Praise for “Mortal Exposures”
The article “Mortal Exposures” by Eva Glosson and Kat Gregersen [March 2019 issue] is very well written and to the point. I have worked in the death care industry for 40 years and was impressed by how up to date and informed they were. The authors did a great job describing embalming and cremation for people outside the death care industry. I could see they knew the area they were talking about.

The company I own put in the first high-pressure aqua cremation unit on the U.S. West Coast that serves the general public. There is one at UCLA that is used just for body donation cadavers. This technology is new to the death care industry even though the process was patented in 1888, so I was impressed with the authors’ knowledge of the process. I heard about their article from a friend who is an industrial hygienist in Oregon. She and I were recently talking about aqua cremation, and she came by to see our unit and learn how the process works.  Regarding the authors’ points on ergonomics, we handle about 8,000 decedents through my facility each year. Many of my 40 employees are mortuary science students. We are able to give them lots of experience in a short period of time. We are often in situations where we are dealing with decedents that weigh 400, 500, 600, and 700 pounds. I also have contracts with the state and county medical examiners for the removal of decedents from the places of death, which are often not in homes or beds but down ravines, on hillsides, in car accidents, etc. We work hard to teach our employees proper lifting and techniques they can use in difficult removal situations.  I’m also a death investigator (deputy medical examiner). I can still be surprised after all these years (when I think I have seen most situations) by how some people die in interesting situations or places.  Anyway, I’m appreciative of good educational articles like the one Glosson and Gregersen wrote. Our industry is not often thought about, but it’s needed nevertheless. Thank you for providing educational and up-to-date articles. Deon Strommer President/Owner First Call Mortuary Services, Portland, Ore.
“The authors did a great job describing embalming and cremation for people outside the death care industry.”
The opinions expressed in letters to the editor are those of the authors and do not necessarily reflect the views of AIHA® or The Synergist®. Letters are published at the discretion of the editor and may be edited for clarity. Send letters to The Synergist.
ERGONOMICS AND THE OPIOID CRISIS I found the article “Can Ergonomics Programs Help Solve the Opioid Crisis?” [May 2019 issue] to be novel and of a timely nature. The article is useful to human factors specialists and industrial hygienists as well as safety experts.  The NIOSH MMWR [Morbidity and Mortality Weekly Report: “Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths—United States, 2007–2012” (Aug. 24, 2018)] mentioned in the article had 5 serious shortcomings that are not discussed. These were identified by the authors of the MMWR report and are condensed herein for brevity. First, the data was not statistically analyzed to account for longitudinal changes. Second, the drugs examined in the study may have been misclassified. Third, intentional overdose deaths were excluded, and might therefore have resulted in overestimates of opioid use. Fourth, proportional mortality ratios (PMRs) are mutually dependent and cannot be used to single out a specific cause of death such as opioid overdose. In addition, and finally, only 21 states participated in the study period, which limits the use of the findings.  The Washington state guidelines [American Journal of Industrial Medicine: “Opioid Dosing Trends and Mortality in Washington State Workers' Compensation, 1996-2002” (August 2005)] did not prove that a causal link existed between opioid use and worker injuries. The authors suggest a relationship with the reduction in opioid overdoses through the use of newly adopted state guidelines; however, no causal link is shown.  The major limitation of the Massachusetts workers study [Massachusetts Department of Public Health: “Opioid-Related Overdose Deaths in Massachusetts by Industry and Occupation, 2011–2015” (August 2018)] is a lack of a causal link as stated by the authors. As stated on page 19 of the report, "While conclusions about causality cannot be drawn from these associations, the findings are suggestive of factors that may be contributing to differences in the rate of opioid-related overdose deaths by industry and occupation."   In conclusion, there is no evidence for a causal link for the use of ergonomics programs and the reduction of opioids use, nor increase in worker morbidity and/or mortality rates. Nicholas J. Giardino The authors respond: While it is difficult for epidemiological studies to prove causation, there is abundant evidence linking work-related injuries and work-related musculoskeletal disorders to opioid use. This strongly suggests that efforts to reduce work injuries and work-related musculoskeletal disorders would also be effective in reducing opioid use among populations at high risk for work injury and WMSD. We agree with Nicholas J. Giardino that there is no directly demonstrated causal link between ergonomics programs and reducing opioid use because (to our knowledge) this hasn’t been studied in an intervention study. The only way this could be studied would be to conduct a controlled study to have employers implement safety and ergonomics programs and to rigorously evaluate effects on injuries and health behavior outcomes, including opioid use. Until such a study is done, we believe there is sufficient evidence to strongly encourage employers to implement good ergonomics and injury prevention programs as part of their efforts to reduce opioid use; preventing injuries is highly likely to reduce opioid prescriptions, and thus opioid use and misuse. Not getting injured can’t hurt. Scott Schneider, Ann Marie Dale, Brad Evanoff, Matt Macomber, Mary O’Reilly, and Jonathan Rosen