Battery-powered pacemakers (PPMs) and implanted defibrillators (ICDs) can explode in cremators, occasionally causing substantial damage to the cremator and/or injury to attendants (reference: Gale 2002).
- Typically, one or more wires (leads) are placed in the heart (or a nerve).
- The leads connect to a device implanted under the skin (usually in the chest wall).
- The implanted device monitors cardiac or nerve activity and administers a shock/stimulus as needed.
- The implanted device also has a small battery that needs to be replaced every few years.
"Leadless pacemakers" are a relatively new class of implanted pacemakers
- without leads or wires to a separate battery.
- Approximate size and shape of a medication capsule;
- embedded into the inner chamber of the heart muscle.
- Leadless pacemakers have an integrated battery that is so small that it can be safely cremated so does not need to be removed.
A battery-powered device.
- does not refer to inert metalware or other implants with no risk of explosion: e.g. joint prostheses, Portacaths.
- does include Implanted Cardiac Defibrillators (ICD) or nerve stimulators.
- Note that a body could contain both a pacemaker and a separate ICD.
A medical practitioner or nurse practitioner must sign Form AB to confirm that they have examined the body and that there is no evidence of a battery-powered device; or
- can specify that there is a leadless pacemaker that does not need removal.
if a battery is present and needs to be removed, the certifying practitioner must indicate what kind of device and that it should be removed by an embalmer.
Previously, the Medical referee could ask the embalmer or funeral director to confirm this but the wording of the updated regulations specify that it must be a doctor.
For Coroner cases, the pathologist who performs the autopsy should issue a Form AB certificate.
Cremation Regulations 1973
S.7: Duties of Medical Referee.
(1) A Medical Referee must not permit any cremation unless a certificate in form AB in the First Schedule to these regulations has been given by a medical practitioner…
* Reference:
Gale CP, Mulley GP. Pacemaker explosions in crematoria: problems and possible solutions. J Royal Soc Med 2002; 95: 353-5