Death Takes A Holiday - Part I

What happens when vacationers don’t make it home?

The Swim Reaper

As I was sitting by the side of a lazy river in Las Vegas recently, I started to wonder about all the folks who visit Las Vegas… and return home in a box. How often do people die while on vacation?

Just once (ha ha).

No, I mean how many people don’t make it home alive after vacationing? And what happens to their bodies?

How about people who die on airplanes or cruise ships?

Do people actually die at Disneyland?

Pour yourself a fruity umbrella drink, and get ready to find out.

Let’s first take a look at how people die while traveling.

The actual number of US citizens who die overseas varies wildly (one report stating around 800 per year, while another claims over 6000 per year, probably including natural deaths), but the methods of death are fairly standard.

About 1/3 of US citizen deaths internationally are due to car crashes. We already crash cars at home, but then factor in unfamiliar territory, different safety standards, conflicting laws, aggressive drivers, travel exhaustion, poorly maintained roads, and the unpredictable nature of pedestrians, animals, and weather. No surprise there.

Next up are homicides at about 17%. Some of those may be attributed to naive travelers wandering into unsafe areas, flashing their new iPhones, jewelry, and cash. Others are related to the local gangs and drug trade. There’s a separate category for deaths related to terrorism, but the numbers are super low compared to the other categories. Like, 1%.

Another big killer is drowning, at 13%. People often engage in riskier behavior and take fewer common sense precautions. Foregoing life vests, trying to scuba dive for the first time, getting caught in rip currents, shallow diving, and swimming in areas unpatrolled by lifeguards all contribute to the higher mortality rate. Add copious amounts of alcohol, and you’ve got a recipe for disaster.

Besides the unnatural deaths, plenty of travelers die from diseases and heart attacks. Perhaps they were ill and wanted one last trip, or maybe the death was caused by the stress of traveling itself.

Many of these deaths are unexpected, but there’s also a market for death tourism. People sometimes travel specifically to die by suicide. It amounts to roughly 100 per year.

Even domestic travel can have different dangers than your daily home routine. A tourist mortality study in the US National Parks revealed that transportation incidents led to 26% of fatalities, water accidents caused 23%, and land accidents caused 18%. Many of these were likely alcohol related, or at least impacted by a lack of situational awareness, carelessness, and flagrant disregard for rules. Unsurprisingly, the highest risk group for unintentional tourist mortality is… the age 20-29 male demographic.

Now What?!

When a person dies far away from home, their families have a few choices:

• Bury the body near the place of death

• Ship the entire body home

• Cremate the body near the place of death

• Mail or hand carry the cremated remains home

The process differs slightly based on how and where the death happens. There will likely be an autopsy or investigation done at the place of death. Once the inquiry is complete, the family must contact either one or two mortuaries to prepare the body, file the necessary paperwork, and arrange transportation.

Let’s talk about shipping domestically, then internationally.

Mr and Mrs Example were having a fabulous time on the east coast until Mr Example inconveniently dropped dead of a heart attack. The nerve! Mrs Example wants to send him home to the west coast to be buried in the family plot. What does she need to do?

Mrs E needs to contract TWO mortuaries: one near the place of death, and the other near her home. The two mortuaries divide the work. One is referred to as the forwarding mortuary, and the other is the receiving mortuary. Makes sense, right?

Forwarding Mortuary is responsible for picking up Mr E’s body from the place of death or medical examiner’s office. They file a death certificate with the county of death and obtain a traveling permit. There’s typically no funeral service here, since friends and family are back home. The funeral director helps Mrs E choose from a couple shipping options:

• Air Tray, with a metal or wood casket inside

• Combo Unit, with just the body inside

Air Tray vs Combo Unit

Aren’t these basically the same thing? Yes and no. Airlines require special protective cases around the casket or body. An Air Tray is designed to enclose a wood or metal casket with a body inside. It’s comprised of a plywood tray underneath the casket, and a heavy duty cardboard box that slides down over the casket. Straps go across the top to keep it securely closed. There are sturdy loop handles to help move it, and a clear plastic pouch for pertinent traveling documents. The cardboard is typically pre-printed with “head end,” so everyone knows which direction the body is oriented during handling. We also use a big black Sharpie on the box, detailing the person’s name, the exact flight details, and the contact info for both mortuaries.

A Combo Unit looks almost identical from the outside, but it’s not as deep. It doesn’t need to accommodate a casket. Instead, the body is placed directly onto the tray. There are straps built in to prevent the body from sliding around. A particleboard “wall” goes around the sides, and a cardboard lid slides down over the walls. More straps secure the cardboard to the tray. The outside is prepared the same way as an Air Tray, with labels and documents.

When the body arrives at the Receiving Mortuary, the outer shipping container is disposed of. Even though they’re still in decent shape, the airlines stipulate that shipping containers must be new.

How is the body prepared for shipping?

In most cases, bodies are embalmed. It’s the most realistic solution that satisfies state and airline requirements, plus it allows for viewings at the home end without fear of decomposition. Embalmers disinfect the body, close the eyes and mouth, shave faces when applicable, and typically use extra strength embalming fluids for the best level of preservation. After the body has been embalmed, it can be fully dressed and placed in its container. Makeup is typically not applied at this point. A conscientious embalmer would rather apply a moisturizer to prevent dehydration.

Sometimes it’s smarter to dress the body in temporary clothing or a clean hospital gown. Bodies in transit, particularly those in changing altitudes, can leak… from both ends. Another courtesy, besides exemplary embalming, is to dress the body in a plastic suit underneath the clothing for added protection from leaks.

Although embalming is usually the most practical, some families decline. That’s ok! It’s usually for religious reasons. Depending on local laws, there’s usually a workaround to transport unembalmed remains. Airlines will accept them.

Ziegler Case vs BioSeal Pouch

Unembalmed bodies are prone to leaks and odors when left out of refrigeration for extended periods. Airlines naturally want those leaks and odors to be contained. When I first began my career, the only option available was a Ziegler Case inside of an Air Tray. Now, developments in technology allow the use of a BioSeal Pouch inside of a Combo Unit instead.

A Ziegler Case is a 20 gauge zinc coated steel box. It’s not designed to be pretty, and there’s no lining or pillow inside like a casket. The channel gasketed lid is screwed on, hermetically sealing it (that means airtight). The Ziegler Case goes in an Air Tray, like a casket. Both are typically disposed of at the destination.

A BioSeal Pouch is kind of like a durable body bag without a zipper. It’s made from a co-laminated flexible metal material, kind of like thick heavy duty foil that doesn’t tear. It comes on a roll and is cut to length for each body. Then it’s laid on a table, opened like an unzipped sleeping bag. The body is laid inside, and the excess is folded over the top of the body. Once the edges are aligned, a special heat sealing tool is used to crimp the three open sides shut. Since the pouch takes up less room than a Ziegler Case, it can be placed inside a Combo Unit instead of an Air Tray. Both are disposed of at the destination.

We used to add dry ice too, but airlines say it’s not necessary. It’s also subject to dangerous goods shipping regulations.

One Ticket To Paradise

Forwarding Mortuary has successfully prepared Mr Example and all of his necessary paperwork. Their next step is to book a flight and drop him off at the airport. Most mortuaries are “known shippers,” and can easily arrange flight details with folks at the airlines. There are even services available that act like travel agents for corpses. Call them, and they’ll seek out the most ideal itinerary at the best price! It’s crucial to get all of the dates and times lined up, so as not to miss any funeral plans at the destination.

Some airlines can’t accommodate human remains, or have a limit per flight. Others don’t offer a direct route and involve transfers. In one particularly memorable case, I was involved in shipping a man from southern California to northern California. Because of the way that airline was set up, the flights were sometimes routed through their hub… in Atlanta, Georgia. This poor guy was flown all the way across the country and back again! Fortunately, his family seemed to think it was funny.

Forwarding Mortuary completes their responsibilities by dropping Mr E off at the airport, at least a couple hours before his flight. He’s delivered directly to that airline’s cargo facility next to the airport. The airline employees carefully and respectfully load the shipping container into the cargo hold (unlike your baggage, probably).

Now Arriving

Time for Receiving Mortuary to fulfill the second half of the duties. Their role consists of picking Mr Example up from the airport, finishing the body preparations, filing paperwork, conducting services, and taking Mr E to his final resting place.

Mr E’s shipping containers are removed and disposed of. If he’s already dressed and in a casket, the Receiving Mortuary only needs to touch up hair and cosmetics. If he was dressed in temporary clothing for the journey, he’ll now be dressed in his nice outfit. If he didn’t arrive in a casket, the Receiving Mortuary provides it and places him inside.

After the out of state paperwork has been refiled with the local county health department, permission for burial is granted. Receiving Mortuary performs the contracted viewing, funeral, burial, and whatever else Mrs Example has arranged.

That’s about it. But what if Mr and Mrs Example had been abroad at the time of his passing? Let’s see how international shipping works.

Leaving On A Jet Plane

Of all the inconvenient places to die, halfway around the world must be at the top of the list. It’s challenging and expensive to get a body sent back home. The process is complicated and takes time. It’s still doable though.

Mr and Mrs Example traveled from the USA to Foreign Country. Mr Example tried to take a selfie and fell off a cliff. He shouldn’t have stepped over that railing. Mrs Example wants to send his body home. What’s different about making international arrangements?

The US Department of State’s Bureau of Consular Affairs will assist Mrs E as a citizen abroad. They’ll help her navigate the local laws and language barriers, and begin the paperwork necessary for “repatriating” Mr E’s body. If Mr E had been traveling alone, the Consulate would have the additional duty of locating and notifying his next of kin. They’d also take possession of his “personal estate,” meaning clothing, jewelry, documents, and other personal effects. They would prepare an inventory for the next of kin, then carry out their instructions.

It’s important to note that the US Consulate will not help Mrs E financially. She must bear the cost of returning Mr E’s body back to the US. If she finds it too costly, she can either bury his body in Foreign Country, or cremate him and carry him home.

Red Tape

Mrs E still has to contract with a local mortuary in Foreign Country, even though she’s working with the US Consulate. Foreign Forwarding Mortuary will pick up and prepare Mr E’s body. More often than not, embalming is performed. Again, it’s the most realistic option, and it satisfies common public health requirements. If a body is not embalmed for some reason, Customs and the US Public Health Service must be notified in advance. They must have faxed documentation that Mr E did not die from a communicable disease (yes, mortuaries still sometimes fax things).

Depending on the Foreign Country involved, a huge stack of forms need to be filled out (like, in triplicate, and with a translation). The Consulate prepares a document called the Consular Report of the Death of an American Abroad. This will function like a US death certificate, and allow Mrs E to settle Mr E’s affairs when she gets home. There’s also a letter written stating that Mr E did not die from something quarantineable. There can be other certificates, permits, proof of embalming, letter stating that the shipping container only contains Mr E and his clothing. Once the extensive list of documents has been prepared, someone from Foreign Forwarding Mortuary meets with someone from US Consulate, and everything is made official with stamps and seals.

Foreign Forwarding Mortuary has prepared Mr E’s body and boxed him up for shipping. The Consulate applies their stamps and seals to the outer Air Tray, then Mr E is delivered to the airport. Domestic Receiving Mortuary picks him up when he arrives. The shipping containers are removed, and everyone admires the foreign casket.

Caskets and coffins vary in design and craftsmanship, and it’s fascinating to see the differences between other countries products. I’ve seen caskets from Mexico that have glass panels to view through. European coffins (the toe pincher style) are much more narrow and tapered than US caskets. Sometimes they’re extremely ornate and embellished.

Body preparation techniques differ too. I’ve seen some oddly placed autopsy incisions that run all the way up the neck and onto the chin. I’ve seen someone embalmed hard as a rock through what appeared to be a ton of tiny acupuncture pricks. It makes me wonder how my own work has been scrutinized and evaluated, continents away.

Mr Example is home safe (well, sort of). Domestic Receiving Mortuary handles refiling the foreign documents and carrying out the final services and burial. The End.

Would you look at the time?!

I’d planned to tell you so much more, like about those poor unfortunates who die on planes and cruise ships. And did I mention something about Disneyland?

It sure would be a shame if I were to save it for another post!

Stay tuned for a follow up post covering MORE vacation deaths!

Special Mention: I used several photos above from The Swim Reaper. Water Safety New Zealand is behind this innovate campaign to promote swimming safety, particularly among the risky young male demographic. Find out more at The Swim Reaper's Website .