1.1 First Call & Removal Procedures

1.1 First Call & Removal Procedures

Quick Answer: The first call is the first notification that a death has occurred and that funeral services are requested. The funeral director confirms death, identity, location, and who has authority to authorize removal, then transfers the remains with dignity, infection control, and a complete personal-effects inventory. Do not confuse first call with the arrangement conference, where disposition, services, merchandise, and FTC-required paperwork are decided.

What Is the First Call?

In funeral service, the first call (also called the initial death notification or death call) is the first contact between the funeral home and the person reporting a death—often a family member, hospital staff, nursing facility, hospice nurse, police, or medical examiner's office. It starts the firm's operational and legal duties: respond, gather facts, obtain authority to take custody of the body, and perform the removal (transfer of remains from place of death to the funeral home or other authorized location).

Who may notify? Anyone with knowledge of the death may call—next of kin, a nurse, a chaplain, law enforcement, a friend, or facility staff. Notification alone does not grant authority to remove or to make funeral arrangements. Your job on the call is to identify the authorizing party (the person with legal right to control disposition under state law, often next of kin in a priority order) and confirm that party (or their written designee) authorizes the funeral home to act.

Immediate Actions on First Contact

Treat the first call as a structured intake, not a casual conversation. Capture and verify:

Scenario: A hospital nurse calls at 2:00 a.m. and says "the family wants you to pick up Mr. Rivera." You still ask: Has death been pronounced? Who is the next of kin? Has anyone signed a release? Is this an ME case? Is the spouse present or only a neighbor? Moving without answers is an exam (and liability) failure.

Removal Authorization and Facility Release

Removal authorization is the legal permission to take custody of the body. Sources vary by setting:

• Residence / hospice at home: Often the authorizing next of kin (or person with right of disposition) gives verbal or written consent; local rules and firm policy may require a signed form before leaving the residence.
• Hospital / nursing home / long-term care: Facilities typically require a signed release from the person with authority, plus facility checkout paperwork. Staff will not release the body to "whoever shows up with a van." Present firm identification, confirm the release matches the authorizing party, and complete the facility's log.
• Medical examiner / coroner: If the death is under ME/coroner jurisdiction, only the ME/coroner can release the remains. The family's preference does not override an ME hold.

When the Medical Examiner or Coroner Must Authorize Release

Exact statutes vary by state, but NBE expects you to recognize common ME/coroner triggers:

• Unattended death (no physician in attendance within a required period)
• Sudden, unexpected, or unexplained death
• Trauma, violence, suicide, homicide, or accident (including traffic and industrial)
• Death in custody or in certain public institutions
• Suspicious circumstances, poisoning, or occupational exposure
• Death of a child under certain ages or circumstances (state-specific)
• Deaths where no physician will certify cause

If ME jurisdiction applies, do not remove until release is granted. Document case number, investigator name, and release time. Removal without ME authorization is a classic exam trap and a serious legal violation.

Personal Effects Inventory and Chain of Custody

Personal effects are items on or with the body—jewelry, wallet, phone, clothing, religious articles, prosthetics, dentures, glasses, hearing aids. From first contact through return to the family:

1. Inventory in writing at place of death when practical (two-person verification is best practice).
2. Describe specifically ("yellow metal band with inscription 'M+R 6-12-98'" not "ring").
3. Secure in a labeled envelope or locked container; note who held keys/access.
4. Track transfers (residence → removal stretcher → prep room → return to family) with signatures and times.
5. Return with receipt signed by the receiving family member, or retain under firm policy if family is not present.

Broken chain of custody is a frequent source of claims ("Mom's wedding ring is missing"). On the NBE, expect questions that test whether you inventoried, documented, and obtained signatures—not whether you "meant well."

Transfer Equipment, Infection Control, Dignity, and Privacy

Equipment: Cot or stretcher, pouch or disaster pouch as needed, sheets, straps, PPE, disinfectants, and a discrete vehicle. Residences may require stair chairs or extra staff; bariatric cases need appropriate gear and enough personnel.

Infection control: Apply Standard Precautions for every removal. Use PPE appropriate to known or suspected pathogens (gloves minimum; add gown, eye protection, mask/respirator per risk). Clean and disinfect equipment after transfer. Handle contaminated laundry and sharps per OSHA Bloodborne Pathogens rules (detailed later in the OSHA chapter). Never assume a "clean" death.

Dignity and privacy: Cover the body, shield from public view when leaving a residence or hospital, avoid hallway delays with exposed remains, and speak professionally around other patients and family. Dignity is both ethical practice and public trust—not optional courtesy.

Documentation at First Call

Minimum first-call / removal documentation typically includes:

• First-call record (who called, when, what was said)
• Authorization to remove / facility release
• Identity confirmation notes
• Personal effects inventory and custody log
• Condition of remains on receipt (trauma, decomposition, medical devices)
• ME case number if applicable
• Staff names involved in removal

These records feed the arrangement conference, death certificate worksheet, and any later dispute. Incomplete first-call notes force families to repeat painful details and create gaps in the legal file.

NBE Exam Traps for This Section

Bottom line: First call and removal are operational, legal, and infection-control tasks under time pressure. Authority, identity, inventory, ME status, and documentation come before the van leaves the dock.