For a local cryonics group to adequately provide assistance for the death of a local member can seem a daunting task. Good capabilities would seem to require an awesome commitment of time & money for equipment & training. The "perfectionist" mentality of many cryonicists leaves them feeling that since they cannot afford all the necessary equipment, it is preferable to do nothing -- and hope that a slow death and a flown-in remote team can handle the situation. Cryonics is not widely accepted and there are few professionals. Doing something is usually far better than doing nothing. Imagine what response you would want from others if you were near death or had just been declared legally dead.
(To read a personal description of my first "hands-on" cryonics local response case, see The First Cryonics Case in Toronto, Canada.)
A more rational approach is to do a cost/benefit analysis on needed equipment and slowly increase the supply, beginning with the most-needed items that are most affordable. This is a far better approach than to do nothing but wait for others to create fully complete kits -- or to save money so a "complete" kit can be purchased.
The damage that can occur to the brain of a cryonics patient immediately after death is potentially far greater and more irreversible than any damage incurred in a cryopreservation protocol. Nanotechnology may one day be capable of repairing freezing damage, but it is unlikely to be able to repair degraded or dissolved brain tissue. Brain tissue degrades & dissolves rapidly without oxygen & nutrient at room temperature.
Studies of normal cadavers have demonstrated that shortly after cell death pH drops and intracellular enzymes begin self-digestion of tissue by a process known as autolysis. The membranes of cellular organelles called lysosomes are ruptured, releasing hydrolytic enzymes which accelerate the autolytic process. Putrefaction by the anaerobic organism Clostridia is normally initiated by autolysis. One study found that after two hours of autolysis "the cell membranes were destroyed and the synaptic formations could no longer be distinguished." [FORENSIC HISTOPATHOLOGY, W. Janssen p.40 (1984)].
The acid hydrolysis, ischemic free radicals and putrefaction of autolysis can turn brain tissue into soup in a period of hours at room temperature. Restoration of circulation & rapid cooling as soon as possible after death can provide cells with oxygen & nutrient while lowering metabolic demands & ischemic damage (see my essay on ischemia). An often-quoted statistic in cryonics is the fact that every 10ºC decrease in temperature reduces cell metabolism by 50%. I think this VASTLY understates the value of temperature-reduction in light of the enormous decrease in ischemic damage which also occurs with a lowering of temperature.
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My first choice for a piece of cooling equipment is a Portable Ice Bath (PIB). A good PIB will be made of a cover material that is waterproof, but strong (like vinyl). It will be lightweight and easily folded for transport. Newton's law of cooling suggests that the fastest cooling to 10ºC without freezing damage would be done by rapidly-moving water which is close to 0ºC. Water has a high thermal conductivity -- about 25 times more thermal conductivity than air. If heat is phyically moved-away by circulating the water, the cooling will be even faster. A human body cools half-again (1.5 times) more quickly in flowing water than in still water (see my essay Physical Parameters of Cooling in Cryonics). The head can cool much more quickly than the body, but it is not feasible to totally immerse the head in ice water. To avoid the danger of water entering a patient airway, the depth of the water should not be higher than the patient's ears. The patient's head could be supported in an ice pillow.
As shown in the diagram, cooling of a human patient in ice-water is much faster than cooling with ice bags. And cooling with running water is even more effective. A device called a SQUID (because it has a squid-like appearance) uses an electric sump pump (ie, a pump which has a chamber at the bottom into which water passively flows and is then actively pumped) to keep ice water flowing over a patient. After 150 minutes, a patient cooled with ice-bags will have gone from 37ºC to 30ºC, whereas an ice-bath patient will be at 20ºC and a SQUID-sprayed patient will be at 5ºC. (Other Spray Cooling Devices, SCDs, of similar design are also used.) (Caveat: the head cools much faster than the rest of the body because it is smaller and has less thermal mass. It would be better to display cooling curves for the head, but none are available.)
The faster the flow of water, the better the cooling (with diminishing returns). An output of 40 gallons per minute has been recommended, although typically a group will be dependent upon whatever water-pressure they have available. Separate sprinklers of the SQUID should be positioned at the patient's head, neck, groin and axilla in particular, because there are the areas of the body where the blood vessels are closest to the surface and where the greatest cooling can occur. (Of course, the head contains the brain, which is the organ we most want to preserve.) Combining CPS with cooling means that the body may warm the head, but the advantages of nutrient and oxygen in the blood outweigh the disadvantages of warming unless there is reperfusion injury.
A bilge pump (obtainable at a boating shop or on-line) is an inexpensive way of circulating water. Bilge pumps are generally powered by battery, so a battery must be obtained. Aquarium pumps are also inexpensive and easily obtained, but generally require an electrical outlet for power. Here are some current (2010) links for some example pumps: sump pump and bilge pump.
In rare cases a cryonics patient will have diarrhea, which can result in an ice-bath being filled with unpleasant (and possibly infective) fecal material. Bleach has typically been added to the water-bath to eliminate infectivity, but the unpleasantness of a water bath full of fecal material has made many cryonicists unwilling to risk the use of SQUIDs or SCDs -- despite the enormous potential benefit to the patient. The diarrhea problem can be prevented with barium retention infusion tips ("pipes") which have a 90-120cc balloon on them made of tough silastic (rubbery plastic silicone) which very effectively seals the anus when inflated. It has suggested that a simple solution might be to soak a tampon in glue, either medical Dermabond or simple Krazy-glue and insert the tampon into the anus -- allowing a few minutes for the glue to bond before putting the patient in icewater. This has not been tried, and is debatable. Another, more accessible and practical suggestion, is to get a "butt plug" from an "adult" bookstore and use KY jelly to simplify insertion.
A good protective measure is obtain a non-chlorine, non-soap containing disinfectant (such as BAK, BenzAlkonium Chloride) to pour into the ice bath. Soap is avoided to prevent foaming and slipperiness. Chlorine is avoided because of its bleaching capability. This is important if the disinfectant is mixed with a food coloring blue dye, which would also be added to the water bath to mask discoloration of the bath by urine.
Some cryonicists might wonder why a local group couldn't use dry ice or even liquid nitrogen to vastly accelerate the patient cool-down rate (minimizing metabolism & ischemic injury). The problem with these approaches is that they could very easily lead to the freezing of patient tissues, damaging blood vessels. Once tissues and vessels have experienced freezing damage, it would be very difficult to wash-out the blood and perfuse with cryoprotectants (anti-freeze). For this reason, the patient should be cooled to water-ice temperature (no lower) as quickly as possible -- and packed for shipping to a cryonics facility at water-ice temperature.
For use in a cryonics emergency, where a patient has deanimated and been pronounced on short notice -- or in a situation where an ice bath is not available or feasible -- a basin for cooling the head alone with ice water can be used. One person cut a neck-sized groove in a picnic cooler for this purpose. A more portable and convenient alternative is an inflatable basin for giving shampoos, such as the EZ-Shampoo Basin (also available from Wisdomking.com, which does not ship to Canada). Body bags are a convenient means of surrounding a person with ice in storage and transport. Inexpensive vinyl body bags in lots of ten can be purchased from AliMed. Sturdier body bags are available from Trevor Owen Limited and the Medical Supply Depot. The last is the most expensive, but for the money you get a very strong bag with strong handles to assist transport. Water cannot be easily ciruculated in a body bag, so when filled with loose ice (not ice in bags) and some water a cooling effect can be achieved equivalent to that of A−1159 shown in the Graph Comparing External Cooling Methods. Where resources are even more limited, a shower-cap/helmet lined with ice or cold-packs could be a means of cooling the head [RESUSCITATION; Hachimi-Idrissi,S; 51(3):275-281 (2001)].
A thermocouple or other temperature monitoring probe (a thermometer, if necessary) should be used to assess the effectiveness of cooling. If a patient is being cooled in a water bath with moving water (fastest cooling), the patient's temperature should be at least as low as 10º before the patient is transferred to a body bag containing ice for transport.
Every cryonicist would be well-advised to have in his home a freezer that has lots of ice as well as a body bag, for rapid use when equipment is being stored elsewhere. But, of course, cooling methods cannot be applied before death has been pronounced.
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The another priority for a local group is means for cardiopulmonary support. In a patient who has just been declared legally dead, most of the cells are still very much alive. Oxygen and nutrient can be supplied to these cells by artificial circulation to prevent ischemia. Circulation is necessary to add medications to prevent blood-clotting and ischemic damage.
An endotracheal tube is useful to prevent an unconscious patient's tongue from obstructing the airway. Endotracheal tubes can be difficult to place, however, and generally end-up in hte esophagus. A Combitube is a two-lumen device that will secure an airway whether it is inserted into the esophagus (to the stomach) or the trachea (to the lungs). A Combitube can also be used to put Maalox into the stomach. For whole body patients this can be very valuable because body perfusion often fails due to edema resulting from stomach acid erosion of blood vessels. Combitubes can be ordered from savelives.com. Combitubes come in two sizes, 37 French (Fr) for people between 4 to 6 feet in height, and 41 Fr for people taller than 5 feet. In practice, 37 Fr can be easier to insert and may be used successfully in tall people.
Ventilation with oxygen may be of some value, but only if applied very soon after cardiac arrest. If applied after too much delay, the oxygen may do more harm than good (cause "reperfusion injury"). (For details on mechanisms of reperfusion injury, see Reperfusion injury and "No-Reflow". )
Another danger with oxygen is that as it becomes increasingly concentrated, it becomes increasingly combustible or even explosive. This could be a serious danger if attempting to deliver oxygen to a cryonics patient in a closed space, such as a van. Note the following quote from Air Products Oxygen Factoids:
More than 21% of oxygen helps materials to burn (oxidize) better and faster and, coupled with the fact that the gas has neither odor nor color, makes an excess of oxygen in air very dangerous. An increase of just 3% from the ambient oxygen concentration of 21% doubles the combustion velocity. By the time this figure reaches 40%, the combustion velocity in contact with a spark or naked flame increases tenfold.
Compressed air would be safer than oxygen. An air compressor would be handy, but air compressors compress water vapor along with air. Unless the water vapor can be removed, it can quickly corrode a "thumper" (see below). Compressed air in cylinders from a commercial vendor will not be full of water vapor.
Normal human blood pressure is 120/80 mm Hg (systolic/diastolic, ie, pressure when the heart is contracted over pressure when the heart is relaxed), whereas manual CPR cannot hope to deliver much more than 20-40 mm Hg. Manual CPR is better than nothing, but a Heart-Lung Machine is far more effective and untiring. A Heart-Lung machine uses pressure from an oxygen tank to drive a chest-compression pump while providing 100% oxygen to the patient. Use of power from oxygen-pressure rather than electricity makes the unit much more portable. A Heart-Lung machine is capable of providing 70-80 mm Hg of blood pressure, which should be more than adequate for cryonics purposes — especially when combined with 100% oxygen. An industrial-grade oxygen tank is adequate (call welding shops to determine availability). Nonetheless, the cost of a Heart-Lung machine will typically be in the $1,000 to $5,000 range, where the latter is a new, state-of-the-art machine (see The Michigan Instruments Thumper).
Although it is barely adequate (if that), manual CPR could be done on a patient with the assistance of a bag-valve device that delivers air through a face-mask when the bag is squeezed. The bag-valve device reduces the possibility of contamination and reduces the labour of CPR. Mouth-blown air face masks also reduce contamination, but require more work. Manual methods may be necessary and sufficient when better equipment is "on the way", but manual CPR can quickly become tiring, and its effectiveness is limited.
Somewhat better than manual CPR — and more effective is AC/DC (Active Compression/DeCompression) CPR with an plumber's helper type Ambu Cardiopump which is applied to the patient's chest and provides cardio-action on both the upstroke and downstroke. But this too can be tiring if manual — mechanical units can be purchased if they can be afforded.
AC/DC units are highly politicized in the United States because the FDA has created bureaucratic barriers. See:
Feel a Heart Attack Coming?
Although AC/DC equipment is not legally sold in the U.S., Americans who want them usually seem able to obtain them. AC/DC equipment is manufactured in Denmark by AMBU International. The company's manual Ambu Cardiopump was legally sold in Canada for about $400 through Allied Medical: www.allied-med.com, but this has been discontinued and they are only obtainable by special order from Europe.
(See Cryonics Institute New Emergency Response Equipment for some good photos of ACDC equipment.)
Resistance to blood flow increases after six minutes of cardiac arrest. Prior to six minutes of ischemia, a cerebral perfusion pressure of 25 mmHg (typical of the pressure achieved by CPR — CardioPulmonary Resuscitation) is adequate to restore cerebral blood flow. After 6 minutes the cerebral perfusion pressure must be 35 mmHg and beyond 12 minutes even 35 mmHg cannot restore cerebral blood flow [CRITICAL CARE MEDICINE; Shaffner,DH; 27(7):1335-1342 (1999)]. After 30 minutes of ischemia, cats require 100 mmHg of pressure to prevent no-reflow [INTENSIVE CARE MEDICINE; Iijima,T; 19:82-88 (1993)].
It was for this reason that Peter Safar, the "father of CPR", advocated wide distribution of spring-loaded pens for rapid intra-muscular epinephrine injection (epi−pens) as a lifesaving adjunct to CPR. His words have not been heeded by many authorities and epinephrine remains unavailable without prescription in the United States and the United Kingdom. True enough, epineprine can be dangerous if an epi−pen injects into a vein (the intra-muscular dose is ten times what would be injected into the circulatory system during ACLS, Advanced Cardiac Life Support), so it is hard to say how many more are lives lost by lack of availability for bystander CPR than are saved by prevention of misuse. However, epinephrine is available without prescription in Canada and can be ordered from Canada in the United States. The easy-to-use epi−pen that can inject epinephrine into the thigh (counteracting the sometimes fatal body-wide vasodilation and loss of blood pressure that can occur within minutes of anaphylaxis) can be ordered from Canadadrugsuperstore.com and will not be seized by US Customs. These devices should be included in cryonics emergency "first aid" kits. ("Twinject" devices might also be convenient.) Used in conjunction with cardiopulmonary support of a cryonics patient, epinephrine can greatly assist in improving blood flow.
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A cooperative patient can be pre-medicated with with anti-oxidants like vitamin E and with a dextromethorphan-containing cough suppressant mixture to antagonize the glutamate of brain ischemia [SCIENTIFIC AMERICAN July 1991, p.56-63]. (Unfortunately, many or most patients become increasingly "uncooperative" in the agonal state.) A cooperative physician may even provide nimodipine (L-type calcium channel blocker) prior to legal death, and administer heparin (anticoagulant) immediately after death has been declared. Pre-treatment of dogs with nimodipine prior to ten minutes of ischemia led to an 80% normal recovery rate, as compared with an 86% death rate in untreated controls. Treatment 2 minutes post-ischemia had a negligible effect. [PHARMACOLOGY OF CEREBRAL ISCHEMIA, Joseph Krieglstein, Editor, p.65-73 (1988)].
Keeping a local kit supplied with up-to-date medications is not an easy task, and may seem fruitless when they are so rarely used. The table below shows what might be viewed as an "ideal" list of stabilization kit medications, which would are intended to minimized damage to the patient being cooled, while at the same time keeping the patient in a condition to most benefit from cryopreservation treatment (maintain blood pressure, prevent blood clotting, etc.). The table lists the medications by purpose to stress that achieving the objectives is what is most important and that other substitutes — even superior substitutes — may achieve the same ends.
TYPICAL DOSE (adult)
|Prevent blood coagulation||Heparin, Sodium Citrate||800+ IU/Kg (hep)|
|Nutrient for tissues||Dextrose||< 70 mg/dL|
|Broad spectrum antibiotic||Ciprofloxin, Gentamycin, Erythromycin|
|Maintain blood pressure||Epinephrine, vasopressin, phenylephrine|
|Dissolve blood clots||Streptokinase||1,000 IU/Kg|
|Neutralize gastric acid||Maalox||200 mL|
|Prevent acidosis (buffer)||Sodium bicarbonate|
|Inhibit cell swelling (osmotic)||Mannitol (Osmitrol)||20%, 2 gm/Kg|
|Prevent cerebral edema (oncotic)||Mannitol (Osmitrol)||20%, 2 gm/Kg|
|Prevent tissue edema (oncotic)||Dextran-40||6%, 200-500 mL|
|Reduce blood cell agglutination||Dextran-40, Methylpredisone|
|Prevent anaphylactic reaction to Dextran-40||Dextran-1 (Promit)||3 gm|
|Stabilize membranes||Methylprednisone, Chlorpromazine||1 gm, 3 mg/Kg|
|Reduce brain metabolism||Propofol, Sodium Pentobarbital, Soporate (GHB)|
|Neuromuscular Blocking||Magnesium Sulfate||100 mg/kg|
|Minimize ischemic damage, suppress cough reflex||Dextromethorphan (DM)|
|Minimize ischemic damage antioxidant, water & lipid phase||Alpha-Lipoic Acid|
|Minimize ischemic damage antioxidant, lipid phase||Vitamin E|
|Minimize ischemic damage, iron chelator||Deferoxamine (Desferal)||2 gm IV|
|Minimize ischemic damage, metal ion chelator||EDTA|
|Minimize ischemic damage, calcium channel blocker||Nimodipine||10 micrograms/Kg|
A cryonics professional informed me that the liquid emulsion of Vitamin E is the most beneficial of any of the anti-ischemia ingredients, by a large margin. He also suggested that (where possible) that the patient pre-medicate by taking anti-oxidants — especially Vitamin E — and aspirin. (For results of my more recent research, see Pre-Treatment for Cryonics Patients. As noted in that discussion, Vitamin C is to be avoided because of its pro-oxidant effect when in contact with metal ions — which are released in great number during brain ischemia.)
Blood pressure from CPR is rarely a third what is achieved by a beating heart, but pressor agents can improve the situation by vasoconstriction to decrease peripheral circulation and increase central circulation. Standard ACLS (Advanced Cardiopulmonary Life Support) uses 1 milligram of epinephrine every 3-5 minutes to maintain blood pressure — or a single bolus of 40 milligrams of vasopressin. The fact that vasopressin is more long-acting is a distinct advantage.
While sodium bicarbonate is useful as a buffer, the sodium is said to contribute to cell swelling. Sodium citrate is used only as a back-up for heparin when long delays are expected before blood washout — because heparin degrades at low pH.
Metocurine (curare) was previously used to inhibit shivering (reduce metabolism), but shivering was not seen in practice and — moreover — curare is a lethal substance which could raise suspicion that it was used to hasten the death of the patient should an autopsy be conducted.
The use of sodium pentobarbital to reduce brain metabolism is also problematic because pentobarbital is a controlled substance — meaning that it can cause legal problems. Similary, potassium chloride has a problematic potential for lethality. For this reason Alcor currently uses the anaesthetic propofol rather than pentobarbital. Although propofol must be obtained by prescription, it has the advantage of not being a controlled substance and therefore not causing legal problems. (Attempts to abuse the substance have failed because it so easily kills those who try to abuse it.) Propofol, however, causes vasodilation and can significantly reduced blood pressure. Propofol not only reduces brain metabolism, it reduces the danger of a cryonics patient who has been pronounced dead recovering consciousness during the application of cardio-pulmonary support. Magnesium sulfate (British, sulphate) can also be of benefit in this connection by decreasing the amount of acetylcholine released at the motor nerve terminal. The neuromuscular blocking of voluntary muscles causes paralysis without affecting heart muscle.
Nimodipine can also significantly reduce blood pressure. Adequate blood pressure is essential if the medicaments are to reach their target, to say nothing of the oxygen & nutrient intended to keep tissues alive. But the hypotensive effects of propofol are transient — and vasopressin is powerful enough to counter the hypotensive effects of both drugs.
EDTA (Ethylene Diamine Tetra Acetic acid) is by far the most widely used chelating agent. A chelate is a molecular complex formed when a cation (metal ion) is bonded by two or more atomic groups within a molecule such as EDTA. Calcium ions engulfed by EDTA cannot contribute to ischemic damage. In practice, EDTA does not effectively chelate calcium at pH (acid levels) less than 7.5 — very difficult to achieve insofar as the ischemic patient is so vulnerable to acidosis. Nonetheless, EDTA chelates ferric ion at pH 1.5, cupric ion at pH 3 and most other metal ions (including ferrous ion) above pH 5 (pH 7 is neutral). [See the chapter on EDTA titrations in QUANTITATIVE CHEMICAL ANALYSIS by Daniel C. Harris]. Most metal ions have a danger of contributing to some extent to free radical oxidation — especially if they have been released from protein due to ischemic damage.
Lipoic acid is not only a chelating agent, it is a very effective antioxidant that can act in both lipid and water phases.
Because blood contains albumin, one might imagine that there is no need for an oncotic agent (ingredient such as hydroxyethyl starch to keep water in the blood vessels rathere than allowing edematous seepage into tissues) before blood washout during cooldown. But both low temperature and the ischemia typically associated with death result in high capillary permeability and increased edema. For this reason Dextran-40 assists albumin as an oncotic agent during patient cooling. Dextran-40 is also helpful in reducing the red blood cell agglutination which increases as temperature drops.
(For a much more in-depth and up-to-date review of cryonics medications, see Future Directions in Human Cryopreservation Combinational Pharmacotherapy.)
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Most of these medicaments are of no value without a proper IV (IntraVenous) set of needles, cannulas, tubes, etc. If the patient deanimates in a hospital setting an IV line may already be established, which can be used for administering cryonics medications. If an IV line must be established by the cryonics emergency rescue team, the preferred route is the largest superficial veins of the arm — the antecubital fossa (otherwise, use the femoral vein in the leg).
An EGTA (Esophageal Gastric Tube Airway) can secure an open airway, preventing aspiration of stomach contents while assisting placement of a gastric tube. The gastric tube can remove air & fluid from the stomach (vomiting can be a problem otherwise) and deliver antacid.
Monitoring a patient to determine moment of death is best done with a pulse oximeter. This device provides information on patient pulse and the oxygen saturation of hemoglobin. Only a very terminal patient will tolerate such a device on the earlobe or tongue for extended periods, and even a finger or toe can be problematic. A pulse oximeter is also useful for monitoring the effectiveness of cardiopulmonary support following legal death.
Motion-detecting bed-pads, wrist-devices or room-motion monitors are more suited than pulse oximeters for long-term use for people living alone. Such devices can be connected to alarms or phone-dialers. It is rare for a healthy living person to go more than 10-15 minutes with no movement, even when sleeping. For some wearable equipment that monitor vital signs see: Digital Angel and Smart Shirt.
A local group that is well-funded and well-staffed may be able to acquire a cardiopulmonary bypass pump (usually a roller pump) which will enable the group to do a much faster cooldown than can be done with and ice-water bath, a field blood washout, and (if necessary) perfuse with cryoprotectant. A roller pump achieves pumping action by the use of rollers on the exterior of flexible tubing that forces fluids through the tube without contaminating those fluids. Embalmer's pumps are easily contaminated (and hard to clean), unless a filter is used. Contamination doesn't matter much in embalming, but in cryonics contaminants entering the patient through the pump can damage blood vessels, interfering with perfusion. The main advantage of roller pumps, however, is the fact that they provide a closed circuit, whereas embalmer's pumps are open-circuit.
A femoral cutdown of the patient (cutting both the femoral artery and femoral vein) allows for an extracorporeal circuit of blood. Blood flows up the femoral artery to the aorta of the heart (opposite to normal direction), but then flows normally through arteries to the head and upper body. Blood returning in veins to the heart is shunted down the femoral vein (opposite to normal direction) through a cannula to the superior vena cava, thus bypassing the heart. The patient's blood passes in series from the femoral vein through an oxygenator, a heat exchanger, the roller pump and then back into the femoral artery. The heat exchanger can lower a patient's body temperature to 10ºC within 40 minutes while the oxygenator helps keep the tissue cells alive.
Once the patient is close to 10ºC, the oxygen-carrying capacity of the blood is no longer needed because the oxygen-carrying capacity of water becomes high at low temperature and the metabolic demands of the patient for oxygen become low. (Water near freezing temperature can hold nearly three times as much dissolved oxygen as water near boiling temperature.) Blood must be washed-out because blood agglutinates into sludge at low temperature. A blood-replacement solution such as Viaspan will contain lactobionic acid, a nonionic osmotic substance (ie, it attracts water and keeps water from going into tissues, which would result in edema — albumin plays this role in blood). An osmotic substance is particularly important because cryonics patients have typically experienced ischemic injury — which exacerbates edema (like the swelling associated with a bump on the head or inflammation). The patient can then be packed in ice water and shipped to cryonics facility.
If the shipping time to the cryonics facility is long, the well-equipped group may choose to complete the cryopreparation by using their extracorporeal circuit to perfuse with glycerol. If this is done, then the patient can be shipped to the cryonics facility at dry-ice temperature. The patient should be put in a sleeping-bag to prevent "burning" the patient with the dry ice. Vitrification is only being done at cryonics facilities — and is incompatible with shipment at dry-ice temperature.
When shipping a patient in water-ice, the ice should be put in zip-lock (well-sealed) bags to prevent any water leakage. Any leakage from of water from a shipping container could prove disastrous. Even the appearance of leakage should be avoided if possible. The coldness of the ice could result in wetness of the container due to water condensation. This can be prevented by stuffing the shipping container with pink fiberglass insulation, held together with duct tape.
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Human resources deserve significant attention. Many people will agree to help even if they are not cryonicists and have no personal interest in being cryopreserved. Lists of such people are useful. The more committed group of local cryonicists should certainly exchange cell phone numbers, pager numbers and other means of making quick contact — and carry that information at all times. Getting a sense of how much each person is willing to help, the kind of help and under what circumstances, is important.
In a volunteer group, vocational and other commitments can make result in unreliable staffing, especially for a long standby. Determine availability on short notice and availability for an extended standby for all potential members of the team. Planning for a standby would be easier if predicting time of death were a more reliable science. Many efforts for predicting remaining time before death have been attempted in medicine, with only modest success. See [THE JOURNALS OF GERONTOLOGY; Porock,D; 60A(4):491-498 (2005), PALLIATIVE MEDICINE; Brandt;HE; 20(5):533-540 (2006) and BRITISH JOURNAL OF ANAESTHESIA; Campbell,AJ; 100(5):656-662 (2008)].
Human resources should not be limited to the local cryonics group, however. Family, friends and co-workers should be informed of your desire to be cryopreserved. In an emergency, many will help and some who might create problems if not forewarned can be neutralized. Physicians, health professionals and funeral directors should also be contacted ahead of time. For funeral directors in Canada, a good resource is the online CANADIAN FUNERAL DIRECTOR MAGAZINE www.thefuneralmagazine.com/home.html. Elsewhere, see the FUNERAL SERVICES section of the GOOGLE Directory. And Yellow Pages are helpful anywhere.
There is nearly no limit when it comes to local group preparedness as long as excessive expectations do not lead to demoralization. Modest objectives achieved stepwise are often more likely to lead to positive accomplishment than perfectionist aspirations. Practice equipment and frequent training sessions are beneficial. Unfortunately, there are very few local cryonics groups in the world that do this.
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Toronto, June 2003
Toronto Local Group cryonics meeting