, these people in your live are likely to be more than willing to provide you information about resources that were helpful to them.