X-Message-Number: 0026
Subject: Cryonics, the Home Town Way

From: 
Message-Subject: The HomeTown Way
Date: Sat,  8 May 93 00:17:02 PDT

To Kevin Q. Brown
>From Steve Bridge

     After  digging  around for "Hometown Cryonics," I discovered  it  was 
really  titled  "Cryonics, the Home Town Way."  I also  remembered  I  had 
revised it following some important suggestions from Jerry Leaf.  It needs 
revised  again,  since things have changed so much; but it is  still  very 
useful.   Perhaps you could place this most recent edition in  a  sub-file 
for people to access.

Steve B.


                       CRYONICS, THE HOME TOWN WAY:
      PRACTICAL PLANNING FOR A CRYONIC SUSPENSION IN YOUR OWN AREA.

By Steve Bridge, Midwestern Coordinator
(Revised 6-89)

***NOTE:  Much about cryonics has changed since this article was  written.  
This is still useful as an introduction; but check with Alcor first before 
you try anything technical.  We hope to revise this someday.

Steve Bridge, currently President of Alcor
***

     So,  you're all signed up with Alcor; you've got your life  insurance 
policy; your will is impeccable; you are wearing your cute little bracelet 
or necktag.  Now all you have to do is live your life and Alcor will  take 
care  of  everything  else, right?  If you live  in  Southern  California, 
especially in Riverside County, you might be able to say "right."  But  if 
you  live  in the other 99% of the country, the answer is:  WRONG!  WRONG! 
WRONG!

     For most of us in this big world, Alcor is too far away to handle all 
steps of an emergency.  Alcor *is* a mutual aid society and its staff  and 
suspension  team  will  do  everything humanly  possible  to  suspend  its 
members.  But while Alcor may be our friend, it is not our MOTHER.  If you 
want  to be suspended in as good a condition as possible, and if you  want 
the same treatment for your nearby friends and family, there is a lot  you 
must do for yourselves.

     In  Indianapolis this fall (1988), we had the first full test of  the 
Alcor Cryonics Coordinators program, which was created in 1986.  The basic 
purpose  of  this  program was to establish  various  members  around  the 
country  (and in other countries) as leaders for members in  their  areas.  
It  was  apparent from the very beginnings of cryonics that the  need  for 
prompt   response  to  emergencies  would  eventually   require   regional 
suspension facilities.  Of course, such sophisticated local  organizations 
are  hopelessly  impractical at the current stage in Alcor's  growth,  but 
Alcor's  leaders felt that there were interim steps which could be  taken.  
Two types of coordinators were appointed (some individuals could  function 
as both types).  Some would share information, speak to the public, and/or 
follow up on membership leads.  Others could receive enough training to be 
able  to  coordinate the first steps of a suspension.  These  steps  might 
include:

     1.  Arranging with hospital personnel, the coroner's office, or other 
officials  to effect the transfer of the patient's person to  Alcor  after 
the patient's legal death.

     2.   Arranging for a mortician to pick up the patient  and  transport 
him to his facility.

     3.  Packing the patient's body (especially the head) in ice to  stave 
off damaging effects of ischemia (lack of blood flow).

     4.  Providing CPR and other cardio-pulmonary support.

     5.  Providing for air transport to Alcor's Riverside facility.

And some individuals with more extensive training might be able to:

     6.  Put in an I.V. and administer various first level medications  to 
further prevent ischemic damage.

     Currently, Alcor maintains fully equipped facilities in Riverside and 
in  Southern Florida.  Thomas Donaldson in Northern California and  myself 
in  Indianapolis also have rescue kits and much of the training  necessary 
to  use  them.   I am sure that Thomas, the Florida team,  and  our  Alcor 
members  in  Australia  and  England  have  their  own  stories  of   what 
preparations they have made and ideas they have which might be useful  for 
all  of  us  to  know.  I hope they will each  share  those  someday.   My 
perspective  will be a bit different, however.  Here in Indianapolis,  far 
from  any  cryonics facility, three local members and  myself  managed  to 
prepare  pretty  well for a cryonics suspension, which  we  then  actually 
accomplished  under the direction of Mike Darwin and Jerry Leaf.   In  the 
November,  1988  issue  of *CRYONICS* ("The Cryonic  Suspension  of  Alice 
Black"), you read how the suspension occurred.  

     We  also learned much from the remote suspension done in Michigan  in 
March,  1989 (see May, 1989 issue of *CRYONICS*).  This  was organized  by 
the patient's  family,  none  of whom were suspension members, with advice 
and assistance from Jerry, Mike,  and myself.

     In  this  article,  I will  describe  the  organizational  background 
required  to set up these suspensions, with suggestions on how  you  might 
organize your friends and family to do something similar.  While you might 
not be ready for the full responsibilities of Coordinator, there is a  lot 
any Alcor member can accomplish which will increase his or her chances  at 
a successful suspension. 


*GETTING YOUR THOUGHTS IN ORDER*

     Preparing for a suspension obviously will be pretty difficult if  you 
are the only suspension member in your area.  Any kind of organization you 
can  put  together  will have to be planned far in advance  of  a  serious 
illness  and must rely on the participation of friends and family who  are 
not  dedicated  to  the  idea of cryonics.   One  of  the  most  important 
motivators  for  commitment to the work required for a suspension  is  the 
thought  of each participating suspension member that they want  the  same 
level of dedication from others when their own suspensions begin.  If  you 
do not have that advantage, you may have to encourage cooperation  through 
financial means.  You could (for example) place a sum of money in a  trust 
account,  which  would be paid out in fees to your  physician,  mortician, 
attorney,  friends, or family only if they properly assist in getting  you 
suspended.

     While this level of organization will require some commitment of time 
and  resources on your part, you may be surprised at how many  people  are 
quite  willing to cooperate.  Many people who do not themselves desire  to 
be  suspended  nevertheless see cryonics as a rational  choice.   This  is 
especially  true  if you have presented it to people as the  result  of  a 
 rational decision  on your part.  

     Whether  you are by yourself or part of a group, the first  essential 
step  is: TELL PEOPLE ABOUT YOUR DESIRE TO BE SUSPENDED.  Make this  known 
to  your family, friends, co-workers, and neighbors; discuss  your  wishes 
and  commitment in detail; emphasize the seriousness and long-term  nature 
of  your decision; make sure they understand that you have  made  definite 
legal  and  financial arrangements to ensure suspension.  This  course  of 
action gives you many advantages: 

     1)   If  you  die or become  incapacitated  suddenly  without  anyone 
knowing  of your wishes, your ALCOR bracelet may well be ignored, and  the 
odds on you getting suspended become extremely low.  However, if you  have 
been  honest  and  open  about your desires, there  will  be  many  people 
available to call Alcor, to refuse permission for autopsy, to pack you  in 
ice, etc.   

     2)   If  your  friends and family have known  of  your  interest  for 
several  years, they are more likely to consider your decision  acceptable 
and less likely to panic when it comes time to call Alcor.  (Some of  your 
friends and family might even become interested in cryonics themselves  -- 
an advantage for all of you.)  

     3)  It  will  be impossible for anyone to claim  that  some  cryonics 
company  suddenly  had taken advantage of your illness to defraud  you  of 
your  money  (and to defraud your relatives of their  inheritance).   This 
*is* a serious consideration, proven by several real-life Alcor  conflicts 
with relatives.

     If  you  are worried that you will lose all of your  friends  and  be 
thrown  out of your family if you tell them of your interest in  cryonics, 
past  evidence (including my own personal experience) suggests  that  your 
fears  are probably unjustified.  Your family will be  surprised,  perhaps 
even  shocked  at first; but your involvement in cryonics is  unlikely  to 
make  them  change their opinion of you.  If they loved you  before,  they 
will still love you.  If they already thought of you as a damn fool and  a 
crackpot,  cryonics is hardly likely to change that opinion  either.   You 
may lose a friend or two, but rarely a close one; and many of your friends 
will actually see you as *more interesting*.  

     Besides,  you will gain many more friends in cryonics than  you  will 
lose  elsewhere.  I have had two romantic relationships badly affected  by 
cryonics;  but  I  can realistically say, in retrospect, that  I  am  much 
better  off now with someone who shares my views than I was  with  someone 
who did not.  In any case, if you are deciding to stay alive, is not  that 
decision  more  important  to you than the sensibilities  of  friends  and 
family?    Few  important decisions have 100% positive results.   Part  of 
growing up is to accept all of the results of our decisions and go on.  If 
you have strong convictions, you must stand up for them.

     Finally, some members state that they don't want to tell anyone about 
their  decision  to  be frozen because it would "upset"  their  family  or 
friends  too much.  Now, if these people are honest with  themselves,  the 
real  reason  is  more likely that they are short on  confidence  and  are 
afraid  to test their family's love for them.  Still, consider  this:   It 
will be a lot easier for your relatives to handle this information  coming 
from *you*, when they can still ask questions and give you a hug, than  it 
will  be after your legal death when I or someone else try to  explain  to 
them that we are carting your body  off to California to be frozen (or  to 
freeze  your head!).  The latter course may eliminate *your*  pain,  since 
you  won't  be there to deal with it, but it will certainly  increase  the 
pain of others.  If you really love your family and friends, give them the 
chance to know your true feelings.

     Whether you are alone or part of a group of suspension members,  most 
of the following suggestions will be useful to you.


*WHAT YOU NEED TO PREPARE FOR*

     There  are  two basic scenarios you will need to  prepare  for.   The 
better   circumstance  (which  we  in  Indianapolis  had  for  our   first 
experience,  thankfully)  is that of a member who is  hospitalized,  in  a 
nursing facility, or at home, with a relatively slowly- developing illness 
(cancer,  heart  disease,  pneumonia, emphysema,  etc.)   This  is  better 
because it gives you and Alcor more time to prepare and because it lessens 
the  need  for an autopsy, since the cause of death will usually  be  well 
established  in advance.  With advance warning, Alcor has the  possibility 
of sending a team out to your location to assist you at the time of  legal 
death.  (Don't let this make you lazy, though.  They can't hang around for 
weeks  at a time, and you still need to have the same  basic  preparations 
accomplished.)   In  this  case, Alcor would send  out  several  boxes  of 
equipment  and a transport team (probably two people), so they could do  a 
full  blood  wash-out (but not a glycerol perfusion)  at  the  mortician's 
before bringing the patient back to California.

     The other circumstance will require more advance preparations and  be 
harder  to motivate yourself for: a sudden, unpredicted illness or  injury 
of  a  member (maybe yourself!), with legal death  occurring  before  your 
organization  can  be  called  in, and  possibly  with  the  member  being 
clinically  dead (no breathing or circulation) for many hours  before  you 
can do anything for him or her.  In this case, the object is to cool  (not 
freeze) the patient as rapidly as possible, pack him in ice, and ship  him 
to  Riverside.   This may require negotiations  with  hospital  personnel, 
attorneys,  police, and coroners.  An emergency like this means that  your 
advance preparations must be thorough.


*CPR (CARDIOPULMONARY RESUSCITATION)*

     Barring severe physical handicaps, almost anyone can learn to do CPR.  
CPR is a system of artificial ventilations and manual chest  compressions, 
used  to continue limited respiration and circulation in a  patient  whose 
heart  has  stopped.  In the initial steps of a  cryonic  suspension,  CPR 
reduces  ischemia,  circulates the medications given to  counter  ischemic 
injury, and increases the patient cooling rate when ice packs are applied.  
Manual  CPR can only be done for a few minutes before exhaustion sets  in.  
If  you have a full coordinator in your area, or if you have about  $5,000 
to  spend,  Alcor may be able to arrange to obtain for  you  a  Heart-Lung 
Resuscitator   (HLR),  a  machine  which  takes  over   ventilations   and 
compressions.

     CPR classes are likely to be offered in your area by the American Red 
Cross,  the  American  Heart Association, and  frequently  by  local  fire 
departments.   The cost is never high, and frequently the class  is  free.  
Besides  the  application  to cryonics, knowing CPR could  help  you  save 
someone's  life  (in the more conventional meaning).  Some  Alcor  members 
have  gone  farther and taken classes to earn an  EMT  (Emergency  Medical 
Technician) certificate (see *Cryonics*, April, 1988).


*PHYSICIAN*

     "A  cooperative  physician is a thing of joy forever."   If  you  can 
manage  to  get a cooperative physician and mortician, a great  number  of 
your  problems  will  be solved.  If you manage to get  either  one,  that 
person might help you find the other.  

     Ideally, the physician's duties would include:

     1.  Interceding for you with hospital or nursing home staff to ensure 
reasonable discussion and cooperation.

     2.   Avoiding medical treatments (such as long periods of  mechanical 
ventilation  without cerebral blood flow) which would tend to  damage  the 
patient's chances for future recovery.

     3.   Planning  for  his own prompt arrival at  the  nursing  home  or 
hospital to pronounce legal death.

     4.   Authorization  and perhaps administration of cooling,  CPR,  and 
post-mortem medications to prevent brain damage.

     5.  Prompt release of the patient to Alcor representatives or to  the 
cooperating mortician.

     I  can't tell you much about how to find a helpful  physician.   Many 
physicians  are willing to be cooperative when the emergency  occurs,  yet 
will  not  commit to such action in advance.  For example, many  will  not 
agree  to  sign the "Physician's Affidavit."  Most physicians  fear  legal 
action  more than death, believe me.  You will just have to be  persistent 
and  keep asking.  Giving your doctor a completed copy of  the  "Patient's 
Declaration  to Physician" and the "Agreement to Hold Harmless" is a  good 
start.   At  least it shows him that you intend no harm to him.   If  your 
physician seems cooperative but will not sign the "Physician's Affidavit," 
ask him or her what could be changed in it so they *would* sign.  Alcor is 
willing to be flexible with this document.

     We  were incredibly lucky here in Indianapolis, since  the  patient's 
personal physician seemed totally unperturbed by the idea of cryonics.  He 
agreed  to come promptly to the nursing home to pronounce legal death,  to 
advise us on the patient's condition, and to advise her son, "Jim," on his 
decisions  concerning her medical care.  He would not agree to  administer 
the medications after her legal death; but not many are willing to do  so.  
While  it would be handy for this to be done by the physician, it  is  the 
least  important of his duties.  You will be doing well indeed if you  can 
find someone who can promise the rest.


*MORTICIAN*

     Just  as  important  (perhaps more so in  many  circumstances)  is  a 
cooperating  mortician.   The list of a mortician's duties  and  abilities 
includes  a number of things which you may find legally impossible  to  do 
for  yourself.   Fortunately,  Alcor's  experience  is  that   cooperative 
morticians are somewhat easier to locate than physicians.  For one  thing, 
handling and transportation of deceased human beings is their *job*.  They 
do it every day; they know the laws and the customs; and they are used  to 
unusual  requests  and  circumstances.   Cryonicists  might  expect   that 
morticians would tend to be defenders of the status quo since they profit, 
in  a  sense, from death; but, in fact, many  morticians  are  independent 
thinkers  who  are  not  interested in  following  the  crowd.   They  are 
practical businessmen who do not promote death, but merely see a job which 
needs  doing.   And you don't have to hem and haw with  morticians.   They 
have few, if any, of the taboos against talking about death or disposition 
of remains which afflicts so many in today's society.  

     I  suggest  that you begin by asking your friends if  they  know  any 
morticians.  A friendly referral is usually a good place to start.  If you 
cannot  come up with a referral, try sending out a few  friendly  letters.  
Seek  for an independent mortuary, not a big chain.  Like  anywhere  else, 
the  bigger the bureaucracy, the more conservative it probably  is.   Also 
try  to  find one which specializes in shipping bodies  to  other  states.  
They will know the procedures and the right people to make the shipping go 
smoothly.  It  is probably a good idea to have at  least  two  cooperating 
morticians.   Murphy's  law would indicate that the one time  you  need  a 
mortician, your first choice will be on vacation.

     When  you  begin  interviewing  morticians,  tell  them  your   basic 
requirements.   If they do not seem interested, ask if they can  recommend 
anyone  else.  That is how we got our mortician in Indianapolis  (courtesy 
of  member Angalee Shepherd's efforts), and it only took about four  phone 
calls.  Before going into details with the mortician, simply say that   a) 
you want to contract with him to use his facility for the initial steps of 
a  cryonic suspension (freezing someone after legal death), b)  that  this 
would  include his cooperation in picking up the "body" (I would use  this 
word  initially, rather than "patient") from the nursing home or  hospital 
and  arranging  for air shipment to California,  and c) that he  would  be 
reasonably compensated for this.

     When  a mortician agrees to talk with you further, you will  need  to 
explain  his  duties  in  detail.  Do not expect that  he  will  think  of 
everything on his own.  We nearly had a problem with our recent suspension 
when  our  mortician booked shipment to California for  the  patient,  but 
neglected to book flights for the suspension team.  We hadn't asked him to 
do this, so why should he have thought of it?

     We  have  also discovered that the mortician  appreciates  the  "hold 
harmless"  and  other legal forms Alcor uses.  They may also like  to  see 
some  document  that  the  patient  signed  agreeing  to  suspension.   It 
increases  the confidence in Alcor and in the procedure itself, if we  can 
show  that  we are a professional, competent organization instead  of  the 
"fly-by-night" outfit some might expect.


     FEES:

     "Reasonable  compensation"  may  vary according  to  the  locale  and 
situation.  Begin by asking the mortician what he would charge for each of 
two basic situations:  a) the use of his facilities for a simple "pack  in 
ice  and  ship"  (1-2  hours at the mortuary) and  b)  the  use  of  those 
facilities for a full blood-washout, cool-down, pack in ice, and ship (3-6 
hours at the mortuary).  Shipping charges would not be part of these fees.  
(They  are  paid  directly to the shipper by Alcor or by  you.   See  "Air 
Shipment"  later  in  this article).  In our recent  experience,  you  are 
likely to found these prices to be under $500 for "a" and under $1000  for 
"b".   If  any  member of the mortuary staff wishes  to  assist  with  the 
patient preparation, the staff member would be compensated by Alcor at his 
full hourly rate.


     MORTICIAN'S DUTIES:

     A.   Pick  up patient at the nursing facility, hospital,  etc.   Sign 
whatever  release  forms are required.  Complete mortician's part  of  the 
death  certificate.  Obtain burial/transit permit and fill  out  correctly 
(with consultation from Alcor).

     B.   Transport  patient to mortuary.  Allow your local group  to  use 
mortician's  preparation room to pack patient in ice and seal up  shipping 
container,  OR  allow Alcor transport team to do blood washout  and  other 
procedures   (primarily  using  Alcor's  equipment)  in  preparation   for 
shipment.

     C.   Arrange air shipment to Ontario Airport, California at  earliest 
possible time.  Shipment should be *direct* (i.e., no change of planes  -- 
a   brief  stop  in  another  city  is  acceptable).    Arrangements   for 
transportation  for any Alcor personnel returning to California should  be 
made  at the same time, either by you or by the mortician.  At  least  one 
Alcor team member should be on the same flight as the patient if possible.  
If not, it would be best to have at least one team member return *earlier* 
than the patient.

     D.  Transport patient to airport and deliver to carrier.

     If a transport team member is not on the same flight as the  patient, 
a local member must watch and make sure the patient is actually loaded  on 
the plane.

     E.   File death certificate and obtain at least three  (3)  certified 
copies:  one to be sent Federal Express to Alcor; one to be given to  next 
of  kin; and one to be kept by the local group (if such a  group  exists).  
In  most  situations, a FAX copy of the death certificate should  also  be 
sent to Alcor as soon as it is available.


*AIR SHIPMENT*  

     Normally,  transport  will  be  made by  "common  carrier,"  i.e.,  a 
regularly scheduled passenger airline, via its air cargo service.  Payment 
should  be  made  to the air carrier by a local member, a  member  of  the 
patient's  family,  or  the  patient may  be  shipped  collect  to  Alcor, 
depending  on  arrangements  made with Alcor staff.  If  the  patient  has 
normal or above normal funding, the transportation costs will come out  of 
his  or  her  suspension fund.  But don't guess at this  --  make  precise 
arrangements with Alcor as the case occurs.

     In  the recent case in Indianapolis, our patient was shipped out  via 
US  Air.   The  weight of the loaded container was  437  pounds  (a  small 
patient,  but  a lot of ice).  The rate was $120.80 per  100  pounds  (the 
normal  shipping charge of $60.40 per 100 is doubled for  human  remains), 
for a total charge of $527.90.

     Note:  there  may be cases where a carrier will  not  normally  allow 
shipments  or pickups by the receiver on weekends.   Special  arrangements 
may have to be made before shipment to allow for this.  Pointing out  that 
you are shipping a unembalmed body on ice for purposes of anatomical  gift 
will  frequently  convince the carrier that they don't want  this  package 
sitting around for a long time.

     Further note:  The regulations for shipping unembalmed human  remains 
vary  significantly  from  state to state.  Most states  will  allow  such 
shipment by common carrier as long as the deceased person did not have one 
of a list of highly communicable illnesses.  Know those details before any 
suspension is even contemplated.  Alcor keeps a list of such  regulations, 
and your mortician should also have such information in his *Directory  of 
Morticians'   Handbook*  (frequently  referred  to  as  the   "Mortician's 
Redbook").  You should also be able to obtain the regulations on this from 
the Division of your State Board of Health which deals with human remains.

     If  you get caught by one of these regulations, it may  be  necessary 
for you to hire a private air ambulance to fly the patient to Riverside or 
even  to  *drive* the patient there yourself.  If the  suspension  becomes 
public, you may have to go through a lot of legal flack even to accomplish 
one  of these.  Staying on the good side of a hot-shot attorney or two  is 
always a useful endeavor.


*AIR SHIPPING CASE*

     The air shipping case we used was one put together by Mike Darwin and 
sent  to  us when it was apparent that our patient's  clinical  death  was 
imminent. Alcor only has one of these, though, and it won't do any good if 
you  have  an  emergency situation.  But you certainly don't  want  to  be 
shipping  your patient in anything less.  Putting your patient only  in  a 
"Ziegler  case" (the standard metal container for shipping human  remains) 
could  cause problems if one of the ice bags should rupture or  be  poorly 
sealed.   A leaking container would probably result in  an  investigation, 
complete with local coroner -- a delay which is definitely something to be 
avoided.    

     Fortunately, this shipping container is something which nearly anyone 
should be able to put together for around $200.  It consists of a standard 
Ziegler  case placed inside a custom-made 1/2" "marine  exterior"  plywood 
crate  and  insulated  with styrofoam and  fiber  glass  insulation.   The 
Ziegler  case  can probably be purchased from a local casket  company  for 
about  $125.   You could make the box yourself or have it  made,  possibly 
even by the casket company.  

     The  shipping box should be made enough larger than the Ziegler  case 
to  allow for 1" of styrofoam in the bottom and on all four sides, but  so 
the case will fit tightly.  Do not overestimate.  Passenger planes have  a 
limited  cargo  area and a box too large simply won't fit, no  matter  how 
much  you  plead.   A US AIR cargo employee  suggested  that  the  outside 
dimensions of the crate not exceed 32" high, 42" wide, and 80" long.

     The  object  is to make a watertight container.  Mike  used  urethane 
varnish  on the inside of Alcor's box and oil-based paint on  the  outside 
(latex would be fine, also).  The outside should be painted orange or some 
other  bright color to make it easier to see it being loaded on the  plane 
and  to make it easier to trace if it somehow gets mis-directed.   As  you 
assemble  the  parts  of the box, caulk all joints  with  paintable  grade 
silicone  caulk.   Use screws --not nails-- to hold the  pieces  together, 
including  the  lid.   If you want to get the unit back  from  Alcor,  you 
should include your name or the name of your group on the *inside* of  the 
lid.   Do  *not*  include any outer labeling which might  make  a  carrier 
nervous, such as "Frozen person.  Handle with care!"

     Note:  Here  is a great opportunity for someone with  good  carpentry 
skills  to  contribute to the organization by contracting to  build  these 
units for various people at a reasonable price.

     PLACING  THE  PATIENT INSIDE THE UNIT: The patient should  be  placed 
inside a plastic body bag (you might be able to get one of these from your 
mortician)  and  laid  inside  the  Ziegler  case.   The  patient's  body, 
beginning  with the head, should be rapidly covered (above and  below,  as 
much  as  possible)  with ice in Zip-Loc bags (1  gallon  size),  *tightly 
sealed*.   Have at least 100 bags on hand.  Get as many ice bags into  the 
Ziegler  as  you can fit.  Do not place ice bags outside of  the  Ziegler.  
Before sealing the top of the Ziegler case, if there is room, lay a  piece 
of  fiberglass insulation -- paper side down -- over the body  bag.   Seal 
the  lids  on  both the Ziegler case and on  the  plywood  container  with 
silicone  caulk and screws.  All of this care appears to work  very  well.  
When  our  patient's container was opened in Riverside after 12  hours  of 
transportation,  only  about 10% of the ice had melted and  the  patient's 
core temperature was 1 o C, exactly what we desired.


*ICE*

     The  immediate availability of large quantities of ice is crucial  to 
the protection of your patient.  Reducing the temperature of the patient's 
brain  and  providing  prompt CPR are the two most  important  factors  in 
preventing  rapid ischemic damage.  You will need to look for ice  sources 
in the hospital or nursing home your patient is in (if you have the luxury 
of  a warning), and you will need to check sources in your area for  large 
quantities (up to 500 pounds) of ice.  Obviously, this should be cube ice, 
not block.  You don't have time to chop.

     Indianapolis  has  only 3 major ice producers.  None  offer  24  hour 
delivery,  but one company has 24-hour vending where one can get  15-pound 
bags  by  feeding  quarters into the machine.  (We now keep  a  supply  of 
quarters  on  hand.)  You will need to have this sort  of  information  in 
advance.  Mike suggests it might be possible to make some kind of personal 
agreement  with employees of an ice company to give you emergency  service 
for a fee.  We were fortunate that our patient's nursing home had a  large 
ice machine which we could use to do rapid cool-down at the nursing  home.  
Also,   her  suspension  began  during  normal  business  hours,  so   ice 
availability was not a problem.


*THE PIZER TANK*

     While plastic bags are fine for containing ice and are essential  for 
shipping  the patient, they severely reduce the cooling capability of  the 
ice.   Not only does the plastic act as an insulating layer,  it  prevents 
the  ice-cold water generated from the melting ice from flowing  over  the 
patient  and carrying away heat.  This is especially critical  immediately 
after  the patient's clinical death, when we wish to lower  the  patient's 
temperature as rapidly as possible in order to protect the brain.

     For  the Michigan suspension, Alcor member David Pizer,  of  Phoenix, 
Arizona built us a portable tank which could be used to place the  patient 
in  an ice bath.  It is portable, lightweight (before the ice and  patient 
are placed in it), and reasonably inexpensive.  The Pizer Tank is a 6'  2" 
long  (inside) framework of 1 1/4" PVC pipe to which a flexible  Naugahyde 
tank  is  attached  with snaps.  It  breaks  down  into  easy-to-transport 
components, is extremely rugged, and can hold a full load of 75 gallons of 
water without leaking or disintegrating.

     The  ice  bath method worked extremely well during  this  suspension.  
The rate of cooling for this patient was about twice that of the  previous 
remote case, in which we had used plastic bags.  

     Dave  Pizer has agreed to make tanks for the Alcor  Coordinators  and 
possibly  for other local groups, as well.  (Contact Mike Darwin at  Alcor 
for  more  information on this.)  Two cautions:  1)  When  loaded  with  a 
patient  and  ice,  the tank becomes extremely  heavy.   In  Michigan,  we 
required six people to carry it from the apartment to the waiting mortuary 
vehicle.    2)   You cannot submerge the backboard (which goes  under  the 
patient)  of the Heart Lung Resuscitator (HLR) in water.  That would  ruin 
the  controls for the unit, which are contained in the backboard.  To  get 
around  this  problem,  we  used  an  empty  backboard,  stripped  of  its 
components,  under the patient and kept the good backboard outside of  the 
tank.   Mike is working on obtaining more "dummy" backboards to  use  with 
the Pizer tanks.


*OXYGEN*

     The Heart-Lung Resuscitators (HLR) we use on suspension patients  are 
powered  by the same pressurized oxygen they deliver to the  patients.  As 
part  of our HLR setup, we have two "E" cylinders  with a dual-tank  yoke.  
The  E  cylinders are small enough to carry easily; but  they  only  carry 
enough  O 2  to run the HLR for 15-20 minutes.  With the advance  notice  we 
had,  we  were able to arrange to have one "H" cylinder (about  200  cubic 
feet  and  hard  to move) delivered to the nursing  home  and  two  others 
delivered  to the mortuary. It is also advisable to rent or buy a  special 
hand  truck  for  moving the H cylinders and to ask  for  tank  stands  to 
prevent tipping.

     You  will also need to know which oxygen companies offer prompt,  24-
hour delivery.  There will be several, since hospitals need this  service.  
We are continuing to keep one H-cylinder at the mortuary for  emergencies, 
to cover the time before a delivery could arrive.

     NOTE: If a patient has undergone more than one hour of warm  ischemia 
before  treatment  can start, we do not recommend the use  of  CPR,  which 
might  actually  accelerate the damage.  In that case, the  patient  would 
receive  sternal compressions only, while medications are given,  if  even 
that  is possible.  Ignore the oxygen, cool the patient, and transport  to 
California  as rapidly as possible.  (Details in  "Emergency  Instructions 
for Stabilization of Alcor Biostasis Patients".)

*STERILE WATER*

     If  you have a situation where a total-body washout will be done,  it 
will  be  handy  for you to have about 20 liters  of  "sterile  water  for 
injection"  or  "for irrigation."  This is a bulky item and  will  save  a 
great  deal of trouble for the transport team.  If possible, purchase  the 
water  in bottles of 2 liters or more, with screw-type caps.  They can  be 
opened and poured more easily than bags and are reusable for many tasks. I 
recently  purchased  a case of nine 1500 ml bottles of sterile  water  for 
irrigation for $70.00.  


*PAGER*

     It  would  be   useful for at least one person in your  group  to  be 
available  by pager at all times.  The burden of being "on call" could  be 
shared  by  several  people, if you have that luxury.  In  any  case,  you 
should  strongly consider this option if one of your members is likely  to 
need Alcor's services soon.  We compared local companies and ended up with 
a Motorola Bravo Numeric Display Pager.  It displays the phone number  you 
need  to  call, or any other prearranged numeric code.  (For  us,  9999999 
meant "drop everything and head for the nursing home.")  This pager was  a 
small  size which easily fit into a pocket, but had a clear  display.   It 
cost  us  $25.00 each per month and was very useful.  We  currently  can't 
afford to keep up this expense, but we are hoping to start it again  soon.  
Cheaper  options  exist, of course, and may be adequate  for  your  needs, 
although  we should point out that the reliability of  answering  services 
are subject to question.


*THE CORONER*

     The  tough question: Do you discuss cryonics with your local  coroner 
or medical examiner in the hope that he or she will understand your  point 
of  view  and be cooperative?  You may get the  tremendous  advantages  of 
cooperation; or you may discover you have sensitized an official who  will 
do  everything  possible to prevent this suspension.   Most  coroners  are 
probably  honorable  people  who  want to do  their  job  well  and  avoid 
publicity  (although our problems in Riverside point out that is not  true 
of  *all*  coroners.)   We  have seen  both  obstructive  and  cooperative 
coroners  in the past.  Perhaps someone else has ideas on how to  approach 
this.

     One  thing  is  for  sure: if you have a situation  which  is  not  a 
coroner's case (as adjudged by your physician and mortician), there is  no 
need to drag one in.  Stay in close touch with Alcor to avoid this type of 
complication.


*THE PRESS*

     While  it is true that cryonics needs more publicity,  you  certainly 
don't  need a bunch of hyperactive reporters running around while you  are 
trying to save someone's life.  If at all possible, keep the press out  of 
the situation until the patient has left your care.  This will not  always 
be easy, since there will be many people, especially healthcare personnel, 
who will find out about the suspension as it proceeds.  You cannot control 
which  of  them  might decide to call her friend,  the  reporter  (or  her 
friend, the policeman, for that matter).

     In  many  cases,  it is not even a very good idea for  the  press  to 
become  involved *after* the suspension.  If you have an uncooperative  or 
extremely  private  family, or if the legal climate at the time  has  made 
officials  especially suspicious of cryonics (such as during the past  few 
months), a low profile might be best.

     If, in spite of your best efforts, the press does become involved, or 
if  you  have a family or group that is *prepared* for (and  desirous  of) 
publicity, you should immediately consult with Alcor.  First, there is the 
problem of confidentiality.  Every suspension member indicates in  his/her 
suspension agreement whether or not Alcor can release his/her name to  the 
media  after suspension.  If you are going to talk to the press, you  need 
to  get  permission from Alcor to release specific information,  even  the 
patient's name.  

     From  that point, there are two basic ways to handle  the  situation.  
Simplest is a brief statement to the effect that "My mother wanted cryonic 
suspension and made the legal arrangements for it.  We are simply carrying 
out  my mother's last wishes."  Then you should resist the  temptation  to 
answer  any questions or provide any further information,  except  perhaps 
some  official  Alcor  literature.   Nothing  will  inflame  a  reporter's 
investigative  instincts  more than a story where little bits  of  strange 
information keep popping up.

     If you want to tell all, hold a press conference (have your  attorney 
there, too) and prepare to hold nothing back.  Alcor leaders can  probably 
advise  you  how to handle these, and may even be able to  participate  if 
they have had time to recover from the suspension itself.  If you opt  for 
full  disclosure,  PLEASE  consult  with Alcor  first.   Your  friends  in 
California  will  not be pleased if the reporters and coroners  decide  to 
hold another "surprise party" at the Riverside facility.

     
*START YOUR PLANNING NOW*

     I  know  that every cryonics group constantly harangues  its  members 
about  the  evils  of procrastination.   But many  people  have  died  and 
disappeared  from our lives before they could "get around to" signing  up.  
Others went into their terminal illnesses assuming they had done what  was 
necessary  to  get to the future, but were lost anyway.  We react  to  our 
pain and frustration by doing everything we can to prevent further losses.  
I am delighted if you have completed your documents; but please don't stop 
there.   We  really  do  want  you to be there  with  us  in  the  future.  
Following through on this advice will be a big step in that direction.

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