Emergency

This information is also available in a printed laminated sheet in duffle bag #2.  Since everyone needs to know where the duffle bags are at all times, duffle bag #1 is also the standard storage location for a few items that we use on a regular basis, such as the thermometer, pulse oximeter, and blood pressure cuff.

In case of serious injury or death, call the Cryonics Institute www.cryonics.org at 1-866-288-2796.  Jordan work: 1-866-239-0469 cell: 503-910-0557.   Other emergency contact numbers are physically posted, but are not included here for privacy reasons.

Preparation
If death has not yet occurred, then you will have time for preparation.  Many of the steps below can be performed simultaneously if there are enough people available.

Duffle bags: The two duffle bags have all the basic supplies in them. In a critical emergency, grab them and go.
Duffle bag one:  This duffle bag contains general purpose first aid supplies, so it's great for any emergency.  It contains:
- Infection Control:
    - Nitrile gloves, one box each of small, medium, and large.
    - 5 Masks
    - 3 Disposable gowns
    - Hand sanitizer
    - 20 gal biohazard bag (ordered)
    - 13 gal garbage bag
    - Paper towels
- Emergency:
    - EpiPen and EpiPen Jr (restocked every time they expire)
    - Glucose tablets
    - 3/4" and 1" band-aids, 20 each
    - Mouth resuscitation mask.
- Equipment:
    - Digital ear thermometer
    - Blood pressure cuff
    - Stethoscope
    - Pulse oximeter
- Record keeping:
    - Sharpie
    - 2 Pens
    - 2 Pencils
    - Calculator
    - Notebook
- Other Supplies:
    - Tape
    - 10 Extra baggies

Duffle bag two: Items specific to cryonics.  The duffle bag itself has not yet been purchased, but the items below are on hand.
- These instructions as well as more detailed instructions.
- Body bag
- Ice bath for head, with U-shaped cutout.
- 10 Ace instant cold packs.
- Datalogging Thermometer with 2 thermocouples, K style, standard plugs.

- Heparin sodium, 10,000 units / 1 mL.  4 mL bottle.  Total 40,000 units, with disposable syringe.
- Ambu Cardiopump

Supplies and equipment still needed: scissors, lubricant for thermocouples, oropharyngeal airways, suction, mechanical CPS, oxygen, etc, etc.

Coolers: We have 2 coolers.  We will get more later.   Each one has wheels and a 62 qt capacity.  There are boxes of gallon zip lock baggies inside each of them.

Cooling calculation: We are ultimately trying to cool the patient about 40 degrees C, and the heat of fusion of water is 80 C/g.  So the weight of ice needed is approximately 1/2 the patient weight.  Additional ice will melt due to absorbtion of heat from equipment and air, so get a little extra.

Ice:  Get about 120 lbs of ice.  A typical bag of ice from the store is 7 lbs, although larger sizes are better if you can find them. Fill some one gallon baggies in case the ice bath cannot be used.  Also leave some ice loose if the ice bath can be used.  One cooler will hold approximately 15 filled gallon baggies.   It will take approximately 8 bags, or 56 lbs of ice to fill those baggies.  Bring the coolers full of ice to the hospital, and begin filling the 1 gallon ziplock baggies with ice.  This can be done in the parking lot inside a vehicle.  It takes about 20 minutes to fill the gallon baggies for one cooler.

Record keeping: One person should be responsible for recording exact times of various events using a pen and a notebook.  Record keeping will include temperatures, time of death, names of people, medications used, instruments used, techniques, etc.

Datalogging Thermometer: Review the manual and usage.

Postmortem
Once death has been pronounced, follow the steps below.

Funeral Director: Contact a funeral director if death looks imminent.  Pay them whatever it takes to get them personally and immediately involved.  A bonus of at least $1000 - $2000 above and beyond their usual fees is appropriate.  They already have fee schedules for basic services, shipping by airplane, and services.  But they will not be accustomed to working after hours or to sitting at the hospital waiting for pronouncement of death.  And they will certainly not be accustomed to other people being present in their facility during procedures.  They will be providing transportation of the body to the funeral home using their vehicle.  They will also be packing the body for shipment.  They will use our ziegler shipping container because it is insulated, but they will be providing the shipping tray.

Ice bath: Place the patient in the ice bath.  Add ice directly to the ice bath to just barely cover the patient.  Add some water, keeping it below the level of the ice.  As the ice melts, some of the water must be drained off.  The entire surface of the body should be kept wet with constantly moving ice water.  A pump with hoses will later be added to improve water flow.

Head ice bath: This can help concentrate the cooling on the head if large quantities of ice are not available or if there are issues with the full ice bath.  Place the patient's head in the prefabricated head ice bath, with the neck passing through the U-shaped cutout. Fill it with ice up to the level of the patient's face.  If access to the face is not needed, the face may also be covered.  Caution.  There is not yet a sump pump, so there is no easy way to drain water.  Because of this, it is not recommended at this time to add water.  Once the sump pump has been added, water will be added and kept between the indicator lines.

Ice baggies: If the ice bath is not available, pack ice baggies around the patient, especially around the head, armpits, and groin.  Ice baggies will tend to slide out of place rather than staying put.  Putting the body in a body bag first will help contain the ice bags, but can also be challenging.  And a body bag is spacious, so it will take a lot of ice bags.  As ice bags melt, try to trade them out for ones that have less water in them.  A leaky ice bag will be a hassle.

Medications: Convince the hospital staff to leave the IV line in place after pronouncement of death.  It can be useful for injecting medications.  If there is no IV line in place, then use the bone injector gun.  Inject all 40,000 U of heparin to prevent blood clotting.  Although it has an expiration date, heparin is stable under normal storage conditions and does not need to be replaced.   Follow with saline and chest compressions to circulate to brain.

Chest compressions: Apply cardiopulmonary support (CPS) vigorously for an hour.  Use the Ambu Cardiopump.  The purpose is to circulate the medications to the brain, provide oxygen to brain cells, and improve cooling.   Some examples of situations where the timing of chest compressions would need to be changed:
* If the head ice bath is being used instead of the full body ice bath, then chest compressions do not need to be continued for more than 5 minutes. The body cannot possibly be cooled quickly enough in this situation, and continuing chest compressions
* If the heart has been stopped for more than 10 minutes and only the head ice bath is being used instead of the full body ice bath, then chest compressions should not be attempted.  The flood of oxygen to the brain would do more harm than good and would also interfere with cooling of the head.
* If very good cooling of the entire body has taken place, and the heart has been stopped for less than 30 minutes, then chest compressions may be initiated.
* If the heart has been stopped for more than 30 minutes, regardless of what cooling methods are used, chest compressions should not be attempted.

Temperature Probes: (aka thermocouples) Place each nasopharyngeal temperature probe by inserting it into the nose 3 to 6 inches.  One probe per nostril.  Wrap a small piece of tape around each wire at that point so that it is easy to tell if the probes later begin to slip out.  Tape the wires down securely.  Connect them to the datalogging thermometer.

Shipping

After many hours of cooling, body temperature will approach zero Celsius.

Enclose the body in a body bag. Place in the insulated ziegler container and fill the body bag will 1 gallon ziploc baggies of ice.  Zip the body bag.  Pack pink fiberglass insulation (not yet obtained) around the body bag.  Screw the ziegler container shut. 

The funeral director will then place it on an air tray, transport it to the airport, and arrange the flight to Detroit.