4/24/2012

Improbable research: the problem of exploding pacemakers



People muse that they will, come the day, "go out with a bang". A little more often than you might expect, someone or other does exactly that, which is why there came into existence a study called Pacemaker Explosions in Crematoria: Problems and Possible Solutions.

Christopher Gale, of St James's University Hospital in Leeds, and Graham Mulley, of the General Infirmary at Leeds, published the report in 2002 in the Journal of the Royal Society of Medicine.

The first crematorium pacemaker explosion on record happened in 1976 in Solihull, in the West Midlands. As pacemakers and cremations both became popular, Gale and Mulley explain, after-death explosions came to be expected.

In the wake of the Solihull surprise, the British Medical Journal published an essay called Hidden Hazards of Cremation. It speaks of the incident, and speculates about even worse things that might happen. There are individuals, it points out, who, as a result of medical procedures, contain tiny amounts of radioactive substances: yttrium-90, iodine-131, gold-198, phosphorus-32 and their ilk. "There is a possibility," the anonymous author confides, "that an explosion (or some other event) during the cremation of a radioactive corpse could produce a blow-back releasing radioactive smoke or fumes into the crematorium. This risk seems to be largely theoretical, but..."

Soon, two questions were added to Form B of the government-mandated Cremation Act Certificate, which a physician fills out prior to a cremation. "Has a pacemaker or any radioactive material been inserted in the deceased (yes or no)?; (b) If so, has it been removed (yes or no)?" (Form B, after being retooled, eventually came to the end of its own life,and was replaced.)

Gale and Mulley surveyed the managers of all 241 cremation facilities in the UK, asking "(1) Have you ever had personal experience of pacemaker explosions in crematoria? (2) What do you estimate is the frequency of pacemaker explosions in crematoria?"

About half the respondents admitted to "personal experience" of pacemaker explosions. Gale and Mulley suspected that the actual numbers were more dire. "Staff may not wish to mention these events," they write, "and their recall may not be accurate." Gale and Mulley also concluded that "crematoria staff rely on accurate and complete cremation forms" – but that the information-gathering/reporting process could, and often did, go astray.

The pair published another report, two years later, to show that pacemakers themselved sometimes go astray. Called A Migrating Pacemaker, it tells how Dr Gale failed, using his medically trained hands and fingers, to find the pacemaker in a 79-year-old deceased man. The man's medical records said there should be one.

Gale got a hand-held metal detector, which showed that the pacemaker had moved elsewhere in the body. He concluded that medical devices don't always stay exactly where surgeons originally placed them, and he recommends using hand-held metal detectors to "help prevent explosions in crematoria".

Source:Guardian.co.uk

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